
sjogren syndrome

sjogren syndrome ledhaa sjogrens syndrome (sjes, sis) anedi deerghakaalika swayam pratirakshaka vyaadhi, idhi sareeram yokka temanu utpatti chese grandhulanu (lacrimal mariyu lalajalam) prabhaavitam chestundi mariyu tarachugaa oopiritittulu, moothrapindaalu mariyu naadii vyavastha vanti itara avayava vyavasthalanu teevramgaa prabhaavitam chestundi.
charitra, epidemiology mariyu rooga niruupana.
eee vyaadhini 1933loe henrique sjogren varninchaaru, ayana paeru meeda dheeniki paeru pettaru, ayithe lakshanaalu unna vyaktula gurinchi aneka munupati vivaranalu unnaayi. janabhalo 0.20 nundi 1.2% madhya prabhaavitamavutundi, sagam praathamika roopam mariyu sagam dviteeya roopam kaligi untundi. idhi purushula kante mahilallo 10 retlu ekkuva saadhaaranam. eee vyaadhi saadhaaranamgaa madhya vayassulo praarambhamainappatiki, yea vayasuloonainaa prajalu prabhaavitamavutaaru. itara swayam pratirakshaka rugmatalu laeni vaarilo, ayurdayam maaradu.
lakshanaalu.
praadhamika lakshanaalu podigaa undatam (noru podigaa undatam mariyu kallu podigaa undatam), noppi mariyu alasata. itara lakshanaalalo podi charmam, yoni podigaa undatam, deerghakaalika daggu, chetulu mariyu kaallaloo timmiri, alasata, kandaraalu mariyu keella noppulu mariyu thyroid samasyalu undavacchu. prabhaavitamaina vaariki kooda lymphoma vachhe pramaadam (15 saatam) ekkuvagaa untundi.
khachitamaina kaaranam aspashtamgaa unnappatikee, idhi janyusaastram mariyu virus ledhaa bacteriaku gurikavadam vanti paryaavarana trigger kalayikanu kaligi untundani nammutaaru. idhi itara aarogya samasyala nundi (primary sjogrens syndrome) ledhaa maroka bandhana kanajaala rugmata (secondary sjogrens syndrome) phalitamgaa swatantramgaa sambhavinchavachhu. sjogrens syndrome anedi rheumatoid arthuritis (arye), systemic lupus erythematosus (slee) ledhaa systemic sclerosis vanti itara swayam pratirakshaka vyaadhulatoe sambandham kaligi undavacchu. phalitamgaa vachhe vaapu kramamga grandhulanu debbateestundi. temanu utpatti chese grandhula biopsy mariyu nirdishta pratirodhakaala kosam rakta pareekshala dwara roganirdhaarana jarugutundi. biopsylo saadhaaranamgaa grandhula lopala lymphocytelu untaayi.
sjogrens syndrome atyanta saadhaarana swayam-roganirodhaka vyaadhulalo okati ayinappatikee, dheeniki nirdishta mariyu invasive kaani roganirdhaarana pareekshalu laevu mariyu chikitsa vyakti yokka lakshanaalanu nirvahinchadaaniki nirdesinchabadutundi. kallu endipovadaaniki, krutrima kanneellu, vaapunu tagginchadaaniki mandulu, panktal plugs ledhaa kanneeti naalaalanu muusivaeyadaaniki shastrachikitsanu prayatninchavacchu. podi noru kosam, chuing gumm (pradhaanyamgaa chakkera laenidi), neeru taagadam ledhaa lalajalam pratyaamnaayam upayoginchavacchu. keella ledhaa kandaraala noppi unnavaarilo, ibuprofen upayoginchavacchu. antihistaminelu vanti podigaa unde mandulanu kooda nilipiveyavacchu. atyanta nirdishtamaina roganirdhaarana pareekshaku pedavi biopsy avasaram.
sjogren syndrome yokka mukhya lakshanam podi noru mariyu caratoconjunctivitis sikka (podi kallu). yoni podigaa undatam, podi charmam mariyu mukku podigaa undatam kooda sambhavinchavachhu. moothrapindaalu, rakta naalaalu, oopiritittulu, kaaleyam, clomum mariyu medadutho sahaa sariiramlooni itara avayavalu kooda prabhaavitamavutaayi.
ss unna kontamandilo, charma grandhulloki lymphocytic chorabatla phalitamgaa charmam podigaa undavacchu. lakshanaalu kapatamgaa abhivruddhi chendavacchu, roganirdhaarana tarachugaa chaalaa samvatsaraalu pariganinchabadadu endukante sikka mandulu, podi vaataavaranam ledhaa vruddhaapyam kaaranamgaa undavacchu ledhaa antarleena swayam pratirakshaka rugmata unikini sthaapinchadaaniki avasaramaina daryaaptu sthaayiki haamii ichhe teevratagaa pariganinchabadadu.
itara swayam pratirakshaka vyaadhula maadirigaane, sjogrens syndrome keelaka avayavalanu debbateestundi, lakshanaalu sthiramgaa ledhaa marinta digajaaravachu ledhaa upasamanam pondavacchu. kontamandi kallu mariyu noru podigaa undatam yokka telikapati lakshanaalanu matrame anubhavinchavacchu, marikondaru teevramaina vyaadhi lakshanaalanu kaligi untaaru. chaalaa mandhi rogulu lakshanaalatoo samasyalanu parishkarinchagalaru. itarulu aspashtamaina drushti, nirantara kanti asoukaryam, punaraavruta noti infections, vaapu parotide grandhulu, dysphonia (gonthu noppitho sahaa swara rugmatalu) mariyu mingadam mariyu tinadamlo ibbandini anubhavistaaru. balaheenapariche alasata mariyu keella noppi jeevita naanhyatanu teevramgaa debbateestaayi. kontamandi rogulu moothrapindaala prameyam (autoimmune tubulointerstile nephritis) nuu abhivruddhi cheyavachu, idhi proteinuria (moothramlo adanapu protein), moothra kendrikarana lopam mariyu distal renal tubelar acidosisku daariteestundi.
praadhamika sjogren syndrome kaaranamgaa hypocalemic pakshavaatam saahityamlo arudugaa nivedinchabadindi.
samasyalu.
paina charchinchina samasyalalo, garbhavati ayina anty-roow/ss-eah mariyu anty-laa/ss-bii pratiroedhakaalu unna mahilallo puttukatho vachhe gunde addanki kaligina navjata lupus erythematosus raetu perugutundi, dheeniki pays maker avasaram. type I cryoglobulinemia anedi sjogrens syndrome yokka telisina samasya.
sjogrens syndrome kaaleyam, clomum, moothrapindaalu, oopiritittulu mariyu kendra naadii vyavastha vanti avayavalanu prabhaavitam chestundi.
anubandha paristhitulu.
sjogrens syndrome aneka itara vaidya paristhithulatho mudipadi untundi, veetilo chaalaa varaku swayam pratirakshaka ledhaa rheumatic rugmatalu, seliac vyaadhi, fibromyalgia, slee (lupus), swayam pratirakshaka thyroidities, multiple sclerosis mariyu spandilo aarthropathi mariyu aneka praanaantakaalu, pradhanamgaa naan-hodgkin lymphoma vantivi.
kaaranaalu.
sjogrens syndromeku kaaranam teliyadu, conny idhi aneka itara swayam pratirakshaka rugmatala maadirigaane janyu, paryaavarana mariyu itara kaarakaala kalayika prabhavam kaavacchu. sumaru 20 auto antibodylu indulo palgone avakaasam undhi.
janyusaastram.
sjogrens syndrome charitra unna kutumbaalalo swayam pratirakshaka rugmatala adhika raetla pariseelana syndromeku janyu siddhatatoe mudipadi untundi. sjogren rogulalo maanava leukocyte antigen (hcla)-dr mariyu hcla-dqu janyu praantaala yokka bahuruupatalapai adhyayanalu phalitamgaa vachhe vividha rakaala autoantibody utpatti phalitamgaa syndromeku avakalana grahanaseelatanu chuuputaayi.
harmonelu.
sjogrens syndrome mahilallo adhika praabalyamtho mudipadi unnanduna, laingika harmonelu, mukhyamgaa eastrogen, syndromeku gurayye saamarthyaanni prabhaavitam chese haasya mariyu kana-madhyavartitva roganirodhaka pratispandanalanu prabhaavitam chestayani nammutaaru. androgenlu saadhaaranamgaa swayam pratirakshaka saktini nivaarinchadaaniki pariganinchabadataayi. elukala namuunaalapai adhyayanalu eastrogen lopam auto antigenla pradarsananu prerepistundani, idhi sjogrens lanty lakshanaalanu prerepistundani suuchistunnaayi.
microchemerism.
pindam kanaala microchemerism (talli prasaranalo santaana lymphoid kanaalu) gatamlo garbhavatigaa unna mahilallo swayam pratirakshaka saktini utpatti cheyavachu. microchemerism dwara swayam pratirakshaka saktini utpatti cheyadam anedi sweeya-sahanam loe vayassu-aadhaarita taggudalatoe swayam-roganirodhaka shakti yokka nissabda roopam nundi maaradaaniki daariteeyavachchu.
paryaavaranam.
viral proteins, chuttabadina anuvulu ledhaa ksheeninchina sweeya-nirmaanaalu molecular mimikri dwara swayam pratirakshananu praarambhinchavacchu mariyu sjogrens syndrome abhivruddhi avakaasaalanu penchavacchu. epstein-baar virus, hepatitis sii, mariyu human tii-sell leukemia virus-1 luu sjogrens syndromelo ekkuvagaa adhyayanam cheyabadina antu agentlalo unnaayi. eee roeju varaku, eee vyadhikaaraka kaarakaalaku mariyu sjogrens syndrome abhivruddhiki madhya pratyaksha kaaranaalu mariyu prabhava sambandham gurtinchabadaledu. apoptosis kosam lakshyamgaa pettukunna debbatinna sweeya-nirmaanaalu porapaatuna roganirodhaka vyavasthaku gurikaavacchu, exocrine grandhulalo swayam pratirakshakatanu prerepistaayi, ivi tarachugaa swayam pratirakshaka pratispandanalaku guravutaayi.
vyadhikaaraka.
sjogrens syndrome yokka vyadhikaaraka vidhanalu puurtigaa spashtam cheyabadaledu, phalitamgaa eee swayam pratirakshaka exocrinopathy nirvahana gurinchi pathophysiology ghnaanam lekapovadam. eee vyaadhi purogatiki dohadapade aneka amsaalu khachitamaina muulaanni kanugonadam mariyu kashtataram chesinappatiki, gatha dasaabdamloo pradhana purogatulu sjogrens syndrome nirdhaaranaku mundu sambhavinche pratipaadita vyadhikaaraka sanghatanalaku dohadapaddayi.
sjogrens syndrome modata exocrine grandhulu, mukhyamgaa asinar mariyu ductal kanaala yokka nirdishta, sweeya-saasvatamaina, roganirodhaka vyavastha-madhyavartitva nashtamgaa pratipaadinchabadindi. idhi marinta spashtamaina lakshanaalanu (lalajalam mariyu lacrimal dravam lekapovadam vantivi) vivarinchinappatikii, vyaadhi purogati loe kanipinche marinta vistrutamaina daihika prabhavalanu idhi vivarinchadu.
haani kaliginche janyu nepathyam samakshamlo, paryaavarana mariyu harmonela karakalu rendoo lymphocytela chorabaatunu prerepinchagalavani bhaavistaaru, mukhyamgaa sidi4 + tii kanaalu, bii kanaalu mariyu plasma kanaalu, lalajalam mariyu lacrimal grandhulalo grandhi panicheyakapovadaaniki kaaranamavutaayi.
sjogrens syndrome anedi interleukin 1 virodhi ayina ill-1raa yokka cerebrospinal fluid (csf) loe perigina sthaayilatho mudipadi untundi. idhi interleukin 1 vyavasthalo perigina kaaryaacharanatoo vyaadhi praarambhamavutundani, taruvaata interleukin 1 daani graahakaalaku vijayavantamgaa bandhinchadaanni tagginchadaaniki ill-1raa yokka swayam niyantrana niyantrananu suuchistumdi. interleukin 1 bahusha alasataku marker kaavacchu, conny perigina ill-1raa CSFloe gamaninchabadutundi mariyu cytokine-prerita anaaroogyam pravartana dwara perigina alasatatho mudipadi untundi. ayithe, sjogrens syndrome lalajalamlo ill-1raa sthaayilu taggadam dwara vargeekarinchabadutundi, idhi noti vaapu mariyu podigaa undataaniki kaaranam kaavacchu. secondary sjogrens syndrome unna rogulu kooda tarachugaa systemic lupus erythematosus, rheumatoid arthuritis ledhaa systemic sclerosis vanti vaari praadhamika rheumatic rugmatala sankethaalu mariyu lakshanaalanu pradarsistaaru.
janyu siddhata.
modati janyu-vistruta anubandha adhyayanam yokka praathamika phalitaala dwara pradarsinchabadinatlugaa, praadhamika ss thoo atyanta gananeeyamgaa sambandham unna janyu sthaanam pradhana hystocompatability complexes/human leukocyte antigen (emhechsi/hcla) praantam. eee adhyayanamlo praadhamika sjogrens syndrome unna european puurveekula 395 mandhi rogulu mariyu 1,975 aarogyakaramaina niyantrana vyaktulu mariyu 1,234 kesulu mariyu 4,779 aarogyakaramaina niyanthranalatho kuudina replication adhyayanam nundi dayta undhi. aaru swatantra sthaanaala vadda unna bahuruupatalatoe anubandhalu kooda kanugonabaddayi; "irf5, stat4, blc, il12eah, tinnip1" mariyu "cxcr5". idhi sahaja roganirodhaka vyavasthanu kriyaaseelakam cheyadaanni kooda suuchimchimdi, mukhyamgaa ifn vyavastha dwara, lymphoid follicals mariyu bii-sell receptor (bcr) kriyaaseelataku "block" thoo kuudina "cxcr5"-nirdesita niyamakam dwara bii-sell kriyaaseelata, mariyu hcla grahanaseelata mariyu il-12-ifn-zii-axis kaaranamgaa tii-sell kriyaaseelata.
vividha jaathi muulaala rogulu vividha hcla-grahanaseelata yugmavikalpalanu kaligi untaaru, veetilo hcla-dr mariyu hcla-dqu sjogrens syndrome yokka vyaadhikaarakamlo palgontayi. udaaharanaku, uttara mariyu paschima airopa mariyu uttara america nundi vacchina rogulu "bii8, dii. aarr. doubleu. 52" mariyu "dii. aarr. 3" janyuvula adhika prabalyanni chuuputaaru. hcla class II yugmavikalpalu vyaadhi kante svayampratipattula yokka nirdishta upasamitula unikitho sambandham kaligi untaayi. svayampratipattulu anevi bii-kana sahanam kolpovadaanni suuchistaayi, idhi vibhina avayava-nirdishta mariyu avayava-nirdishtata laeni antigenlaku vyatiraekamgaa nirdesinchabadina pratirodhakaala utpattiki daariteestundi. hcla mariyu ss madhya anubandham anty-ssa/roow ledhaa anty-ssb/laa antibodies unna rogulaku parimitam cheyabadindi. anty-roow mariyu anty-laa kosam seropositivity ekkuva teevrata mariyu vyaadhi yokka ekkuva vyavadhitho mudipadi untundi, mariyu sjogrens rogula lalajalam grandhula nundi vaati adhika samruddhi kanugonadam anedi ss yokka vyaadhikaarakamlo vaati atyavasara paatranu suuchistumdi.
janyusaastraaniki minchi, dna methylation, histone acetylation ledhaa microrna vyakteekaranaku sambandhinchina epigenetic asaadhaaranata bahusha sjogrens syndromtho sahaa swayam pratirakshaka vyaadhula vyaadhikaarakamlo keelaka paatra poeshistumdi, ayithe eee praantamloo parisoedhana chaalaa parimitamgaa undhi.
paryaavarana karakalu.
grandhi viral sankramana vanti paryaavarana karakalu, toll-lanty graahakaala dwara hcla-swatantra sahaja roganirodhaka vyavasthanu sakriyam cheyadaaniki epithelial kanaalanu prerepinchagalavu. epstein-baar virus (ebv), human tii-lymphotropic virus 1 mariyu hepatitis sii virus vanti aneka antu, bahya karakalu sjogrens syndrome yokka vyaadhikaarakamlo chikkukunnappatiki, sjogrens syndromtho vaati anubandham balaheenamgaa kanipistundi. saadhaarana vyaktula lalajala grandhulalo ebv unnappatikee, sjogrens rogulalo ebv tirigi sakriyam ayye adhika sambhavam ebv dna sthaayila perugudalato nivedinchabadindi. idhi viral reactivation mariyu sjogrens syndromelo ebv replicationnu niyantrinchadaaniki lymphoid chorabadalekapovadaanni suuchistumdi, idhi lakshya avayavaalalo roganirodhaka pratispandana praarambhaaniki ledhaa saasvatiki daariteestundi. edemaina, sjogrens syndrome unna rogula gayalalo ebv yokka punahsakriya elaa prerepinchabadutundo mariyu viral punahsakriya prakriyaloo yea nirdishta paramaanu vidhanalu palgontayo spashtam cheyalsi undhi.
vaapu.
sjogrens syndrome gayalalo epithelial kanaalu inflammatory prakriya yokka prerana mariyu saasvatataloo churukuga palgontayi. paryaavarana mariyu harmonela karakalu, tagina janyu nepathyamtho kalisi, sjogrens syndromenu prerepistaayani nammutaaru, idhi epithelial kanaalanu kramabaddheekarinchadu mariyu asaadhaaranamaina hoaming mariyu dendritic kanaalu (disi), tii kanaalu mariyu bii kanaalanu sakriyam cheyadaaniki anumatistundi. dendritic kanaalu antigen-andinche kanaalu, ivi antigen padaarthaanni proses chesi itara tii kanaalaku andistaayi. chemosinelu mariyu nirdishta antukune anuvulaku pratispandanagaa grandhulloki lymphocytelu valasa vacchina taruvaata, tii kanaalu epithelial kanaalatoe sankarshana chendutaayi. epithelial kanaalu procomputer cytokins (ill-1β, ifn-gm, mariyu tnf) dwara marinta sakriyam cheyabadataayi, ivi prakkane unna tii kanaala dwara utpatti cheyabadataayi. adhika sthaayi type 1 ifnlanu utpatti chese lakshya kanajaalaalo plasmacetoid dendritic kanaalu praarambhamlo perukupovadam mukhyamainadigaa anipistundi, endukante eee kanaalu kanajaalaalo lymphocytelanu asadhaaranamgaa nilupukovadam dwara roganirodhaka pratispandananu marinta niyantrinchalevu mariyu vaati tadupari kriyaaseelata. iffan-α epithelial kanaalu, disi mariyu tii kanaala dwara bii-sell activating phyaaktar (baaph) utpattini prerepistundi. baaph asaadhaaranamaina bii-kana paripakvatanu prerepistundi, idhi sweeya-pratispandinche bii kanaala aavirbhaavaaniki daariteestundi, ivi sthaanikamgaa swayam-pratighatanalanu utpatti chestaayi, idhi suukshmakrimula kendram lanty nirmaanamloo (zii. sii. laantidi), idhi lymphomagenesis (lymphoma yokka muulam) yokka sthaanam kooda.
programme cheyabadina kana maranam.
apoptosis yokka kramabaddheekarana (kramabaddheekarinchina kana maranam) vividha rakaala swayam pratirakshaka vyaadhula vyaadhikaarakamlo paatra pooshistundani nammutaaru, ayithe sjogrens syndromelo daani paatra vivadaspadamga undhi. praathamika sjogren rogulalo phaas mariyu phaas ligand proteins rendoo atigaa vyakteekarinchabadataayi, ayithe apoptosisnu tagginche bii. sii. ell-1 yokka vyakteekarana, aarogyakaramaina vyaktulatoe poliste sjogren rogula asinar mariyu ductal epithelial kanaalalo gananeeyamgaa tagginatlu kanugonabadindi. "inn situ" adhyayanalu grandhi epithelial kanaalalo perigina apoptosisnu choopinchaledu, conny chorabadutunna mononuclear kanaalalo apoptosis tagginatlu choopinchaayi. grandhulalo kanipinche autoractive bii-kanaala perukupovadamlo kooda apoptosis taggudala chikkukundi. sjogrens syndromelo apoptosisto vyakteekarinchabadina autoantibodyla sambandham inca parisoedhimchabadutoemdi.
harmonela karakalu.
laingika harmonelu haasya mariyu kana-madhyavartitva roganirodhaka pratispandananu prabhaavitam chestaayi, eastrogen laingika-roganirodhaka dviruupataku kaaranamayye atipedda karakallo okatigaa pariganinchabadutundi. eastrogen lopam sjogrens syndrome abhivruddhilo paatra pooshistunnatlu kanipistundi. kanti uparitalampai androgen ivvadam valla kallu endipovadaaniki samarthavanthamaina chikitsagaa upayogapadutundani oohinchabadindi.
rooga nirdhaarana.
rogiki kanipinche lakshanaala paridhi, mariyu sjogrens syndrome mariyu itara paristhitula lakshanaala madhya saaruupyata kaaranamgaa sjogrens syndrome (ss) nirdhaarana sanklishtamgaa untundi. alaage, ss lakshanaalu unna rogulu chikitsa kosam vividha pratyaekatalanu aasrayistaaru, idhi rooga nirdhaarananu kashtataram chestundi. kallu podibaaradam mariyu noru podigaa undatam chaalaa saadhaarana lakshanaalu, mariyu tarachugaa 40 ellu paibadina vaarilo sambhavistaayi kabatti, prabhaavita vyaktulu lakshanaalu vayassu-sambandhitamani nammavacchu, kabatti vaatini vismarinchandi. konni mandulu sjogrens syndrome maadirigaane lakshanaalanu kaliginchavacchu. oka shrenilo cheyagala aneka pareekshala kalayika, chivariki sjogrens syndromenu nirdhaarinchagaladu.
rakta pareekshalu.
rogiki antinuclear antibody (eah. enn. yea) mariyu rheumatoid phyaaktar (endukante sjogrens syndrome tarachugaa rheumatoid artharaitisku dviteeyamgaa sambhavistundi) vanti paristhitini soochinche adhika sthaayi pratiroedhakaalu unnaya anie nirnayinchadaaniki rakta pareekshalu cheyavachu, ivi swayam pratirakshaka vyaadhulatoe sambandham kaligi untaayi. vilakshanhamaina ssna namuunaalu ssa/roow mariyu ssb/laa, veetilo anty-ssb/laa chaalaa nirdishtamainadi; anty-ssa/roow aneka itara swayam pratirakshaka paristhithulatho mudipadi untundi, conny tarachugaa ss loe untundi, conny aanti-ssa mariyu anty-ssb pareekshalu tarachugaa ss loe sanukoolamgaa undavu.
roez bengaul test.
gulabi bengaul pareeksha lacrimal grandhula sthithi mariyu paniteerunu koliche marakanu upayogistundi. eee pareekshalo vishapuuritam kaani gulabi rangunu kallapai unchadam untundi. rangu yokka vilakshanhamaina rangu kanneeti pora yokka sthithi mariyu paniteerunu mariyu kanneeti aaviri retunu nirnayinchadamlo sahaayapadutundi. edainaa vilakshanhamaina rangu maarpu ssnu suuchimchavachchu, conny paristhitini nirdhaarinchadaaniki aneka sambandhita roganirdhaarana sadhanalu avasaram.
skirmer pareeksha.
skirmers pareeksha kanneella utpattini kolustundihi filter paper yokka oka stripnu diguva kanureppa lopala aidu nimishalu unchutaaru, aapai daani tadigaa unde teerunu oka paalakuditho kolustaaru. dravam kante takkuva utpatti cheyadam saadhaaranamgaa ssnu suuchistumdi. eee kolata vislaeshanha itara kanti sambandhita paristhitulu mariyu pareeksha teesukunnappudu upayogamlo unna mandulanu batti vyaktulalo maarutuu untundi. cheelika-deepam pareeksha kanti uparitalampai podigaa undataanni bahirgatam chestundi.
noti podini pareekshinchadaaniki skirmer strips upayoginchadam saadhyame.
lalajalam pravaaha pareekshalu.
lalajala grandhula (parotid grandhi, submondibular grandhi mariyu sublingual grandhi) nundi lalajalam utpatti taggadam valla noti podigaa undatam mariyu noti kuharamlo podigaa undatam yokka lakshanaalu sambhavistaayi. 
uttejaparachabadani mottam lalajalam pravaaha sekaranalo, vyakti prati nimishaaniki 15 nimishala paatu test tubeloki ummi vestaadu. phalitamgaa vacchina sekarana kante takkuva unte saanukuula phalitamgaa pariganinchabadutundi.
 oka uddeepana lalajalam pravaaha pareekshalo, vyakti lalajalam sekarinchetappudu chakkera laeni teepini peelchukuntaadu. 0. 1 nundi 0.2 millilitres/nimisham varaku uttejaparachabadani lalajala pravaham raetu mariyu 0.7 millilitres/nimisham ledhaa anthakante takkuva uddeepana pravaham raetu asadhaaranamgaa takkuva pravaham raetlu lalajala grandhi hypofunction suuchistaayi.
20 mariyu 80 samvatsaraala madhya vayassu galavaaru uttejita lalajalam utpattini 40 nundi 70 saatam varaku taggistaaru, conny uddeepana lalajalam utpattini prabhaavitam cheyaru.
pedavi biopsy.
pedavi/lalajala grandhi biopsy anedi lalajala grandhula chuttoo samuuhamgaa unna lymphocytelanu mariyu vaapu valla eee grandhulaku nashtam kaliginche kanajaala namuunaanu teesukuntundi. eee pareekshalo oka vyakti lopali pedavi/lalajala grandhi nundi kanajaala namuunaanu teesivesi suukshmadarshini krinda pariseelinchadam untundi. atuvanti jeevaanhupareekshalalo, sjogren syndrome yokka noti bhaganni nirdhaarinchadamlo atyanta mukhyamaina pareeksha phalitam bahusha "phocus score", idhi 4 mimi2 grandhi vibhaagamlo kaneesam 50 shotha kanaalanu kaligi unna mononuclear kanaala chorabatla sankhya. chishom-mayson gradelu lalajalam grandhi jeevaanhupareekshala kosam kooda vistrutamgaa upayoginchabadataayi (pattika chudandi).
itara pareekshalu.
sialogram roopamlo sjogrens syndrome kosam nammadagina mariyu khachitamaina pareekshagaa radiological vidhanam andubaatulo undhi. oka contrast agentnu parotid vaahikaloki inject chestaaru, idhi chempa nundi eguva rendava molar panti medaku edurugaa unna noti westibule loki teruchukuntundi. lalajalam grandhi naalaalaloo edainaa addankini gurtinchadaaniki eee pareeksha uddesinchabadindi (i.ii. parotid vaahika) mariyu notiloki pravahinche lalajalam mottam.
sjogrens syndrome kosam, electrochemical skin conductains dwara sudomotor function rooga nirdhaarana prakriyaloo sahaayapadavachhu.
gatha thala mariyu meda radiation therapy, aquired immuno deficiency syndrome, mundugaa unna lymphoma, sarcoidosis, graft-verses-host vyaadhi mariyu anticholinergic aushadhaala vadakam unna vyaktula nundi sjogrens syndromenu minahaayinchavacchu.
nivaarana.
swayam pratirakshaka rugmatagaa sanklishtata kaaranamgaa sjogrens syndrome (ss) kosam nivaarana yantraangam ledhu, conny jeevanasaili maarpulu ss abhivruddhi chendadaaniki sambandhinchina pramaada kaarakaalanu tagginchavachhu ledhaa ippatike nirdhaarana cheyabadina rogulaku paristhiti yokka teevratanu tagginchavachhu. aaharam anedi ss thoo sahaa aneka swayam pratirakshaka sambandhita vyaadhulalo kanipinche vaaputo balamgaa mudipadi untundi. ss rogulu tarachugaa neerugaa vaapuku sambandhinchina gluten patla adhika sunnitatvaanni chuuputaarani oka prayogaatmaka adhyayanam teelchindi. ss rogulaku mitamaina vyayamam kooda sahaayapadutundi, pradhanamgaa oopiritittula vaapu prabhavanni taggistundi.
chikitsa.
sjogrens syndromeku nivaarana ledhaa nirdishta chikitsa grandhi sraavamnu saasvatamgaa punaruddharinchadu. badulugaa, chikitsa saadhaaranamgaa rogalakshanamgaa mariyu sahayakamga untundi.
kanti samrakshana.
krutrima kanneellu vanti thema bharti chikitsalu podi kalla lakshanaalanu tagginchavachhu. marinta teevramaina samasyalu unna kondaru rogulu sthaanika temanu penchadaaniki gagulsnu upayogistaaru ledhaa kanti uparitalampai ekkuva kaalam kanneellanu nilupukovadamlo sahaayapadataaniki panktal pluglanu choppistaaru.
adanamgaa, kanneeti sraavaaniki antaraayam kaliginche vaapunu anachiveyadam dwara deerghakaalika podi kantiki chikitsa cheyadaaniki cyclosporin (restasis) prescription dwara andubaatulo untundi. sevimeline (evoxac) mariyu pylocarpine vanti lalajalam pravahanni prerepinchadaaniki sahayapade prescription mandulu kooda andubaatulo unnaayi. pilocarpine yokka tayaaru cheyabadina roopam ayina salazen nuu kanneellanu utpatti cheyadaaniki, alaage noti mariyu pregulalo lalajalam utpatti cheyadaaniki upayoginchavacchu. idhi jaborandi mokka nundi udbhavinchindi.
yoni podigaa undatam.
sjogrens syndrome unna mahilallo, yoni podigaa undatam, valvodainiya mariyu dysperunia (baadhaakaramaina laingika samparkam) tarachugaa nivedinchabadataayi; yoni mariyu yoni praantaalalo podigaa undatam valla kalige chikaku ledhaa noppini tagginchadamlo sahaayapadataaniki vyaktigata kandenalu sifaarsu cheyabadataayi.
kandaraala asthipanjaram.
kandaraala kanajaala lakshanaalaku chikitsa cheyadaaniki steroid kaani shotha nirodhaka mandulanu (ensides) upayoginchavacchu. teevramaina samasyalu unna vyaktulaku, carticosteroids ledhaa immunosuppressive mandulu suuchimchabadavachchu, mariyu konnisaarlu intravenous immunoglobulins suuchimchabadavachchu. alaage, methotrexate vanti vyaadhi-savarinche anty rheumatic mandulu sahaayapadavachhu. hydroxychloroquine (plackwinil) maroka empika mariyu idhi saadhaaranamgaa methotrexate kante surakshitamainadigaa pariganinchabadutundi. ayithe, eee suuchimchina mandulu vikaram, aakali lekapovadam, maikamu, juttu raladam, kadupu noppi/timmiri, talanoppi, kaaleya vishapuuritam mariyu infectionla pramaadam vanti aneka dushprabhaavaalanu kaligi untaayi.
vyavastheekruta.
alasata, keella noppi, myositis mariyu neuropathy vanti daihika lakshanaala kosam, bii-sell pathology dwara panichese retuximab mariyu belimabab vanti biologic immunosuppressant mandulu tarachugaa upayoginchabadataayi mariyu saampradaaya immunosuppressive niyamaala kante takkuva vishapuurita profilenu kaligi untaayi.
dantha samrakshana.
gerostomiatho sambandham unna lalajalam lekapovadam kuharalaku kaaranamayye bacteria vistaranaku anuvaina vaataavaranaanni srushtistundi kabatti nivaarana dantha chikitsa kooda avasaram (mariyu tarachugaa roogi nirlakshyam chestaaru). dantaala enaamelnu balopetam cheyadaaniki intlo samayochita fluoride application mariyu dantha parisubhrata nipunudiche tarachugaa dantaalanu subhraparachadam chikitsalalo unnaayi. ippatike unna kuharalaku kooda chikitsa cheyali, endukante dantaalaloki vistarinche kuharalaku dantaalanu subhraparachadam dwara matrame samarthavantamgaa chikitsa cheyalemu, mariyu dantaala gujjuloki vyaapti chendhe pramaadam ekkuvagaa untundi, idhi saktini kolpovadaniki mariyu velikiteeta ledhaa ruut kenal therapy avasaraniki daariteestundi. eee chikitsa niyamaavali anni gerostomia rogulaku, thala mariyu meda radiation therapy cheyinchukuntunna vaariki, adhe vidhamgaa untundi, idhi tarachugaa lalajala grandhulanu debbateestundi; eee grandhulu itara shareera kanajaalaala kante radiationku ekkuvagaa guravutaayi.
rooga niruupana.
avayava sambandhita prabhavalu.
naan-hodgkin lymphoma.
aneka adhyayanala phalitaalu, itara swayam pratirakshaka vyaadhulatoe poliste, sjogrens syndrome anedi tella rakta kanaala cancer ayina naan-hodgkin lymphoma yokka adhika sambhaavyatatoo mudipadi undani suuchistunnaayi. ss unna rogulalo sumaru 5 saatam mandhi edho oka rakamaina lymphoid praanaantakaanni abhivruddhi chestaaru. telikapati ledhaa mitamaina kesulu unna rogula kante teevramaina kesulu unna rogulaku lymphoma vachhe avakaasam ekkuvagaa untundi. atyanta saadhaarana lymphomalu lalajalam extranodal marginal john bii sell lymphomas (lalajalam grandhulalo malt lymphomas) mariyu pedda bii-sell lymphomanu vyaapti chestaayi.
praadhamika sjogrens syndrome rogulalo lymphomagenesis oka bahula dasala prakriyagaa pariganinchabadutundi, modati dasha swayam pratirakshaka bii kanaala deerghakaalika uddeepana, mukhyamgaa vyaadhi lakshyamgaa unna pradaesaalaloo rheumatoid karakanni utpatti chese bii kanaalu. idhi ancogenic mutation yokka frequencini penchutundi, idhi auto emmune bii-sell activation yokka chekpaayintla vadda edainaa panicheyakapovadam valla pranantakamga maarutundi. swayam pratirakshaka bii kanaala nirantara uddeepananu oka adhyayanam kanugonnadi, idhi bii kanaalalo nirdishta parinaamaalanu kaligi unna janyuvulalo suukshmamaina ankura asaadhaaranatalaku daariteestundi, idhi lymphoma yokka grahanaseelataku aadharam.
itara avayavalu.
praanaantaka enhetchl yokka adhika sambhaavyata kakunda, sjogren rogulu nirdishta avayava sambandhita paniteerulo niraadambaramaina ledhaa vaidyaparamgaa chinna ksheenatanu matrame chuuputaaru.
vyaadhi bhaaram.
sjogrens syndrome anaaroogyam yokka adhika bhaaramtho mudipadi undhi, mariyu vaikalyam yokka perigina raetla phalitamgaa pani cheyagala saamardhyampai gananeeyamaina prabhaavamtho jeevana naanhyatanu (cole) gananeeyamgaa taggistundani choopabadindi. kollo taggudala anedi rheumatoid arthuritis, lupus mariyu fibromyalgia vanti itara deerghakaalika paristhitulalo kanipinche maadirigaane untundi.
maranaalu.
sjogrens syndrome rogula manugadapai prachurinchina adhyayanalu vividha koonaalloo parimitam cheyabaddaayi, bahusha saapekshamgaa chinna namuunaa parimaanaala kaaranamgaa, mariyu secondary sjogrens syndrome itara swayam pratirakshaka vyaadhulatoe mudipadi undhi. 
2010 adhyayanam migilina janaabhaato poliste sjogrens rogula maranaala retulo swalpa perugudalanu kanugondi. saadhaarana janaabhaato poliste praathamika sjorgrenlu anni kaaranaala valla maranaala perugudalato sambandham kaligi levani, conny grahaantara prameyam, vasculitis, hypocomplementamia mariyu cryoglobulinaemia unna rogula upasamiti maraninche pramaadam ekkuvagaa undavacchani 2016 adhyayanam kanugondi. 2021 meta vislaeshanhaloo vruddhaapyam, maga lingam, vasculitis, madhyantara oopiritittula vyaadhi, takkuva puurakaalu, saanukuula anty-laa/ssb mariyu cryoglobulinaemia unna rogulalo maranaala pramaadaanni gananeeyamgaa penchadamtho maranaalalo 46 saatam perugudalanu choopinchindi.
epidemiology.
sjogrens syndrome (ss) anedi rheumatoid arthuritis mariyu systemic lupus erythematosus taruvaata rendava atyanta saadhaarana rheumatic auto emmune desorder. ss raetlaloo bhougolika thedaalu laevu. praantiiya raetlu baga adhyayanam cheyabadanappatiki, prapanchamlooni anni praantaalalo sjogrens syndrome nivedinchabadindi. prabalyanni nirnayinche pramaanaalanu batti, adhyayanalu united stateslo 500,000 nundi rendu millionla mandhi madhya ss prabalyanni anchanaa vestaayi. ss praabalyam yokka vistruta adhyayanalu vistrutamgaa unnaayi, janabhalo 3 saatam varaku praabalyam unnatlu konni nivedikalu unnaayi. syndrome sambhavam samvatsaraaniki 100,000 mandiki moodu nundi aaru madhya maarutundani konni adhyayanalu nivedinchaayi.
prati 10 mandhi ss rogulalo tommidi mandhi mahilalu unnaaru. mahilallo praabalyamtho paatu, swayam pratirakshaka vyaadhi mariyu munupati garbhaalato modati-sthaayi sambandhaanni kaligi undatam anedi epidemiological pramaada karakaluga gurtinchabaddaayi. purushulaku takkuva pramaadam unnappatikee, purushulalo praadhamika ss vyaadhi yokka marinta teevramaina roopaanni suuchistumdi. vyaadhi praabalyamlo jaathi mariyu jaathi paatra teliyadu.
sjogrens syndrome anni vayasulavaarilo sambhavinchinappatikii, praarambhamayye sagatu vayassu 40 mariyu 60 samvatsaraala madhya untundi, ayithe anni kesulalo sagam varaku rooga nirdhaarana cheyabadavu ledhaa nivedinchabadavu. ss praabalyam saadhaaranamgaa vayassutho perugutundi.
rheumatoid arthuritis unna vyaktulalo 30-50% mariyu systemic lupus erythematosus unna vyaktulalo sjogrens syndrome nivedinchabadindi.
charitra.
zaan mikulikz-radekki (1850-1905) saadhaaranamgaa ss yokka modati vivaranhatho ghanata pondaadu. 1892loe, round-sell intlitrate mariyu asinar ksheenatatoo sambandham unna parotid mariyu lacrimal grandhula vistaranatoe 42 yella vyaktini ayana varninchaaru. ayithe, roganirdhaarana kosam miculiz erpaatu chesina pramaanaalu tarachugaa miculics syndrome yokka tappudu nirdhaaranaku daariteesaayi. kshayavyadhi, antuvyaadhulu, sarcoidosis mariyu lymphoma vanti aneka paristhitulu, miculics syndromeku aapaadinchabadina vaatitho samaanamaina paristhithulatho untaayi. ayinappatikee, lalajalam-grandhi jeevaanhupareekshalapai lymphocytic chorabatla roopaanni vivarinchadaaniki "miculics syndrome" anae padaanni ippatikee appudappudu upayogistaaru.
1930loe, sweedanlooni jonkopingloni netra vaidyudu henrique sjogren (1899-1986), lacrimal mariyu lalajalam grandhula nundi takkuva sraavaalu unna rogini pariseelinchaaru. sjogren podi kallu (caratoconjunctivitis) lakshanaaniki caratoconjunctivitis sikka anae padaanni pravesapettaadu. 1933loe, athanu 19 mandhi mahilalanu vivaristuu thana doctorate theesisnu prachurinchaadu, veerilo ekkuva mandhi rutukramam aagipoyinavaaru mariyu arthuritis kaligi unnaaru, syndrome yokka clinical mariyu pathological vyakteekaranalanu chuupimchaaru. neeti lopam valla kalige caratoconjunctivitis sikaku, vitamin eah lopam valla kalige gerofthalmiatho etuvanti sambandham ledani sjogren spashtam chesaaru. examiners boardu konni clinical amsaalanu vimarsinchinanduna sjogren yokka thesis baga aadarana pondaledu.
vistrutamaina parisoedhana mariyu dayta sekarana taruvaata, sjogren 1951loe oka mukhyamaina patraanni prachurinchaadu, indulo caratoconjunctivitis sikka unna 80 mandhi rogulanu vivarinchaadu, veerilo 50 mandiki arthuritis kooda undhi. athani kaagitaaniki sambandhinchina tadupari samavesa paryatanalu sjogrens syndrompy antarjaateeya aasaktini penchaayi. caratoconjunctivitis sikka" anae padaanni sjogren swayamgaa roopondinchaaru mariyu saahityamlo sjogrens syndromga gurtinchadam praarambhinchaaru, ayithe idhi ippudu marinta saadhaarana viniyogaanni kaligi untundi.
parisoedhana.
ss vanti multifactorial auto emmune vyaadhulapai parisoedhana rugmata chuttoo unna gnaanaanni vistarinchadam, roganirdhaarana saadhanaalanu meruguparachadam mariyu rugmatanu nivaarinchadaaniki, nirvahinchadaaniki mariyu nayam cheyadaaniki maargaalanu kanugonadampai drushti pedutundi. united kingdom primary sjogrens syndrome registry, parisoedhana kosam teesukunna namuunaala kanajaala biobank, vaidya parisoedhana mandali, UK maddatutoe, 2010loe sthaapinchabadindi. idhi sjogrens syndrome yokka clinical trials mariyu janyu adhyayanalaku maddatu istundi mariyu parisoedhana adhyayanaalalo paalgonaalanukune vaariki mariyu vyaadhini adhyayanam chese parisoedhakulaku andubaatulo undhi.
itara swayam pratirakshaka vyaadhula maadirigaane, sjogrens syndromeku gurikavadam anedi maanava leukocyte antigen dwara baga prabhaavitamavutundi. dqa1 * 05:01, dqb1 * 02:01, mariyu drb1 * 03:01 yugmavikalpalu pramaada karakaluga gurtinchabaddaayi, ayithe dqa1 * 02:01, dqa1 * 03:01 mariyu dqb1 * 05:01 yugmavikalpalu vyaadhiki rakshana karakaluga kanugonabaddayi. yugmavikalpalu mariyu nirdishta jaathi madhya sambandham kooda sthaapinchabadindi. hcla-dqu2 mariyu hcla-bii8 saadhaaranamgaa caucassian rogulalo kanipistaayi, ayithe hcla-dr5 greeku mariyu izrael rogulaku sambandhinchinadi. keelaka pramaada vaividhyaalanu gurtinchadaaniki bhavishyattulo bahula janyu-vistruta anubandha skaanlu nirvahinchabadavachhu.
sjogrens syndromtho sambandham unna vairaslalo human tii-lymphotropic virus rakam 1 (hetch tii ell vii-1), epstein-baar virus (ii bii vii), human immuno deficiency virus (hetch ii vii), hepatitis delta virus (hetch dii vii) mariyu hepatitis sii virus (hetch sii vii) unnaayi.
vitamin eah mariyu vitamin dii korata eee vyaadhitho mudipadi undani konni parisoedhanalu choopinchaayi. vitamin dii lopam naraala vyakteekaranalu mariyu rogulalo lymphoma unikiki sambandhinchinadani kanugonabadindi, ayithe vitamin eah sthaayilu vyaadhi yokka grahaantara vyakteekaranalato vilomamgaa sambandham kaligi unnaayi.
lalajalam anedi sjogrens syndromeku sambhaavya roganirdhaarana sadhanam, endukante vyaadhi praarambhamaina tarvaata lalajalam bhaagam maarchabadutundi. lyab aann eah chip anie piluvabade kotta chinnadigaa chese saanketikatato, rooga nirdhaarana marinta soukaryavantamgaa untundi.
chikitsaku sambandhinchi, 2007loe bahula monoclonal pratiroedhakaalu parisoedhanaloo unnaayi. atyanta asajanakamga anty-sidi20 retuximab mariyu anty-sidi22 epratuzumab unnatlu anipinchindi, ayithe anty-tnf-α mariyu ifn-α takkuva prabhaavavantamgaa kanipinchaayi.
2014loe, sjogrens syndrome foundation vyaadhi nirdhaaranaku vyaadhi yokka sagatu samayanni sagaaniki tagginchadaaniki aidella lakshyanni prakatinchindi.

