#Dysautonomia damages ur body's automatic pilot (AP) system that controls where blood goes, how food processes/moves, temperature & glucose regulation, BP, HR,sweating etc. W AP damage there is no homeostasis, no "static" issues. Problems shift & change & r unpredictable.
#Sjogrens commonly has #AutonomicNeuropathy. Most patients have lost the ability to predict how one feels day 2 day. Hr to hr. Even minute to minute sometimes. The days of predictable baseline function are gone for many #NeuroSjogrens patients.
Loss of this baseline functionality in #NeuroSjogrens #dysautonomia erodes ability to follow thru w plans. Steals ability to work full time or at all. Wears on friends/family. Eventually many are left disabled, unemployable, poor, alone & sadly unrecognized by MD's 4 many yrs.
@Dysautonomia
@dysclinic
@SarahSchaferMD are great sources of vetted information. Online resources include Dysautonomia International & Sjogrens Advocate. Smart Patients has great moderated online Sjogrens patient support group for support & crowd sourcing. Please share!
@D_Bone @loscharlos I tagged you since undoubtedly many #LongCovid folk will recognize this description (for NeuroSjogrens dysautonomia) & it may help people to describe/understand what they experience & why it's so difficult. Many people work better w framework & understanding.

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More from @NeuroSjogrens

Feb 24
@mariaj_morenom @AbrahamAubry @SEReumatologia @SMurcianaReuma @reumalorca5 @aesjogren @CatSjogren 👋👀⬇️🚨
Paradigm shifting article in the Green Journal of Neurology courtesy of cooperation between Neuro and Rheum at hosp in Hanover Germany. A cohort study of 512 "primary" #Sjogrens presenting to Neuro and to Rheum were evaluated for "strictly selected neuro symptoms." 1/n
@mariaj_morenom @AbrahamAubry @SEReumatologia @SMurcianaReuma @reumalorca5 @aesjogren @CatSjogren 2/n NB many of the most common neuro accompaniments to Sjogrens WERE NOT tested for (or were not reported) in this cohort including autonomics, HA, hearing loss, trigeminal involvement etc.) Despite this, 46% (!!) of #Sjogrens pts are #NeuroSjogrens patients.
@mariaj_morenom @AbrahamAubry @SEReumatologia @SMurcianaReuma @reumalorca5 @aesjogren @CatSjogren 3/n IMPORTANTLY, the authors take pains to note
1) Neuro involvement has been v underestimated
2) The disease course is more severe than previously anticipated BUT responds well to immunosuppression
3) ESSDAI issues--multiple neuro probs w same level activity only scored once so
Read 26 tweets
Nov 19, 2022
@gurdeep_dulay @buckleydebbie @SarahSchaferMD @SjogrensForum @MdStens History items to eval for trigeminal small fiber include change in taste (pH, loss of pain w/ hot peppers.) In irritative phase sneeze frequency & # sneezes at a time & trace nasal discharge can increase. In burned out phase sneezes & nasal secretions can stop. 1/n
@gurdeep_dulay @buckleydebbie @SarahSchaferMD @SjogrensForum @MdStens 2/n I noticed in my case most small fiber presentation has an irritative phase (IP) (positive findings of increased nerve activity) followed by a loss of function phase burned out (BO) phase (loss of small fiber sensibilities.) During IO ice cream headaches can ⬆️ 2/n
@gurdeep_dulay @buckleydebbie @SarahSchaferMD @SjogrensForum @MdStens 3/n in BO phase ice cream headaches diminish or disappear. In BO phase there is no sinus pain w/ Wasabi or strong horseradish & corneal & eye pain sensation decreases. Ophtho lidocaine drops dont sting & corneal reflex decreases (when bilateral both sides respond 3/n
Read 18 tweets
Nov 17, 2022
Low dose interleukin 2 Sjogren's double blind RCT
showed impressive changes in Sjogrens. Beneficial alterations in pain, fatigue, sicca, ILD pulm tests, leukopenia, thrombocytopenia favorable shift in immune profiles [Treg's, Breg's] & more. I'd try it!

jamanetwork.com/journals/jaman…
Dose of interleukin 2 in study: "dose of 1 million IU or placebo subcutaneously every other day for 2 weeks, followed by a 2-week break as one treatment cycle" So, 22 doses for ~5.5K at this site:
drugs.com/price-guide/pr….
Read 9 tweets
Oct 26, 2022
Sjogrens can cause acute, subacute & chronic polyradiculopathy as seen in this report. MD's need to learn about SSEP testing when routine nerve conduction studies are normal or they might miss this diagnosis which comes in motor, sensory or both.
Sjogrens polyradiculitis can present in a pure motor form which can mimic ALS/Lou Gherig's disease.
synapse.koreamed.org/articles/11212…
Sjogren's can also have a pure sensory polyradiculopathy with gait ataxia/imbalance & regular nerve conduction studies are normal. SSEP's are the only electrophysiologic tests that can localize this damage. MD's often stop at NCS & fail to obtain SSEP's.
n.neurology.org/content/96/16/…
Read 10 tweets
Oct 9, 2022
@AbrahamAubry Thread: Most DMARDS used in Sjogren's are those which have shown efficacy in related diseases and are off label uses. In part because Sjogren's gets so little research attention & systemic aspects of Sjogren's are seldom emphasized as much as sicca. 1/n
@AbrahamAubry 2/n In regards to NeuroSj use of classification criteria as selection criteria in studies excludes close to half of NeurSj patients. Even w/ limitations noted one can find smaller studies on DMARDS in Sjogrens. Here is a list of DMARDS: 1.hydroxychloroquine/chloroquine 2/n
@AbrahamAubry 3/n azathioprine, cyclosporine A, cyclophosphamide, leflunomide, methotrexate (oral and subcutaneous), and mycophenolate.

Biologic DMARDs: tumour necrosis factor (TNF) inhibitors (adalimumab, certolizumab, etanercept, golimumab, infliximab)
3/n
Read 10 tweets
Oct 6, 2022
@TwylaHoney @SarahSchaferMD 1/n Some neurologic disorders in Sjogren's:
1)Neuropathies (small fiber skin & autonomic,small & large fiber sensory ganglionopathies, CIDP "like" relapsing weakness/CISMP, both demyelinating & axonal)
2) Cranial neuropathies (trigeminal small fiber ganglionopathies, 1/n
@TwylaHoney @SarahSchaferMD 2/n trigeminal & glossopharyngeal neuralgia, burning mouth/tongue syndrome.
3) CNS (cognitive dysfunction, alterations in white matter/MS mimic, aseptic meningitis, Orthostatic cerebral hypoperfusion syndrome, NMOSD disorders-optic neuritis & transverse myelitis. 2/3
@TwylaHoney @SarahSchaferMD 3/n an apparent motor neuron disease like component can also occur.

Headaches are extremely common in Sjogren's.

There are more neurologic disorders associated with Sjogren's. Anyone can feel free to add to this list. Quite a few small fiber neuropathy 3/n
Read 6 tweets

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