Sjogrens Syndrome and Hyper Lipoprotienemiaa A Detrimental Association

Sjogren’s Syndrome and Hyper Lipoprotienemia(a) - A Detrimental Association - Dr. Uday Shanker Sagaram Director, Maruthi Rheumatology Research Centre, Hyderabad, India

Sjogren’s Syndrome and Hyper lipoproteinemia(a) - Detrimental Association What is Lp(a) • Lipoproteins are the spherical particles composed of Proteins (Apolipoproteins), Phospholipids, Triglycerides and Cholesterol • They are manufactured in the liver and are associated with LDL fraction of lipid profile, which is highly risky and detrimental • They penetrate and are strongly retained to the arterial wall • They possess pro-inflammatory activity • Lp(a) is a strong risk factor for CVD. The lack of clinical trial data has resulted in Lp(a) being largely ignored by clinical guidelines

Sjogren’s Syndrome and Hyper lipoproteinemia(a) - Detrimental Association What is Sjogren’s Syndrome? “Chronic auto-immune disorder where, WBC attack salivary and lacrimal glands” Causes • Hereditary • Viral/ bacterial infections Diagnosis • Xero stomia • Kerato conjunctivis sicca • Submandibular gland enlargement • Hoarseness of voice • Dysphagia, etc.

Sjogren’s Syndrome and Hyper lipoproteinemia(a) - Detrimental Association What is Sjogren’s Syndrome? … contd… Tests • Anti SSA and Anti SSB • Ophthalmologist tests - Rose Bengal test and Schirmer test • Immunological test Complication(s) • 44% times more risk of having Non-Hodgkins Lymphoma • Pregnant women deliver Neonatal Lupus child with heart block • Hepatitis • Bronchitis • Dyspareunia • Corneal ulcer

Sjogren’s Syndrome and Hyper lipoproteinemia(a) - Detrimental Association When and Why did I start checking for Lp(a) • In some of the Inflammatory Arthritis patients, we noticed persistently (3 -6 months) elevated Lipid Profile in their routine blood examinations • Research and discussion with other physicians lead to the identification of Lp(a) as the root cause • We then discovered associated increase in Lp(a) levels and also noticed associated drowsiness and cardiac pain

Sjogren’s Syndrome and Hyper lipoproteinemia(a) - Detrimental Association Why this association is to be given importance? • This association is detrimental, as it produces coronary premature Atherosclerosis and also Cerebral Vascular Stroke • Since Sjogren’s syndrome alone generally has a long life span, only its association with Lp(a) can reduce it

Sjogren’s Syndrome and Hyper lipoproteinemia(a) - Detrimental Association Effects • Coronary Artery Calcification - In diabetic and rheumatoid arthiritis patients • Dyslipedemia with low cholesterol level, low HDL level and high triglyserides • Associated hypo-thyroidism • Irritable Bowel Disorder (IBD) • Mixed Connective Tissue Disorders (MCTD) • Scleroderma • Psoriatic Arthritis

Sjogren’s Syndrome and Hyper lipoproteinemia(a) - Detrimental Association Treatment for Lp(a) • Treatment of Sjogren’s Syndrome (hydroxyl chloroquine and deflaza cort) combined treatment of Lp(a) (1 gm Niacin, 1000 mg Omega Fatty-acids and aspirin) • Correction of hypothyroidism, any associated diabetes and Nephropathy • Treatment of associated dyslipidemia • Vitamin C administration • Bovine collustrum

Sjogren’s Syndrome and Hyper lipoproteinemia(a) - Detrimental Association ?

About the Presenter • Dr. S. Uday Shanker Director of Maruthi Rheumatology Research Center, Secunderabad, India. • Recent Awards • Life Time Achievement Award in Medicine with Gold Medal • Bharatiya Chikitsak Award • Hind Ratan International Award and more • Published several papers in Cardiology and Rheumatology. • Contact Information • Email: uday. sagaram@gmail. com • Cell: +1(850) 559 -2929 (USA) • Cell: +(91) 9000245586 (India)