Sjogren's Syndrome and Trigeminal Neuralgia

Image found here. 

::facepalm::

Good grief. I shouldn't be surprised, EVER, by a reader telling me that her physician informed her that Sjogren's syndrome is just dry mouth and dry eyes. I've read and heard and seen this repeatedly.

But I am. I feel surprised and disappointed and somewhat cranky. Every single stinkin' time.

Case in point: A reader recently asked me if her trigeminal neuralgia pain could possibly be related to Sjogren's syndrome. She was hesitant to ask her rheumatologist since "He just thinks Sjs is dry eyes and mouth, so quit whining."

Grrr. Breathe, Julia....just breathe.

Trigeminal neuralgia, or tic douloureux (gosh I haven't seen that term for TG since the '70s) causes pain or numbness in the face, specifically in the areas which the trigeminal nerve -- also known as the fifth cranial --  innervate. It can cause a variety of symptoms, some of which are described as pain that is stabbing, electric-shock like, numbness, or burning. You can read more about TG here.

To answer the reader's question, I sent her links to several studies and reputable information sources that do indeed connect Sjogren's syndrome to this disorder as one of the many neurologic complications of Sjs:


A PRIMER ON THE NEUROLOGICAL
COMPLICATIONS OF SJÖGREN’S
By Julius Birnbaum, MD
Johns Hopkins Neurology-Rheumatology Clinic

"....Sjögren’s syndrome can cause numbness or burning of the face, called “trigeminal neuralgia.” Pain in the back of the throat, which may worsen while swallowing, is called “glossopharyngeal neuralgia.” Patients with trigeminal or glossopharyngeal neuralgia can have agonizing mouth and facial pain. These neuropathies may co-exist with other neuropathies in different parts of the body. For example, up to 20% of patients with a “small-fiber” neuropathy may also have trigeminal neuropathy.
Medicines which may help alleviate symptoms in small-fiber neuropathy may also have efficacy in trigeminal neuralgia. Such medications may include a class of agents which are typically used to treat seizures, and include gabapentin, topiramate, andpregabalin. In seizure disorders, paroxysmal and irregular bursts of electrical activity in brain nerves may lead to propagation of seizures. Similarly, in Sjögren’s neuropathy, irritative electrical signals produced by nerves in the skin instead of the brain, may similarly contribute to pain. Just as anti-seizure medicines can dampen electrical activity of brain cells, the dampening of electrical activity produced by pain-fibers may ameliorate burning pain. It is important to note that use of these symptomatic medications does not target the neuron-inflammation which may be contributing to neuropathy. In such cases, judicious use of immunosuppressant medications should be considered."
(bolding mine)

Here's another:

Clinical Summary 
Sjogren syndrome: neurologic complications
Contributors:
Gustavo C Roman MD, author; Pedro J Ruiz MD, author; Raymond P Roos MD, editor.

".....Mori and colleagues reviewed 92 patients (86% women, mean age 60 years) with Sjögren syndrome and found the following varieties of neuropathy: sensory ataxia (39%); sensory painful neuropathy (20%); trigeminal neuropathy (17%); multiple mononeuropathy (12%); multiple cranial neuropathies (5%); autonomic neuropathy (3%); and radiculoneuropathy (4%) (Mori et al 2005)."(bolding mine)

And ANOTHER:

Neurological Manifestations Of Sjögren's Syndrome
Steven Mandel, M.D.
Clinical Professor of Neurology
Jefferson Medical College

"Trigeminal sensory neuropathy can occur and may be characterized by progressive sensory complaints on the face. They are generally spontaneous and nonlancinating. They could start on one side and subsequently become bilateral. They may be progressive over months to years."

One could wonder why, once the diagnosis of TN is established, it would be necessary to link the cause to Sjogren's syndrome.

Here's why: Because common medications used to treat TN address the symptoms, not the cause:

It is important to note that use of these symptomatic medications does not target the neuron-inflammation which may be contributing to neuropathy. In such cases, judicious use of immunosuppressant medications should be considered.

Need more? There's zillions of good, recent studies out there. So. Are there neurologic manifestations in Sjogren's syndrome including trigeminal neuralgia?

YES.

Does Sjogren's syndrome affect more than the eyes and the mouth?

GAAAAAAAHHHHHH! YES!

It would appear that the Johns Hopkins Jerome L. Greene Sjogren's Syndrome Center would agree, seeing as it brings together the expertise of rheumatologists, neurologists, ophthalmologists, dentists/oral surgeons, gynecologists, and otolaryngologists to treat this disease. Hm. I wonder why they would need a neurologist on staff seeing as "it's only dry mouth and dry eyes?"

Excuse me while I take out my frustration by pounding my head against the nearest wall.

::thud thud thud::