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The tear and saliva film allow a “blanket of lubrication” that permits decreased friction necessary for actions such as blinking. The most recent evidence favors the major role at the level of the brain However, the relation to stress does not mean that there is not a neurochemical basis for these symptoms. In addition to the autoimmune process, other factors that lead to nerve damage including elevated cholesterol or diminished B12 or thyroid need to be considered, as well as toxic agents including drugs (especially herbal that may contain high levels of heavy metals such as lead or mercury).

In these patients, the cause of dryness and decreased memory is the loss of myelinated nerve fibers ina particular region of the brain called the subcortical white matter projections. It is equally important to recognize that SS patients are not exempt from other common problems that may occur in these age groups. It is possible that Asian patients may be partially exacerbated by the use of herbal medicines, which are increasing used by a variety of other individuals. In describing rashes in patients with Sjцgren’s syndrome, it is important to use the normal guidelines of whether the rash is elevated (called palpable) or flat (non-palpable), symmetric or asymmetric, on the trunk (proximal) or the extremities (distal), itching (pruritic) or non-itching (non-pruritic), discrete lesions (the outside borders of each portion of the rash exists as a discrete “island”) or grouped lesion (ie. However, if they represent neurochemical imbalance―then an entirely different therapeutic approach involving behavioral modification and perhaps selected drugs that do not increase dryness will be required.

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The volume of resting saliva produced per day by normals can be up to several liters (or quarts) of fluid. Since patients with Sjцgren’s syndrome often have positive blood tests for rheumatoid arthritis (i. Therefore, this disease is termed an“autoimmune” disorder to denote the apparent reaction of the immune system against the patient's own tissues.

Currently, the condition is named for Henrik Sjцgren (pronounced sho-gren), a Swedish ophthalmologist, who reported the association of severe dry eyes Later, it was recognized that patients might have dry eyes and dry mouth but no rheumatoid arthritis. In some patients, the fatigue is that related to positional (or orthostatic fatigue) that may be related to hormones produced by the brain (the hypothalmic-adrenal axis). A more serious and less reversible renal manifestation are interstitial nephritis or glomerulonephritis. Diagnosis is based on clinical examination of the eyes and mouth, including measurement of the flow rate for tears and saliva. They may involve "cranial nerves" which innervate the facial nerves and muscles.

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