Sjögren's Syndrome

Overview

Sjögren's syndrome is a long-term autoimmune condition in which the immune system mistakenly attacks the body's moisture-producing glands, especially the tear glands and salivary glands. The result is dryness, most noticeably dry eyes and a dry mouth. It can occur on its own (primary Sjögren's) or alongside another autoimmune disease such as rheumatoid arthritis or lupus (secondary Sjögren's).

While dryness is the hallmark, Sjögren's can also cause fatigue, joint pain, and, less commonly, effects on other organs. It is more common in women and often develops in middle age, though it can occur at any age. There is no cure, but treatments can relieve symptoms, protect the eyes and mouth, and address any organ involvement, helping most people maintain a good quality of life.

Saliva and tears do more than provide comfort: they protect the surface of the eyes, keep the mouth healthy, help with swallowing and speech, and guard against tooth decay and eye surface damage. When the glands that make them are damaged by the immune system, the loss of these fluids explains much of what people with Sjögren's experience. Because the symptoms are common and can develop slowly, Sjögren's is sometimes overlooked for years, and people may see several specialists, for dry eyes, dry mouth, or joint pain, before the pieces are connected into a single diagnosis.

Symptoms

The two main symptoms are dry eyes and a dry mouth, but the condition can affect the whole body. Symptoms may include:

• Dry, gritty, or burning eyes, sometimes with sensitivity to light
• A dry mouth, difficulty swallowing dry food, and increased dental decay
• Fatigue, which can be significant
• Joint pain and stiffness
• Dry skin, dry nose, or vaginal dryness
• Swelling of the salivary glands near the jaw and cheeks

Less commonly, Sjögren's can affect the lungs, kidneys, nerves, and other organs. People with Sjögren's also have a small increased risk of a lymphoma, so persistent gland swelling should be assessed.

Causes

Sjögren's syndrome is an autoimmune disorder, meaning the immune system attacks the body's own tissues, in this case the moisture-producing glands. The exact trigger is not fully understood, but it is thought to involve a combination of factors:

• Genetic predisposition: Certain genes may make a person more susceptible.
• Environmental triggers: Such as a viral infection that may set off the immune response in susceptible people.
• Hormonal factors: The condition is much more common in women, suggesting hormones play a role.

It is not contagious and is not caused by anything a person did.

Risk Factors

• Being female
• Middle age, though it can occur at any age
• Having another autoimmune disease such as rheumatoid arthritis or lupus
• A family history of autoimmune conditions

Diagnosis

Diagnosing Sjögren's can take time because its symptoms overlap with other conditions. A doctor may use a combination of:

• Symptom history and examination: Focusing on dryness, fatigue, and joint symptoms.
• Eye tests: Measuring tear production and the eye surface.
• Blood tests: Looking for specific antibodies and signs of inflammation.
• Salivary gland tests: Including measuring saliva flow or a small lip gland biopsy in some cases.

No single test confirms Sjögren's on its own, so doctors look at the overall picture: the pattern of dryness, the results of eye and salivary gland tests, blood antibodies, and, when needed, a small biopsy of minor salivary glands from the inner lip. Because the symptoms overlap with many other conditions, and because dryness is common with aging and many medications, the diagnosis can take time and may require input from several specialists. A rheumatologist often coordinates the assessment, working alongside an eye specialist and a dentist to evaluate and protect the eyes and mouth.

Treatment

There is no cure, so treatment focuses on relieving dryness, protecting the eyes and mouth, and managing any wider effects.

• For dry eyes: Artificial tears, lubricating gels, and sometimes prescription drops or measures to conserve tears.
• For dry mouth: Frequent sips of water, sugar-free gum or lozenges to stimulate saliva, saliva substitutes, and diligent dental care.
• Medications that stimulate saliva and tears: May be prescribed for more troublesome dryness.
• Managing systemic disease: Joint symptoms and organ involvement may be treated with anti-inflammatory or immune-modulating medicines.

Regular dental and eye check-ups are important to prevent complications such as tooth decay and eye surface damage.

Self-Care & Living With It

• Use artificial tears regularly and protect the eyes from wind and dry air
• Sip water often, avoid drying habits like smoking, and limit caffeine and alcohol
• Keep up excellent dental hygiene and see your dentist regularly
• Use a humidifier and moisturizers for dry skin and air
• Pace activities and rest to manage fatigue
• Report new lumps, persistent gland swelling, or new symptoms to your doctor

When to See a Doctor

See a doctor if you have persistent dry eyes and a dry mouth, especially with fatigue or joint pain, so the cause can be identified and managed. Also seek medical advice if you have:

• Persistent or one-sided swelling of the salivary glands
• New, unexplained lumps
• Symptoms suggesting other organ involvement, such as a persistent cough, numbness, or breathlessness

Because Sjögren's carries a small increased risk of lymphoma, ongoing gland swelling should always be evaluated. Regular follow-up helps catch and treat complications early.

Related Topics

Frequently Asked Questions

References

1. National Institute of Dental and Craniofacial Research (NIDCR). Sjögren's Syndrome.
2. American College of Rheumatology. Sjögren's Syndrome.
3. Mayo Clinic. Sjogren's syndrome.
4. MedlinePlus, U.S. National Library of Medicine. Sjögren syndrome.