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

What is Sjogren’s Syndrome? 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.

What is Sjogren’s Syndrome? … contd… 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

When and Why did I start checking for Lp(a) 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

Why this association is to be given importance? 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) (1gm Niacin, 1000mg 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)