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Conditions & treatments

Inflammatory conditions and treatments

  • Food Allergies

A food allergy is when the body’s immune system reacts unusually to specific foods. 

Allergic reactions are often mild, but they can sometimes be very serious. In young children, common food allergies include milk and eggs. In adults, allergies to fruit and vegetables are more common. Nut allergies, including peanuts, are relatively common in both school-age children and adults. Symptoms of a food allergy can affect different areas of the body at the same time. Some common symptoms include:

  • an itchy sensation inside the mouth, throat or ears
  • a raised itchy red rash (known as urticaria or hives)
  • swelling of the face, around the eyes, lips, tongue and roof of the mouth (known as angioedema)
  • vomiting

Treating a food allergy

There are two main types of medication that can be used to relieve the symptoms of an allergic reaction to foods:

  • antihistamines, which can be used to treat mild to moderate allergic reaction
  • adrenaline, which can be used to treat severe allergic reactions (anaphylaxis)

Antihistamines

Antihistamines work by blocking the effects of histamine, which is responsible for many of the symptoms of an allergic reaction.

Many antihistamines are available from your pharmacist without prescription – stock up in case of an emergency. Non-drowsy antihistamines are preferred. Some antihistamines, such as alimemazine and promethazine, aren’t suitable for children under two years old. If you have a younger child with a food allergy, ask your GP about what types of antihistamines may be suitable. Avoid drinking alcohol after taking an antihistamine as this can make you feel drowsy.

Adrenaline works by narrowing the blood vessels to counteract the effects of low blood pressure, and by opening up the airways to help ease breathing difficulties. If you or your child is at risk of anaphylaxis or has had a previous episode of anaphylaxis, you will be given an auto-injector of adrenaline to use in case of emergencies.

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  • Alzheimer

Alzheimer’s disease is the most common type of dementia, affecting almost 500,000 people in the UK. The term “dementia” describes a loss of mental ability associated with gradual death of brain cells. The exact cause of Alzheimer’s disease is unknown, although a number of things are thought to increase your risk of developing the condition. These include:

  • increasing age
  • a family history of the condition
  • previous severe head injuries

Signs and symptoms of Alzheimer’s disease

Alzheimer’s disease is a progressive condition, which means the symptoms develop gradually and become more severe over the course of several years. The first sign of Alzheimer’s disease is usually minor memory problems. For example, this could be forgetting about recent conversations or events, and forgetting the names of places and objects. As the condition develops, memory problems become more severe and further symptoms can develop, such as:

  • confusion and disorientation
  • personality changes, such as becoming aggressive, demanding and suspicious of others
  • hallucinations(seeing things that are not there) and delusions (believing things that are untrue)
  • problems with language and speech
  • problems moving around without assistance

Treating Alzheimer’s disease

There is currently no cure for Alzheimer’s disease, although medication is available that can temporarily reduce some symptoms or slow down the progression of the condition in some people. Support is also available to help someone with the condition cope with everyday life.

Care plan

Once you’ve been diagnosed with Alzheimer’s disease, your future health and social care needs will need to be assessed and a care plan drawn up. A care plan is a way of ensuring you receive the right treatment for your needs. It involves identifying areas where you may need some assistance, such as:

  • what support you or your carer need for you to remain as independent as possible
  • whether there are any changes that need to be made to your home to make it easier to live in
  • whether you need any financial assistance

Healthcare professionals (such as your GP or psychiatrist) and social care services, which is normally your local council working in conjunction with the NHS, will usually both be involved in helping draw up and implement care plans.

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  • Arthritis, Osteoarthritis

Osteoarthritis is a long-term condition that causes pain, swelling and stiffness in the joints. The hands, feet and wrists are commonly affected, but it can also cause problems in other parts of the body. There may be periods where your symptoms become worse, known as a flare-up or flare. A flare can be difficult to predict, but with treatment it is possible to decrease the number of flares and minimise or prevent long-term damage to the joints.

  • Exercise
  • Exercise is one of the most important treatments for people with osteoarthritis, whatever your age or level of fitness. Your physical activity should include a combination of exercises to strengthen your muscles and exercises to improve your general fitness.
  • If osteoarthritis causes you pain and stiffness, you may think exercise will make your symptoms worse.
  • But usually, regular exercise that keeps you active and mobile and builds up muscle, thereby strengthening the joints, will improve symptoms.
  • Exercise is also good for losing weight, improving your posture and relieving stress, all of which will ease symptoms.
  • Your GP, or possibly a physiotherapist, will discuss the benefits you can expect from your exercise programme and can give you an exercise plan to follow at home.
  • It’s important to follow this plan because there is a risk that doing too much exercise too quickly, or doing the wrong sort of exercise, may damage your joints.
  • Read more about health and fitness including simple ways to exercise at home.
  • Losing weight
  • Being overweight or obese often makes osteoarthritis worse as it can place some of your joints under increased strain.
  • To find out if you are overweight or obese, use the healthy weight calculator.
  • If you are overweight, try to lose weight by doing more physical activity and eating a healthier diet.
  • Discuss any new exercise plan with your GP or physiotherapist before you start. They can help plan a suitable exercise programme for you. Your GP and practice nurse can also advise about how to lose weight slowly and safely.

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  • Arthritis, Rheumatoid

Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints.The hands, feet and wrists are commonly affected, but it can also cause problems in other parts of the body. There may be periods where your symptoms become worse, known as a flare-up or flare. A flare can be difficult to predict, but with treatment it is possible to decrease the number of flares and minimise or prevent long-term damage to the joints.

Treating rheumatoid arthritis

There is no cure for rheumatoid arthritis, but treatment can help reduce inflammation in the joints, relieve pain, prevent or slow joint damage, reduce disability and enable you to live as active a life as possible. Early treatment and support – including lifestyle changes, medication, supportive treatments and surgery – can reduce the risk of joint damage and limit the impact of the condition. Your treatment will usually involve care from your GP in addition to a number of different specialists.

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  • Asthma

Asthma is a common long-term condition that can cause coughing, wheezing, chest tightness and breathlessness. The severity of these symptoms varies from person to person. Asthma can be controlled well in most people most of the time, although some people may have more persistent problems. Occasionally, asthma symptoms can get gradually or suddenly worse. This is known as an “asthma attack”, although doctors sometimes use the term “exacerbation”. Severe attacks may require hospital treatment and can be life threatening, although this is unusual.

Treating asthma

Anyone with asthma should be able to lead a full and unrestricted life. The treatments are effective in most people and should enable you to keep the condition under control.

Taking asthma medicines

Inhalers. Asthma medicines are usually given by inhalers – devices that deliver medication directly into the lungs as you breathe in. This is an effective way of taking an asthma medicine as most goes straight to the lungs, with very little ending up elsewhere in the body. Each inhaler works in a slightly different way. You should have training from your GP or nurse in how to use your device or how to help your child use theirs. This should be checked at least once a year. Some inhalers are pressurised canisters – similar to a spray deodorant or an air freshener. You press the inhaler while breathing in, so the vapour containing the medication can pass into your lungs. Some inhalers are not pressurised canisters but contain the medication in dry powder form, usually in a capsule that is punctured when the inhaler is “primed”. It is not possible to use a spacer with these inhalers and, unlike pressurised canisters, the powder must be inhaled quickly and forcefully if the medication is to reach the lungs.

Spacers. Pressurised canister inhalers can work better if given through a spacer – a hollow plastic or metal container with a mouthpiece at one end and a hole for the inhaler at the other. Children under the age of three may have a spacer attached to a face mask rather than a mouthpiece, as this can make it easier for them to breathe in the medicine. When using a spacer, the vapour from the inhaler is released into the container, where it is held while you breathe in slowly and progressively until your lungs are full. You should then hold in your breath before relaxing so the vapour has time to settle in your lungs. This can make the medication more effective because much more of it reaches your lungs and much less stays in your mouth or is swallowed, where it has no effect on your lungs but is more likely to cause possible unwanted effects. Spacers are also good for reducing the risk of thrush in the mouth or throat, which can be a side effect of some inhaled asthma preventer medicines. Spacers can also be very helpful for people who find using inhalers difficult, such as young children. As spacers also improve the distribution of medication into the lungs, their regular use is preferred in many cases – particularly for preventer medications – even in people who use inhalers well.

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  • Cancer

Cancer is a condition where cells in a specific part of the body grow and reproduce uncontrollably. The cancerous cells can invade and destroy surrounding healthy tissue, including organs. Cancer sometimes begins in one part of the body before spreading to other areas. This process is known as metastasis. There are over 200 different types of cancer, each with its own methods of diagnosis and treatment.You can find out more about specific types of cancer by using the links on this page.

Spotting signs of cancer. Changes to your body’s normal processes or symptoms that are out of the ordinary can sometimes be an early sign of cancer. For example, a lump that suddenly appears on your body, unexplained bleeding or changes to your bowel habits are all symptoms that need to be checked by a doctor. In many cases, your symptoms won’t be related to cancer and will be caused by other, non-cancerous health conditions. However, it’s still important for you to see your GP so that they can investigate your symptoms.

Read more about the signs and symptoms of cancer.

Reducing your risk of cancer

Making some simple changes to your lifestyle can significantly reduce your risk of developing cancer. For example, healthy eating, taking regular exercise and not smoking will help lower your risk. Read more about how a healthy lifestyle can help reduce your chances of developing cancer.

How common is cancer? Cancer is a very common condition. In 2011, almost 331,500 people in the UK were diagnosed with cancer. More than one in three people will develop some form of cancer during their lifetime. In the UK, the four most common types of cancer are:

Cancer treatment

Surgery is the primary treatment option for most types of cancer, because solid tumours can usually be surgically removed. Two other commonly used treatment methods are chemotherapy (powerful cancer-killing medication) and radiotherapy (the controlled use of high-energy X-rays).

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  • Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease. People with COPD have difficulties breathing, primarily due to the narrowing of their airways, this is called airflow obstruction. Typical symptoms of COPD include:

  • increasing breathlessness when active
  • a persistent cough with phlegm
  • frequent chest infections

Treating COPD

There is no cure for chronic obstructive pulmonary disease (COPD), but treatment can help slow the progression of the condition and reduce the symptoms. If you smoke, the best way to prevent COPD from getting quickly worse is to stop smoking and avoid further damage to your lungs. Read about the support available to help you stop smoking. There are also medicines that can help relieve the symptoms of COPD. The type of medicine you take will depend on how severe your COPD is and what symptoms you have. You may have to try different medicines to find which suits you best. Often, people with COPD have to take a combination of medicines. In addition, many people keep different medicines available in case they have a flare-up, when symptoms are particularly bad. Your doctor will discuss the best options with you.

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  • Coronary Artery (Heart) Disease

Coronary heart disease (CHD) is the leading cause of death both in the UK and worldwide. It’s responsible for more than 73,000 deaths in the UK each year. About 1 in 6 men and 1 in 10 women die from CHD. In the UK, there are an estimated 2.3 million people living with CHD and around 2 million people affected by angina (the most common symptom of coronary heart disease). CHD generally affects more men than women, although from the age of 50 the chances of developing the condition are similar for both sexes. As well as angina (chest pain), the main symptoms of CHD are heart attacks and heart failure. However, not everyone has the same symptoms and some people may not have any before CHD is diagnosed. CHD is sometimes called ischaemic heart disease.

The heart. The heart is a muscle about the size of your fist. It pumps blood around your body and beats approximately 70 times a minute. After the blood leaves the right side of the heart, it goes to your lungs where it picks up oxygen. The oxygen-rich blood returns to your heart and is then pumped to the body’s organs through a network of arteries. The blood returns to your heart through veins before being pumped back to your lungs again. This process is called circulation. The heart gets its own supply of blood from a network of blood vessels on the heart’s surface called coronary arteries.

What causes coronary heart disease? Coronary heart disease is the term that describes what happens when your heart’s blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries. Over time, the walls of your arteries can become furred up with fatty deposits. This process is known as atherosclerosis and the fatty deposits are called atheroma. Atherosclerosis can be caused by lifestyle factors and other conditions, such as:

Treating heart disease

Although coronary heart disease (CHD) cannot be cured, treatment can help manage the symptoms and reduce the risk of further problems. CHD can be managed effectively with a combination of lifestyle changes, medicine and, in some cases, surgery. With the right treatment, the symptoms of CHD can be reduced and the functioning of the heart improved.

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  • Diabetes and Prediabetes

Diabetes is a lifelong condition that causes a person’s blood sugar level to become too high. There are two main types of diabetes – type 1 diabetes and type 2 diabetes. Type 2 diabetes is far more common than type 1. In the UK, around 90% of all adults with diabetes have type 2. There are 3.9 million people living with diabetes in the UK. That’s more than one in 16 people in the UK who has diabetes (diagnosed or undiagnosed).  This figure has more than doubled since 1996, when there were 1.4 million. By 2025, it is estimated that five million people will have diabetes in the UK. Many more people have blood sugar levels above the normal range, but not high enough to be diagnosed as having diabetes. This is sometimes known as prediabetes. If your blood sugar level is above the normal range, your risk of developing full-blown diabetes is increased. It’s very important for diabetes to be diagnosed as early as possible because it will get progressively worse if left untreated. You should therefore visit your GP as soon as possible if you have symptoms, such as feeling thirsty, passing urine more often than usual, and feeling tired all the time.

The main symptoms of diabetes are:

  • feeling very thirsty
  • urinating more frequently than usual, particularly at night
  • feeling very tired
  • weight loss and loss of muscle bulk
  • itching around the penis or vagina, or frequent episodes of thrush
  • cuts or wounds that heal slowly
  • blurred vision (caused by the lens of the eye becoming dry)

Type 1 diabetes can develop quickly over weeks or even days. Many people have type 2 diabetes for years without realising because the early symptoms tend to be general.

What causes diabetes? The amount of sugar in the blood is controlled by a hormone called insulin, which is produced by the pancreas (a gland behind the stomach). When food is digested and enters your bloodstream, insulin moves glucose out of the blood and into cells, where it’s broken down to produce energy. However, if you have diabetes, your body is unable to break down glucose into energy. This is because there’s either not enough insulin to move the glucose, or the insulin produced doesn’t work properly. In type 1 diabetes, the body’s immune system attacks and destroys the cells that produce insulin. As no insulin is produced, your glucose levels increase, which can seriously damage the body’s organs.

Type 1 diabetes is often known as insulin-dependent diabetes. It’s also sometimes known as juvenile diabetes or early-onset diabetes because it usually develops before the age of 40, often during the teenage years. It is  less common than type 2 diabetes. In the UK, it affects about 10% of all adults with diabetes. If you’re diagnosed with type 1 diabetes, you’ll need insulin injections for the rest of your life. You’ll also need to pay close attention to certain aspects of your lifestyle and health to ensure your blood glucose levels stay balanced. For example, you’ll need to eat healthily, take regular exercise and carry out regular blood tests. Read more about type 1 diabetes and living with diabetes.

Type 2 diabetes is where the body doesn’t produce enough insulin, or the body’s cells don’t react to insulin. This is known as insulin resistance. If you’re diagnosed with type 2 diabetes, you may be able to control your symptoms simply by eating a healthy diet, exercising regularly, and monitoring your blood glucose levels. However, as type 2 diabetes is a progressive condition, you may eventually need medication, usually in the form of tablets. It is often associated with obesity. Obesity-related diabetes is sometimes referred to as maturity-onset diabetes because it’s more common in older people. You can use the BMI healthy weight calculator to check whether you’re a healthy weight. Read more about type 2 diabetes.

Diabetic eye screening. Everyone with diabetes aged 12 or over should be invited to have their eyes screened once a year. If you have diabetes, your eyes are at risk from diabetic retinopathy, a condition that can lead to sight loss if it’s not treated. Screening, which involves a half-hour check to examine the back of the eyes, is a way of detecting the condition early so it can be treated more effectively. Read more about diabetic eye screening.

Gestational diabetes (in pregnancy). During pregnancy, some women have such high levels of blood glucose that their body is unable to produce enough insulin to absorb it all. This is known as gestational diabetes and affects up to 18 in 100 women during pregnancy. Pregnancy can also make existing type 1 diabetes worse. Gestational diabetes can increase the risk of health problems developing in an unborn baby, so it’s important to keep your blood glucose levels under control. In most cases, gestational diabetes develops during the second trimester of pregnancy (weeks 14 to 26) and disappears after the baby is born. However, women who have gestational diabetes are at an increased risk (30%) of developing type 2 diabetes later in life (compared with a 10% risk for the general population).

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  • Fatigue and Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) causes persistent fatigue (exhaustion) that affects everyday life and doesn’t go away with sleep or rest. CFS is also known as ME, which stands for myalgic encephalomyelitis. There’s some debate over the correct term to use for the condition, but these pages will refer to the condition as CFS. It is a serious condition that can cause long-term illness and disability, but many people – particularly children and young people – improve over time.

Who is affected? It’s estimated around 250,000 people in the UK have CFS. Anyone can get the condition, although it’s more common in women than men. It usually develops when people are in their early 20s to mid-40s. Children can also be affected, usually between the ages of 13 and 15.

How it affects quality of life? Most cases of CFS are mild or moderate, but up to one in four people with CFS have severe symptoms. These are defined as follows:

  • mild– you’re able to care for yourself, but may need days off work to rest
  • moderate– you may have reduced mobility, and your symptoms can vary; you may also have disturbed sleep patterns and need to sleep in the afternoon
  • severe– you’re able to carry out minimal daily tasks, such as brushing your teeth, but have significantly reduced mobility, and may also have difficulty concentrating

Treatments for chronic fatigue syndrome (CFS) aim to help relieve the symptoms.

Cognitive behavioural therapy (CBT) is a type of therapy that can help you manage CFS by changing the way you think and behave. It’s often used as a treatment for a range of health conditions. CBT aims to help reduce the severity of your symptoms and the distress associated with CFS. It works by breaking down overwhelming problems into smaller parts, and by breaking the negative cycle of interconnected thoughts, feelings, physical sensations and actions. Ideally, your CBT therapist will have experience of dealing with CFS and treatment will be offered on a one-to-one basis. The treatment will be tailored to your needs and may include some of the following:

  • helping you accept your diagnosis
  • challenging feelings that could prevent your symptoms improving
  • trying to increase your sense of control over your symptoms

The use of CBT doesn’t mean CFS is considered to be a psychological condition. It’s often used as a treatment for a variety of long-term conditions, such as cancer and rheumatoid arthritis.

Graded exercise therapy (GET) is a structured exercise programme that aims to gradually increase how long you can carry out a physical activity. This usually involves exercise that raises your heart rate, such as swimming or walking. You’ll have your own exercise programme adapted to your own physical capabilities. GET should only be carried out by a trained specialist with experience of treating CFS and, if possible, should be offered on a one-to-one basis. After finding out what you can comfortably do already in the exercise (the baseline), you will gradually increase:

  • the length of time you do the exercise
  • the intensity of the exercise

As part of your exercise programme, you and your therapist will set goals, such as being able to walk to the shops or carry out some gardening. It may take weeks, months or even years for you to achieve these goals, but it’s very important not to exceed the exercise duration and intensity set for you. Activity management is another aspect of your treatment programme. It involves setting individual goals and gradually increasing your activity levels. You may be asked to keep a diary of your current activity and rest periods to establish your baseline. Activities can then be gradually increased in a way you find manageable.

There’s no medication available to treat CFS specifically, but different medicines may be used to relieve some of the symptoms of the condition. Over-the-counter painkillers can help ease any muscle pain, joint pain and headaches you may have. Stronger painkillers can also be prescribed by your GP, although they should only be used on a short-term basis. If you have chronic (long-term) pain, you may be referred to a pain management clinic. There are about 300 of these across the UK, mostly located in hospitals.

Antidepressants can be useful for people with CFS who are in pain or having trouble sleeping. Amitriptyline is a low-dose tricyclic antidepressant that may be prescribed.

It is not suitable for everyone – for example, it may not be suitable if you have a history of heart problems. It can also cause side effects such as a dry mouth, blurred vision, dizziness and drowsiness. If you experience severe nausea as a result of CFS, you may benefit from a type of medication called an anti-emetic.

Lifestyle advice. As well as these treatments, you may find the the following lifestyle advice helpful: Pacing may be a useful way of controlling CFS symptoms. It involves balancing periods of activity with periods of rest. It means not overdoing it or pushing yourself beyond your limits. If you do more than you are ready to, this could slow down your progress in the long term. Over time, you can gradually increase your periods of activity while making sure they’re balanced with periods of rest. Learning how to make the most of your energy helps increase the amount you can do. However, you may need to arrange your daily and weekly activities around when you can be active and when you need to rest. If you pace your activities at a level that’s right for you, rather than rushing to do as much as possible in a short space of time, you may be able to make steady progress. However, there are some uncertainties about pacing. There’s insufficient evidence on the benefits or harm of this treatment, although it’s often recommended for CFS.

The following recommendations may also help:

  • Avoid stressful situations
  • Avoid alcohol, caffeine, sugar and sweeteners
  • Avoid any food and drink you’re sensitive to
  • Eat small regular meals to help reduce any nausea
  • Spend time relaxing
  • Try not to sleep or nap excessively, as this doesn’t help and may make any sleeping problems worse

A relapse is when your symptoms get worse for some time, leaving you unable to function at the level you previously managed. They are a common part of CFS and can be caused by a number of factors, such as an infection or an unplanned activity. Sometimes there’s no clear cause. The healthcare professionals treating you can help you manage your relapse by:

  • including more breaks with your current levels of activities
  • Teaching you relaxation and breathing techniques
  • Encouraging you to be optimistic about your recovery

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  • Fibromyalgia

Fibromyalgia, also called fibromyalgia syndrome (FMS), is a long-term condition that causes pain all over the body. As well as widespread pain, people with fibromyalgia may also have:

  • increased sensitivity to pain
  • fatigue (extreme tiredness)
  • muscle stiffness
  • difficulty sleeping
  • problems with mental processes (known as “fibro-fog”) – such as problems with memory and concentration
  • headaches
  • irritable bowel syndrome (IBS)– a digestive condition that causes stomach pain and bloating

What causes fibromyalgia? The exact cause of fibromyalgia is unknown, but it’s thought to be related to abnormal levels of certain chemicals in the brain and changes in the way the central nervous system (brain, spinal cord and nerves) processes pain messages carried around the body. It’s also suggested that some people are more likely to develop fibromyalgia because of genes inherited from their parents. In many cases, the condition appears to be triggered by a physically or emotionally stressful event, such as:

  • an injury or infection
  • giving birth
  • having an operation
  • the breakdown of a relationship
  • the death of a loved one

Treating fibromyalgia

There is no cure for fibromyalgia, but treatment can ease some of your symptoms and improve quality of life. Your GP will play an important role in your treatment and care. They can help you decide what is best for you, depending on what you prefer and what treatments are available. In some cases, several different healthcare professionals may also be involved in your care, such as:

  • a rheumatologist (a specialist in conditions that affect muscles and joints)
  • a neurologist (a specialist in conditions of the central nervous system)
  • a psychologist (a specialist in mental health and psychological treatments)

Fibromyalgia has numerous symptoms, meaning no single treatment will work for all of them. Treatments that work for some people will not necessarily work for others. You may need to try a variety of treatments to find a combination that suits you. This will normally be a combination of medication and lifestyle changes.

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  • Gastritis, Ulcers, and Stomach Cancer

Gastritis‘ means inflammation of the stomach lining. It is a common symptom with a wide range of causes. The stomach lining (‘mucosa’) contains special cells that produce acid and enzymes that start to digest food. The acid can potentially break down the stomach lining too, so other cells in the lining produce mucus to provide a slimy layer that protects it from this acid. Happens when this defence barrier is damaged – by H. pylori bacteria or after excessive consumption of alcohol, for example (see What are the possible causes?). For most people, gastritis isn’t serious and improves quickly with treatment. But if it is left untreated, it can last for years.

What are the symptoms of gastritis? Many people with gastritis don’t have any symptoms – usually because they have a non-erosive form of the disease caused by a bacterial infection (see What are the possible causes?). In other cases, gastritis can cause:

  • gnawing or burning stomach pain
  • nausea and vomiting
  • feeling full after eating

If the stomach lining has been worn away, it is classed as erosive gastritis.Damaged areas of stomach lining (unprotected by mucus) are exposed to stomach acid, which can cause pain and lead to stomach ulcers and bleeding. If symptoms come on suddenly and severely, it is classed as acute gastritis.If it has lasted a long time (usually because of bacterial infection), it is chronic gastritis.

What are the possible causes of gastritis? Gastritis is usually caused by one of the following:

  • An infection: almost always a Helicobacter pylori bacterial infection (see below), but occasionally viruses, parasites, fungi, and bacteria other than H. pylori are the culprits
  • Excessive use of cocaine or alcohol
  • Regularly taking aspirin, ibuprofen or other painkillers classed as non-steroidal anti-inflammatory drugs (NSAIDs)
  • A stressful event – such as a bad injury or critical illness, or major surgery. Exactly why stress and serious illness can lead to gastritis is not known, but it may be related to decreased blood flow to the stomach.

Treatment

aims to reduce the amount of acid in the stomach to relieve symptoms and allow the stomach lining to heal, and to tackle any underlying cause. You may be able to treat gastritis yourself, depending on the cause. Easing symptoms:

  • antacids– these over-the-counter medicines neutralise the acid in your stomach, which can provide rapid pain relief
  • histamine 2 (H2) blockers such as ranitidine– these medicines decrease acid production, and are available both over the counter and on prescription
  • proton pump inhibitors (PPIs) such as omeprazole– these medicines decrease acid production even more effectively than H2 blockers, and are available both over the counter and on prescription

What else can I do to help myself? If you think the cause of your gastritis is repeated use of NSAID painkillers, try switching to a different painkiller that isn’t in the NSAID class, such as paracetamol. You may want to talk to your GP about this. Also, consider:

  • eating smaller, more frequent meals
  • avoiding irritating (spicy, acidic or fried) foods
  • avoiding or cutting down on alcohol
  • managing stress

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  • Hepatitis

Hepatitis is a term used to describe inflammation (swelling) of the liver. It can occur as the result of a viral infection or because the liver is exposed to harmful substances such as alcohol. Some types of hepatitis will pass without causing permanent damage to the liver. Other types can persist for many years and cause scarring of the liver (cirrhosis). In the most serious cases, it may lead to loss of liver function (liver failure) or liver cancer, which can both be fatal. These types of long-lasting hepatitis are known as chronic hepatitis. Initial symptoms of hepatitis caused by infection are similar to the flu and include:

  • muscle and joint pain
  • a high temperature (fever) of 38ºC (100.4ºF) or above
  • feeling sick
  • being sick
  • headache
  • occasionally, yellowing of the eyes and skin (jaundice)

Symptoms of chronic hepatitis can include:

  • feeling unusually tired all the time
  • depression
  • jaundice
  • a general sense of feeling unwell

In many cases hepatitis causes no noticeable symptoms, so when hepatitis is caused by a virus, many people are unaware they are infected. Similarly, many people with hepatitis caused by alcohol are unaware that their drinking is harming their liver.

Types of hepatitis

The most common types of hepatitis are described below.

Hepatitis A

Hepatitis A, caused by the hepatitis A virus, is the most common type of viral hepatitis. It occurs in the UK, but is more common in countries where sanitation and sewage disposal are poor. Around 350 cases are reported each year in England, with most cases occurring in people who have travelled abroad. Hepatitis A is usually caught by putting something in your mouth that has been contaminated with the faeces of someone with hepatitis A. It is usually a short-term (acute) infection and symptoms will pass within three months. There is no specific treatment for hepatitis A other than to relieve symptoms. A vaccination can protect you against hepatitis A. Vaccination is recommended if you are travelling to countries where the virus is common, such as the Indian subcontinent, Africa, Central and South America, the Far East and Eastern Europe. Read more about hepatitis A.

Hepatitis B

Hepatitis B is caused by the hepatitis B virus. This can be found in blood and body fluids, such as semen and vaginal fluids, so it can be spread during unprotected sex, by sharing needles to inject drugs, and from pregnant women to their babies. Hepatitis B is uncommon in England and cases are largely confined to certain groups, such as drug users. It is much more common in other parts of the world, particularly East Asia and sub-Saharan Africa. Most people infected with hepatitis B are able to fight off the virus and fully recover from the infection within a couple of months. However, a small minority of people develop a long-term infection. This is known as chronic hepatitis B. In some people, chronic hepatitis B can cause cirrhosis and liver cancer. Chronic hepatitis B is treatable with antiviral medication. A vaccination is available for preventing hepatitis B, which is recommended for people in high-risk groups, such as injecting drug users or healthcare workers. Read more about hepatitis B.

Hepatitis C

Hepatitis C is the most common type of viral hepatitis in England. It is estimated that around 215,000 people in the UK have chronic hepatitis C. Hepatitis C is caused by the hepatitis C virus. This can be found in the blood and, to a much lesser extent, the saliva and semen or vaginal fluid of an infected person. It is particularly concentrated in the blood, so it is usually transmitted through blood-to-blood contact. In England, it’s most commonly spread through sharing needles to inject drugs, which account for 9 out of 10 cases. Hepatitis C often causes no noticeable symptoms, or symptoms that are mistaken for the flu, so many people are unaware they are infected. Around one in four people will fight off the infection and will be free of the virus. In the remaining three out of four people, the virus will stay in their body for many years. This is known as chronic hepatitis C. In some people, chronic hepatitis C can cause cirrhosis and liver failure. Chronic hepatitis C can be treated by taking antiviral medications, although there can be unpleasant side effects. There is currently no vaccination for hepatitis C. Read more about hepatitis C.

Alcoholic hepatitis

Drinking excessive amounts of alcohol over the course of many years can damage the liver, leading to hepatitis. This type of hepatitis is known as alcoholic hepatitis. It is estimated that as many as one in four moderate to heavy drinkers has some degree of alcoholic hepatitis. The condition does not usually cause any symptoms and is often detected with a blood test. If a person with alcoholic hepatitis continues to drink alcohol, there is a real risk that they will go on to develop cirrhosis and possibly liver failure. Read more about alcoholic liver diseases and the health risks associated with alcohol.

Rarer types of hepatitis

Hepatitis D

Hepatitis D, caused by the hepatitis D virus, is only present in people already infected with hepatitis B (it needs the presence of the hepatitis B virus to be able to survive in your body). Chronic hepatitis D can increase the risk of cirrhosis developing. Cirrhosis is more likely to develop in someone with chronic hepatitis B becoming infected with hepatitis D (superinfection). It is much rarer when both infections occur together (co-infection). Infection rates in the UK are low.

Hepatitis E

Hepatitis E, caused by the hepatitis E virus, is very rare in the UK and is generally a mild and short-term infection. It is caught by putting something in your mouth that has been contaminated with the faeces of someone with hepatitis E. Person-to-person transmission is rare. See the British Liver Trust website to find out more about hepatitis E.

Autoimmune hepatitis

Autoimmune hepatitis is a very rare cause of chronic (long-term) hepatitis. The white blood cells attack the liver, causing chronic inflammation and damage. This can lead to more serious problems, such as liver failure. The reason for this reaction is unknown.

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  • Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common, long-term condition of the digestive system. It can cause bouts of stomach cramps, bloating, diarrhoea and/or constipation. The symptoms vary between individuals and affect some people more severely than others. They tend to come and go in periods lasting a few days to a few months at a time, often during times of stress or after eating certain foods. You may find that some of symptoms improve after having a poo. IBS is thought to affect up to one in five people at some point in their life, and it usually first develops when a person is between 20 and 30 years of age. Around twice as many women are affected as men. The condition is often life-long, although it may improve over several years.

Treating IBS

The symptoms of irritable bowel syndrome (IBS) can often be managed by changing your diet and lifestyle, and understanding the nature of the condition. In some cases, medication or psychological treatments may also be helpful.

IBS-friendly diet. Changing your diet will play an important part in controlling your symptoms of IBS. However, there is no “one size fits all” diet for people with the condition. The diet that works best for you will depend on your symptoms and how you react to different foods. It may be helpful to keep a food diary and record whether certain foods make your symptoms better or worse. You can then avoid foods that trigger your symptoms. However, it’s important to remember that these foods will not necessarily need to be avoided for life. People with IBS are often advised to modify the amount of fibre in their diet. There are two main types of fibre: soluble fibre (which the body can digest) and insoluble fibre (which the body cannot digest). Foods that contain soluble fibre include:

  • oats
  • barley
  • rye
  • fruit – such as bananas and apples
  • root vegetables – such as carrots and potatoes
  • golden linseeds

Foods that contain insoluble fibre include:

  • wholegrain bread
  • bran
  • cereals
  • nuts and seeds (except golden linseeds)

If you have diarrhoea, you may find it helps to cut down on the insoluble fibre you eat. It may also help to avoid the skin, pith and pips from fruit and vegetables. If you have constipation, increasing the amount of soluble fibre in your diet and the amount of water you drink can help.

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  • Lupus Erythematosus

Lupus is a complex and poorly understood condition that affects many parts of the body and causes symptoms ranging from mild to life-threatening. There are some types of lupus that just affect the skin – such as discoid lupus erythematosus and subacute cutaneous lupus erythematosus. Some medications can also cause lupus-like side effects. However, the term “lupus” is most often used to describe a more severe form of the condition called systemic lupus erythematosus (SLE), which can affect many parts of the body, including the skin, joints and internal organs. Symptoms range from mild to severe, and many people will have long periods with few or no symptoms before experiencing a sudden flare-up, where their symptoms are particularly severe. Even mild cases can be distressing and have a considerable impact on a person’s quality of life. The rest of this article will focus on SLE.

Signs and symptoms. SLE can cause a wide range of symptoms, depending on the areas of the body that are affected. The most common symptoms are:

  • fatigue (extreme tiredness)
  • rashes – particularly on the face, wrists and hands
  • joint painand swelling

As the symptoms of SLE can be similar to a number of other conditions, many of which are more common, it can be difficult to diagnose. If you have persistent or troublesome symptoms that you think could be caused by SLE, you should see your GP so they can try to determine the cause. Read more about the symptoms of lupus and diagnosing lupus.

What causes lupus? SLE is an autoimmune condition, which means it is caused by problems with the immune system. For reasons not yet understood, the immune system in people with SLE starts to attack and inflame healthy cells, tissue and organs. As with other more common autoimmune conditions, such as rheumatoid arthritis, it is thought a combination of genetic and environmental factors may be responsible for triggering SLE in certain people. Read more about the causes of lupus.

Who is affected?. SLE is an uncommon condition that is estimated to affect around 15,000 people in England and Wales. Around 90% of cases occur in women. The condition is most common in women of childbearing age (between the ages of 15 and 50), but it can also affect people of other ages. The condition tends to be less common in people of white European origin and more common in those of African, Caribbean or Asian origin.

Treating lupus

There is currently no cure for systemic lupus erythematosus (SLE), but treatments that can ease the symptoms and make it easier to live with are available. In most cases, treatment will involve a combination of self-care measures and medication.

Protecting yourself from the sun.Exposure to sunlight can sometimes make symptoms such as rashes worse, and it’s important to protect your skin when in the sun. This means wearing clothing that covers your skin, a wide-brimmed hat and sunglasses. You will also need to apply sunscreen with a high SPF to prevent sunburn. However, some people with lupus are not sun-sensitive and do not need to take extra precautions. As people get most of their vitamin D as a result of direct sunlight on the skin, there is a risk you may not get enough of this vitamin if you need to avoid sun exposure. This means you may need to make an extra effort to include good sources of vitamin D in your diet to avoid problems such as osteoporosis (weakened bones), and you may be advised to take vitamin D supplements.

Non-steroidal anti-inflammatory drugs (NSAIDs) are a common painkilling medication that reduces inflammation in the body. If you experience joint or muscle pain as a result of SLE, you may be prescribed a NSAID to help ease your symptoms. Commonly prescribed NSAIDs for SLE include ibuprofen, naproxen and diclofenac. You can buy some NSAIDs, such as ibuprofen, over the counter. These NSAIDs may be suitable if your joint or muscle pain is mild. For more severe pain, you will need stronger medication prescribed by your GP. NSAIDs may not be suitable for people who have stomach, kidney or liver problems, or have had these problems in the past. They may also be unsuitable for people with asthma. Your GP will advise about which NSAID is right for you.

Side effects. If taken in high doses or over long periods of time, NSAIDs can damage your stomach lining, which may cause internal bleeding. If you need to take NSAIDs on a long-term basis, your GP will carefully monitor you to check for any problems, and you may be prescribed an additional medication called a proton pump inhibitor (PPI) to protect your stomach.

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  • Multiple Sclerosis

Multiple sclerosis (MS) affects nerves in the brain and spinal cord, causing a wide range of symptoms including problems with muscle movement, balance and vision. Each nerve fibre in the brain and spinal cord is surrounded by a layer of protein called myelin, which protects the nerve and helps electrical signals from the brain travel to the rest of the body. In MS, the myelin becomes damaged. This disrupts the transfer of these nerve signals, causing a wide range of potential symptoms, such as:

  • loss of vision – usually only in one eye
  • spasticity – muscle stiffness that can lead to uncontrolled muscle movements
  • ataxia – difficulties with balance and co-ordination

fatigue – feeling very tired during the day

Types of multiple sclerosis

Relapsing remitting MS. Around eight out of 10 people with MS are diagnosed with the relapsing remitting type of MS. Someone with relapsing remitting MS will have flare-ups of symptoms, known as relapses. These can last from a few days to a few months. These will be followed by periods where symptoms are mild or disappear altogether. This is known as remission and can last for days, weeks or sometimes months.

Secondary progressive MS. Usually after around 15 years, around half of people with relapsing remitting MS will go on to develop secondary progressive MS. Symptoms gradually worsen over time. Some people may still have relapses, but without full recovery from symptoms.

Primary progressive MS. The least common form of MS is primary progressive MS. In this type, symptoms gradually get worse over time and there are no periods of remission.

Treatment

There is currently no cure for MS but there are a number of treatments that can help. Relapsing remitting MS can be treated with disease-modifying drugs. These are designed to reduce the number of relapses someone has. They may also be able to slow the progression of MS. But they are not suitable for all people with MS. Some of these drugs can also be used for treating secondary progressive MS, if someone is still experiencing relapses. At the moment, there is no treatment that can slow the progress of primary progressive MS. There are also a wide range of treatments, including physiotherapy, that can help relieve symptoms and make day-to-day living easier. Steroids can also be used to speed up recovery from relapses.

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  • Overweight and Obesity

Obesity is a term used to describe somebody who is very overweight, with a lot of body fat. It’s a common problem, estimated to affect around one in every four adults and around one in every five children aged 10 to 11 in the UK. Defining obesity: There are many ways in which a person’s health in relation to their weight can be classified, but the most widely used method is body mass index (BMI). BMI is a measure of whether you’re a healthy weight for your height. You can use the BMI healthy weight calculator to work out your score. For most adults:

  • a BMI of 25 to 29.9 means you are considered overweight
  • a BMI of 30 to 39.9 means you are considered obese
  • a BMI of 40 or above means you are considered severely obese

BMI is not used to definitively diagnose obesity – as people who are very muscular sometimes have a high BMI, without excess fat – but for most people, it can be a useful indication of whether they may be overweight. A better measure of excess fat is waist circumference, and can be used as an additional measure in people who are overweight (with a BMI of 25 to 29.9) or moderately obese (with a BMI of 30 to 34.9). Generally, men with a waist circumference of 94cm or more and women with a waist circumference of 80cm or more are more likely to develop obesity-related health problems. Read more about diagnosing obesity.

Risks of obesity. Taking steps to tackle obesity is important because, in addition to causing obvious physical changes, it can lead to a number of serious and potentially life-threatening conditions, such as:

Obesity can also affect your quality of life and lead to psychological problems, such as low self-esteem or depression. Read more about the complications of obesity.

Causes of obesity. Obesity is generally caused by consuming more calories – particularly those in fatty and sugary foods – than you burn off through physical activity. The excess energy is then stored by the body as fat. It is an increasingly common problem, because many modern lifestyles often promote eating excessive amounts of cheap, high-calorie food and spending a lot of time sitting at desks, on sofas or in cars. There are also some underlying health conditions that can occasionally contribute to weight gain, such as an underactive thyroid gland (hypothyroidism), although conditions such as this don’t usually cause weight problems if they are effectively controlled with medication.

Treating obesity

If you are obese, speak to your GP for advice about losing weight safely. Your GP can advise you on the type of diet you should be following and how you can much exercise you should do. They can also let you know about other services, such as:

  • local weight loss groups – these could be provided by the NHS or may be commercial services you have to pay for
  • exercise on prescription – where you are referred to a local active health team for a number of sessions under the supervision of a qualified trainer

If you have underlying problems associated with obesity, such as polycystic ovary syndrome (PCOS)high blood pressurediabetes or obstructive sleep apnoea, your GP may recommend further tests or specific treatment. In some cases, they may refer you to a specialist. Read more about how your GP can help you lose weight.

Diet. While there is no single rule that applies to everybody, most obese people are advised to reduce the energy intake from their diet by 600 calories a day. The best way to achieve this is to swap unhealthy and high-energy food choices – such as fast food, processed food and sugary drinks (including alcohol) – for healthier choices. A healthy diet should consist of:

  • plenty of fruit and vegetables
  • plenty of potatoes, bread, rice, pasta and other starchy foods (ideally you should choose wholegrain varieties)
  • some milk and dairy foods
  • some meat, fish, eggsbeans and other non-dairy sources of protein
  • just small amounts of food and drinks that are high in fat and sugar

Try to avoid foods containing high levels of salt as these can raise your blood pressure, which can be dangerous in people who are already obese. Read some tips for a lower-salt diet. You will also need to check calorie information for each type of food and drink you consume, to make sure you do not go over your daily limit. Some restaurants, cafés and fast food outlets provide calorie information per portion, but providing this information is not compulsory. Be careful when eating out, as some foods can quickly take you over the limit, such as burgers, fried chicken and some curries or Chinese dishes. Read more about calorie counting.

Diet programmes and fad diets. You should avoid fad diets that recommend unsafe practices, such as fasting (going without food for long periods of time) or cutting out entire food groups. These can make you feel ill and are not sustainable, because they don’t teach you long-term healthy eating habits. This is not to say that all commercial diet programmes are unsafe. Many are based on sound medical and scientific principles and can work well for some people. A responsible diet programme should:

  • educate you about issues such as portion size, making changes to behaviour and healthy eating
  • not be overly restrictive in terms of the type of foods you can eat
  • be based on achieving gradual sustainable weight loss rather than short-term rapid weight loss, which is unlikely to last

On average, people attending a lifestyle weight management programme lose around 3% of their body weight, although this varies considerably. Read about the pros and cons of different diets.

very low calorie diet (VLCD) is where you consume less than 1,000 calories a day. These diets can lead to rapid weight loss, but they are not a suitable or safe method for everyone. VLCDs are usually only recommended if you have an obesity-related complication that would benefit from rapid weight loss, such as severe sleep apnoea. VLCDs should usually not be followed for any longer than 12 weeks at a time, and they should only be adopted under the supervision of a suitably qualified healthcare professional. For more information on diet and weight loss read about:

Exercise. Reducing the amount of calories in your diet will help you lose weight, but if you want to keep off the weight, you have to combine a calorie-controlled diet with regular exercise. Your GP or weight loss adviser can provide an exercise plan suited to your circumstances, which will probably involve several hours of moderate-intensity physical activity a week. Moderate-intensity physical activity is any activity that increases your heart and breathing rate, and may make you sweat, but still allows you to hold a normal conversation. Examples include:

  • fast walking
  • jogging
  • swimming
  • tennis
  • using a step-trainer (or similar) at the gym

Choose physical activities that you enjoy, as you are more likely to continue doing them. You should aim to start gradually. For example, start off by doing 15 to 20 minutes of exercise five times a week and then build on it. The Department of Health recommends most adults should do at least 150 minutes of moderate-intensity exercise every week. However, if you are obese and trying to lose weight, or have successfully lost weight and want to keep it off, you probably need to do more exercise. In most cases, up to five hours a week is recommended.

Other useful strategies. Evidence has shown that weight loss can be more successful if it involves other strategies, in addition to diet and lifestyle changes. This could include things like:

  • setting realistic weight loss goals – even losing just 3% of your original body weight can significantly reduce your risk of obesity-related complications
  • eating more slowly and being mindful of what and when you are eating (for example, not being distracted by watching TV)
  • avoiding situations where you know you may be tempted to overeat
  • involving your friends and family with your weight loss efforts, as they can motivate you
  • monitoring your progress – for example, weigh yourself regularly and note your weight in a diary

You may also find psychological support from a trained healthcare professional helps you change the way you think about food and eating, through techniques such as cognitive behavioural therapy (CBT).

Medication. Many different types of anti-obesity medication have been tested in clinical trials, but only one has proved to be both safe and effective: orlistat. Orlistat works by preventing around a third of the fat from the food you eat from being digested. This undigested fat is not absorbed into your body and is passed out with your faeces (stools). This will help you avoid gaining weight, but will not necessarily cause you to lose weight. Therefore, it’s still important to stick to your recommended diet and exercise plan. It is usually only recommended if you have made a significant effort to lose weight through diet, exercise or changing your lifestyle. Even then, orlistat is only prescribed if you have:

  • a body mass index (BMI) of 28 or more and other conditions related to weight, such as high blood pressure
  • a BMI of 30 or more

Treatment with orlistat must be combined with a low-fat diet and other weight loss strategies, such as doing more exercise. If you are prescribed orlistat, you will also be offered advice and support about diet, exercise and making lifestyle changes. Orlistat is not usually recommended for pregnant or breastfeeding women.

Dosage and duration of treatment. One orlistat capsule is taken with each main meal (up to a maximum of three capsules a day). You can take the capsule either before, during or up to one hour after each meal. If you miss a meal or the meal does not contain any fat, you may not need to take the orlistat capsule. Your GP should explain this to you, or you can check the patient information leaflet that comes with your medication. Treatment with orlistat should only continue beyond three months if you have lost 5% of your body weight. It usually starts to affect how you digest fat within one to two days. If orlistat has not worked after three months, it is unlikely to be an effective treatment for you. If you have type 2 diabetes, it may take you longer to lose weight using orlistat, so your target weight loss after three months may therefore be slightly lower. If orlistat is successful after three months, your prescription may be continued for up to a year. After that, your GP will review your condition and decide whether you should continue with orlistat. Common side effects of orlistat include:

These side effects are much less likely to occur if you stick to a low-fat diet.

Women taking the oral contraceptive pill are advised to use an additional method of contraception, such as a condom, if they experience severe diarrhoea while taking orlistat. This is because the contraceptive pill may not be absorbed by your body if you have diarrhoea, so it may not be effective.

Surgery. Weight loss surgery, also called bariatric surgery, is sometimes used to treat people who are severely obese. This type of surgery is usually only available on the NHS to treat people with severe obesity that have not responded to other measures. Severe obesity is defined as:

  • having a body mass index (BMI) of 40 or above
  • having a BMI of 35 or above and having another serious health condition that could be improved if you lose weight, such as type 2 diabetes, obstructive sleep apnoea or high blood pressure

In rare cases, surgery may be recommended as the first treatment if your BMI is 50 or above.

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  • Sjögren’s  Syndrome

Sjögren’s (pronounced Show-grin’s) syndrome is an autoimmune disorder. The body’s immune system attacks glands that secrete fluid, such as the tear and saliva glands. The effects of Sjögren’s syndrome can be widespread. Certain glands become inflamed, which reduces the production of tears and saliva, causing the main symptoms of Sjögren’s syndrome, which are dry eyes and dry mouth. In women (who are most commonly affected), the glands that keep the vagina moist can also be affected, leading to vaginal dryness.

What causes Sjögren’s syndrome?. Sjögren’s syndrome is an autoimmune condition, which means that instead of protecting the body from infection or illness, the immune system reacts abnormally and starts attacking healthy cells and tissue. The immune system attacks the tear and saliva glands, and other secretory glands throughout the body, the reasons for this remains unknown, but research suggests that it’s triggered by a combination of genetic, environmental and, possibly, hormonal factors. Some people are thought to be more vulnerable to the syndrome when they’re born and that certain events, such an infection, can trigger the problems with the immune system. Healthcare professionals classify Sjögren’s syndrome as being either:

  • primary – when the syndrome develops by itself and not as the result of another condition
  • secondary– when the syndrome develops in combination with another autoimmune disorder, such as lupus or rheumatoid arthritis

Diagnosing Sjögren’s syndrome. It can be difficult to diagnose, because it has similar symptoms to other conditions and there is no single test for it. Your doctor will ask about your symptoms and carry out a test to see how dry your mouth and eyes are.

Treating Sjögren’s syndrome

There’s no cure for Sjögren’s syndrome, but treatments help relieve symptoms such as eye and mouth dryness. It affects everyone in different ways, so your treatment plan will be tailored to suit you.

Eye care: Artificial tears. Mild to moderate cases of dry eye can usually be successfully treated with eye drops containing “artificial tears” – a liquid that mimics tears. These eye drops are available from a pharmacist, without a prescription. There are many different types of eye drops, so you can try different brands to find the one that works best for you. If you’re using eye drops regularly (more than three times a day), you should use one that doesn’t contain preservatives. This is because there’s evidence that over-exposure to preservatives can damage the surface of the eye. A short-term dose of eye drops containing corticosteroids may be recommended if your eyes become irritated. However, long-term corticosteroid use isn’t recommended because they can cause serious side effects. To minimise the chance of experiencing side effects from corticosteroids, you’ll be prescribed the lowest effective dose for the shortest possible time.

Moisture chamber spectacles. Wearing glasses reduces tear evaporation by up to 30%, and this effect can be maximised by wearing specially-made glasses called moisture chamber spectacles. These wrap around your eyes like goggles and help retain moisture and protect the eyes from irritants. Some people used to be embarrassed to wear them, but modern designs look like sports glasses.

Punctal plugs. Punctual occlusion is a widely-used technique that seals the tear ducts (into which the tears drain) with small plugs. This should help keep the eye better protected by tears. Temporary plugs made of silicone are usually used first to see if they help. If it does, more permanent plugs can be used.

Mouth care. A number of techniques can be used to keep your mouth lubricated, including:

  • maintaining good oral hygiene to prevent tooth decay and gum disease
  • increasing your fluid intake
  • using sugar-free chewing gum to stimulate saliva production
  • sucking ice cubes to help lubricate your mouth and reduce dryness
  • regularly using mouth rinses to soothe your mouth and protect it against infection

If you smoke, you should try to quit. Smoking irritates the mouth and increases the rate at which saliva evaporates. Read more about how to stop smoking.

Saliva substitutes. There are a number of saliva substitute products that can help lubricate your mouth. However, they don’t replicate the role of saliva in preventing infection, so you’ll still need to maintain excellent oral hygiene. Saliva substitutes are available as a spray, lozenge (medicated sweet), gel, or gum. Your GP or pharmacist can tell you which product is most suitable for you.

Medication for Sjögren’s syndrome.Pilocarpine. It is often used to treat the symptoms of dry eyes and dry mouth. Pilocarpine stimulates the glands to produce more saliva and tears. Side effects of pilocarpine include:

For some people, the side effects of pilocarpine are mild. Others find that the side effects outweigh the benefits. Don’t take pilocarpine if you have asthma or chronic obstructive pulmonary disease (COPD), or if you’re pregnant or breastfeeding.

Hydroxychloroquine has been shown to slow down the immune system’s attack on the tear and saliva glands. It can also help reduce any associated symptoms of muscle pain, joint pain and stiffness.You’ll need to take hydroxychloroquine for several weeks before you notice any improvements, and it could be six months before you experience the full benefit of the treatment. Side effects are uncommon and usually mild. They include:

  • nausea
  • skin rash
  • loss of appetite
  • stomach cramps
  • vomiting

In very rare cases, hydroxychloroquine can damage the retina, affecting vision. You’ll probably be asked to attend an eye examination so that your retina can be checked before you start treatment. Regular eye examinations (usually at least once a year) are also recommended after you begin treatment. It shouldn’t be used by breastfeeding women.

Dry skin. Several soaps and creams are specifically designed for people with dry skin.

Vaginal dryness. The symptoms of vaginal dryness can be treated using a lubricant. Some women also use oestrogen creams or hormone replacement therapy (HRT).

Muscle and joint pains. Muscle and joint pains can be treated with an over-the-counter non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen. If this doesn’t work, see your GP, as stronger NSAIDs are available on prescription. They can increase your risk of developing stomach ulcers and internal bleeding, particularly if they’re taken on a long-term basis. If you find swallowing NSAIDs difficult because of your dry mouth, you can try an NSAID cream that’s rubbed into affected joints. They  aren’t recommended for pregnant or breastfeeding women, or for people with pre-existing risk factors for cardiovascular or kidney conditions.

General advice. These simple tips can help prevent many of the problems associated with Sjögren’s syndrome:

  • have a dental check-up every six months
  • practise good dental hygiene – brushing, flossing and using mouthwash regularly
  • avoid eating too many sweet foods
  • avoid strong and perfumed soaps – use special creams and soaps from your pharmacist
  • avoid dry environments, such as air-conditioned offices, whenever possible
  • avoid drinking too much alcohol

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