Sjogren’s Syndrome

What is Sjogren's syndrome?

Sjogren’s syndrome is an autoimmune disorder concentrated in the lacrimal and salivary glands. Lacrimal glands help create tears, and salivary glands help create saliva. These glands keep the eyes and mouth moist. Sjogren’s syndrome prevents the body from producing adequate moisture, usually resulting in dry mouth and eyes.

If someone only has Sjogren’s syndrome, without any accompanying autoimmune diseases, then that person has primary Sjogren’s syndrome. Secondary Sjogren’s syndrome means that someone has Sjogren’s syndrome in addition to other autoimmune diseases. Sjogren’s syndrome can present with other autoimmune diseases, like lupus and rheumatoid arthritis.

What causes Sjogren's syndrome?

The immune system exists to ward off infection. An autoimmune disorder occurs when the immune system begins to attack the body as though it were a foreign infectant. Sjogren’s syndrome is an autoimmune disease that targets the lacrimal and salivary glands. There is no specific cause of Sjogren’s syndrome. Certain genes can increase someone’s chance of developing Sjogren’s syndrome. However, those genes also need an infection to trigger the actual development of Sjogren’s syndrome. That trigger usually comes in the form of an infection from a specific bacteria strain or virus.

What are symptoms of Sjogren's syndrome?

The most identifiable and prevalent symptoms of Sjogren’s syndrome are dry mouth and dry eyes.

• Dry mouth. Some people describe this symptom as a cotton-like feeling in the mouth. It might also be difficult to speak or swallow.
• Dry eyes. The eyes might itch, burn, or feel gritty, as though there are particles of dirt or sand in them.

Although dry mouth and dry eyes are the main symptoms of Sjogren’s syndrome, this autoimmune disease can actually impact the entire body. Other symptoms of Sjogren’s syndrome include:

• Swollen salivary glands (specifically behind the jaw and in front of the ears)
• Vaginal dryness
• Rashes
• Fatigue
• Joint pain, stiffness, and swelling
• Dry skin
• Chronic dry cough

Sjogren’s syndrome can also affect other parts of the body, causing pain or inflammation in the:

• Lungs
• Kidneys
• Nerves
• Joints
• Liver
• Skin
• Thyroid
• Lymph nodes

Are there complications associated with Sjogren's syndrome?

As a result of certain Sjogren’s syndrome symptoms, people with the condition are at risk of also developing:

• Vision problems. Dryness in the eyes can cause blurred vision, light sensitivity, and corneal damage.
• Yeast infections. Sjogren’s syndrome increases the risk of oral thrush, which is a yeast infection that occurs in the mouth.
• Dental cavities. Saliva is essential in protecting teeth from cavity-causing bacteria. Dry mouth from Sjogren’s syndrome can increase cavities.
• Lymphoma. Sjogren’s syndrome can increase risk of developing cancer of the lymph nodes.

Are there any risk factors or groups for Sjogren's syndrome?

Because the exact cause of Sjogren’s syndrome is unknown, there are limited known risk factors for the autoimmune disease.

• Sex. Women account for 9 out of 10 every ten people who have Sjogren’s syndrome, so women have a much higher risk of developing the condition.
• Age. People over the age of 40 are more likely to develop Sjogren’s syndrome.
• Rheumatic disease. Autoimmune diseases like lupus and rheumatoid arthritis are associated with Sjogren’s syndrome.

How is Sjogren's syndrome diagnosed?

The symptoms of Sjogren’s syndrome can overlap with other potential diagnoses. A doctor will likely run several different diagnostic tests to parse through which disease best fits the symptoms.

After a review of the patient’s medical history and a physical exam, a doctor will usually conduct blood tests to see if the patient has antibodies specific to Sjogren’s syndrome.

Additionally, a lip biopsy and eye exam test for salivary gland production and eye moisture. A sialogram, or x-ray imaging of the salivary glands, is another step of the Sjogren’s syndrome diagnostic process.

Some supplements and medications have side effects that are similar to symptoms of Sjogren’s syndrome. A doctor might review medications when trying to form a diagnosis.

How is Sjogren's syndrome treated?

Sjogren’s syndrome has no cure, but treatment helps to alleviate its symptoms.

Some medications that might accompany treatment for Sjogren’s syndrome include:

• Hydroxychloroquine, which treats general symptoms associated with Sjogren’s syndrome.
• Nonsteroidal anti-inflammatory drugs (NSAIDS), which alleviate arthritis symptoms.
• Antifungal medications, which treat yeast infections.
• Lifitegrast and cyclosporine, which help reduce eye inflammation in dry eyes.
• Cevimeline and pilocarpine, which increase the production of saliva and, sometimes, tears.

Sjogren’s syndrome is typically associated with one surgical procedure. Punctal occlusion, a minor surgery, can seal the tear ducts. This procedure can provide relief for dry eyes. A surgeon will put collagen or silicone plugs into the ducts for tear preservation.

What are lifestyle changes that could help with Sjogren's syndrome?

Sjogren’s syndrome often results in dry eyes and dry mouth. Some lifestyle changes can address dryness in these areas.

Lifestyle changes to help with dry eyes:

• Focus on humidity. Use a humidifier at home and try to avoid sitting in front of fans or air conditioning. Some people with Sjogren’s syndrome like to wear protective eyewear outdoors to avoid further eye dryness.
• Use eye lubricant or artificial tears. Eye lubricants are great for overnight use. A doctor might recommend artificial tears as a way to combat everyday dry eyes.

Lifestyle changes to help with dry mouth:

• Facilitate saliva flow. Chew on gum or suck on hard candies to stimulate saliva production. Opt for the low-sugar or sugarless options, as Sjorgren’s syndrome increases risk of cavities.
• Focus on fluids. Drink water often during the day. Removing alcohol and coffee helps with dry mouth. Sodas and other sports drinks are acidic, which can eat away at the delicate enamel of the teeth.
• Experiment with artificial saliva. Water helps lubricate the mouth, but artificial saliva tends to work more effectively. Artificial saliva comes as a lozenge or spray.
• Do not smoke. Smoking dries out the mouth even further and can cause irritation.
• Try out nasal saline spray. Relieve and moisturize nasal passages with a nasal saline spray.

Lifestyle changes to boost oral health:

• Brush teeth and floss after meals. A regular oral care practice can prevent cavities.
• Keep up with dentist appointments. Aim for one appointment every six months.
• Rinse with antimicrobial mouthwashes and use topical fluoride treatments. Adding antimicrobial mouthwashes and topical fluoride treatments to an oral care routine can support oral health.

Sjogren’s syndrome can dry out other parts of the body beyond the eyes and mouth. If dry skin is an issue, use a moisturizer after showers and wear gloves to protect sensitive skin while cleaning. Vaginal dryness is a common issue for people with Sjogren’s syndrome. Vaginal lubricants and moisturizers relieve vaginal dryness.

Should you see a doctor for Sjogren's syndrome?

Depending on how symptoms present, someone with Sjogren’s syndrome might see a variety of doctors before receiving a diagnosis. Dry eyes can send someone to the optometrist, while dry mouth might prompt a visit to the dentist. As the disease progresses, a patient with Sjogren’s syndrome might seek out a doctor who specializes in arthritis or inflammation treatment.

Seek the help of medical professionals as soon as irregular symptoms present. Even though there is no cure for Sjogren’s syndrome, the oversight of a dedicated care team can make treatment more successful. The medication and surgery used to treat Sjogren’s syndrome requires a doctor’s approval.

Secondary Sjogren’s syndrome can be associated with serious health complications. The sooner a patient with this autoimmune disease receives treatment, the sooner a care team can address another potentially life-threatening condition.

What is the outlook for people living with Sjogren's syndrome?

With the proper treatment plan, people with Sjogren’s syndrome can usually manage symptoms of the condition. Sjogren’s syndrome does not necessarily impact life expectancy.

Cases of primary Sjogren’s syndrome are manageable. On the other hand, a secondary Sjogren’s syndrome diagnosis can complicate a patient’s outlook. Patients with secondary Sjogren’s syndrome might experience further health problems because they have more than one autoimmune disease.