What Causes Dry Eyes And Mouth, Joint Pain, Fatigue And Swallowing Difficulty?

Posted on Wed, 25 Nov 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Wed, 25 Nov 2015 Answered on

Mon, 21 Dec 2015 Last reviewed on

Question : I have developed dry eyes and mouth, joint pain, fatigue and difficulty swallowing. My doctor has ruled out Sjogren's and SLE but I have no answers. This has been getting worse over the past month and impacting on my life. The dry eyes and mouth are waking me up at night I am using artificial tears a few times a day and before bed. I am well hydrated, so that is not the problem

Answered by Dr. Dr. Shruti Rijhwani (2 hours later)

Brief Answer:
It can be due to aging also.

Detailed Answer:
Dear Madam,

Thank you for posting your query on HCM.

Well looking into your problem I would like to tell you that , since your doctors have already ruled out SLE , Sjogrens and you are not diabetic even not much options are left else attribute it to aging considering your age . But still i would like to see your autoimmune profile before coming to any conclusion. You Blood pressure medication is unlikely to cause this . So please upload your tests and I will get back to you .

Take care.

Dr. Shruti

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Shruti Rijhwani (9 hours later)

Here are some recent labs. The onset of this is recent, but I have been old for a while. Something has changed dramatically. The joint pain has also worsened during this period. The dry mouth and eyes developed concurrently and I cannot sleep though the night. Have also had some severe headaches. The pulsatile tinnitus comes and goes. Appreciate your thoughts.
Color - UA     Yellow
The specimen collection time is unknown to [More information]           YELLOW
10/27/2015
Clarity - UA     Clear          CLEAR
10/27/2015
Glucose - UA     Negative          NEG
10/27/2015
Bilirubin - UA     Negative          NEG
10/27/2015
Ketones - UA     Negative          NEG
10/27/2015
Specific Gravity, ur     1.012          1.001-1.035
10/27/2015
Blood - UA     Negative          NEG
10/27/2015
pH - UA     6.0          5.0-9.0
10/27/2015
Protein - UA     Negative          NEG
10/27/2015
Urobilinogen - UA     Negative          NEG
10/27/2015
Nitrites - UA     Negative          NEG
10/27/2015
Leukocyte esterase, ur     1+          NEG
10/27/2015
RBC - UA     None
The specimen collection time is unknown to the [More information]      /hpf     0-2
10/27/2015
WBC - UA     0-2     /hpf     0-2
10/27/2015
Bacteria     1+
10/27/2015
Squamous Cells     Present
10/27/2015
Renal tubular cells     1+
10/27/2015     Mucus     Present
10/20/2015
dsDNA Ab     NEG
10/16/2015
SS-A(Ro) Ab     <0.2     U     <1.0 Negative
10/16/2015
SS-B(La) Ab     <0.2     U     <1.0 Negative
10/16/2015
Sm Ab     <0.2     U     <1.0 Negative
10/16/2015     RNP Ab     <0.2     U     <1.0 Negative
10/15/2015
ESR     3     MM/HR     0-30
10/15/2015
CRP (mg/dL)     <0.5     MG/DL     <1.0
10/02/2015
RHF     <30     IU/ml     <30
10/02/2015
ANA (qual)
POSITIVE AT 1:40 AND 1:160 (ENDPOINT) *** Normal [More information]
10/02/2015     ANA (Pattern)     SPECKLED
A positive test for antinuclear antibody [More information]
10/02/2015
Lyme Ab(s)     Negative
10/01/2015
TSH     1.84     uIU/mL     0.40-5.00
10/01/2015
WBC     9.13     K/uL     4.5-11.0
10/01/2015
HCT     42.9     %     36.0-46.0
10/01/2015
HGB     13.8     g/dL     12.0-16.0
10/01/2015
RBC     4.68     M/uL     4.00-5.20
10/01/2015
PLT     350     K/uL     150-400
10/01/2015
MCV     91.7     fL     80.0-100.0
10/01/2015
MCH     29.5     pg     26.0-34.0
10/01/2015
MCHC     32.2     g/dL     31.0-37.0
10/01/2015
RDW     14.9     %     11.5-14.5
10/01/2015
MPV 10.8

Answered by Dr. Dr. Shruti Rijhwani (17 hours later)

Brief Answer:
Follows.

Detailed Answer:
Dear Madam,

Thanks for reverting back .

I note that your ANA is positive in 1:160 titre but since further testing is normal ssa and ssb antibodies , they have ruled out lupus , There is not much abnormality in other tests to point out something . I think its better to be conservative at this point of time and treat symptoms only that you are doing by using artificial tears . Also there is artificial saliva available which you can use to relieve the symptoms .

Dr. Shruti

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Shruti Rijhwani (4 days later)

I am using Biotin and artificial tears. It is not keeping the symptoms under control. I cannot get a decent sleep as I wake up from dryness. I use CPAP and the face mask is humidified, so that is not the problem. I am also having some difficulty swallowing liquids.

What is the significance of the speckled ANA pattern?

Answered by Dr. Dr. Shruti Rijhwani (3 hours later)

Brief Answer:
Follows.

Detailed Answer:
Dear Madam,

Well , I think you should try to wear glasses and avoid airy areas like just sitting below fans as they lead to evaporation of tears .

Speckled pattern of ANA can be seen in many disorders and is not specific for SLE . It can be seen in SLE , Sjogrens , Scleroderma etc .So without other symptoms present I dont think much importance can be given to them.

Dr. Shruti

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Shruti Rijhwani (7 hours later)

Just got back from the eye doctor, dry eyes worsening. She has prescribed new drops. My lips feel so dry it is getting painful and I am getting hoarse. Still have some problems swallowing. Something is wrong. You mention Scleroderma. How does that manifest itself?

Thanks.

Answered by Dr. Dr. Shruti Rijhwani (15 hours later)

Brief Answer:
Follows.

Detailed Answer:
Dear Madam,

Scleroderma wont manifest at your age , it is generally seen in young patients . Plus it has peculiar skin appearance like pinched nose , fish like mouth. So its highly unlikely that you are having it .

Dr. Shruti

Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar