Sjogren's Syndrome: Symptoms, Causes, & Treatments
If your mouth is very dry, your skin is dry, and you have low energy and trouble sleeping at night, you may have Sjorgen’s syndrome. This chronic condition can be frightening, and is sometimes tricky to diagnose.
The disease is named after Henrik Sjögren, a Swedish eye doctor who first described the disease in the early 1900’s. Sjogren detected the illness in a group of women experiencing dry eye and dry mouth, along with chronic arthritis.
Up to 4 million Americans live with Sjogren's syndrome. It can affect anyone of any age, race, or gender, though it’s more common in older women. The severity of the disorder can range from merely uncomfortable to debilitating.
Read on to learn more about what causes Sjogren's syndrome and how to manage symptoms.
What is Sjogren's syndrome?
Sjogren's syndrome is a chronic autoimmune disease where the immune system mistakenly attacks the glands that produce moisture, such as tears and saliva. This can lead to uncomfortable symptoms of dry eyes and dry mouth, as well as a host of issues affecting different parts of the body.
About half of people with Sjogren's disease have another autoimmune disease, such as lupus or rheumatoid arthritis.
Sjogren's syndrome symptoms checklist
Since Sjogren's syndrome affects the glands that produce saliva and tears. The primary symptoms are dry eyes and dry mouth.
You may have dry eyes if you experience any of the following symptoms:
- Red eyes
- Burning or stinging eyes
- Gritty feeling in the eyes
- Blurred vision
- Sensitivity to light
Dry mouth may manifest in the following ways:
- A dryness or stickiness in your mouth
- Thick or stringy saliva
- Difficulty chewing, swallowing, or talking
- Bad breath
- Hoarseness or sore throat
- Changed sense of taste
In addition to dry eyes and dry mouth, other Sjogren's syndrome symptoms can include fatigue, swollen salivary glands, cough, and vaginal dryness.
Sjogren's syndrome complications can affect other areas of the body, including:
- Joints: Sjogren's syndrome can lead to joint swelling, stiffness, and pain. This pain may emanate all over the body, similar to fibromyalgia.
- Lungs: Inflammation associated with Sjogren's disease can lead to pneumonia, bronchitis, and other issues with the lungs. If you smoke, quitting may help reduce the risk of these complications.
- Liver: People with Sjogren's disease may experience abnormal liver function and have a higher risk of hepatitis or cirrhosis of the liver.
- Kidneys: While rare, research suggests that people with Sjogren's syndrome are at an increased risk of chronic kidney disease.
- Skin: People with Sjogren's disease may experience skin rashes or xerosis, a dryness of the skin.
- Nerves: It’s possible that people with Sjogren's syndrome may experience peripheral neuropathy — a numbness or tingling sensation in the hands and feet.
Common causes of Sjogren's syndrome
Doctors do not know exactly what causes the autoimmune response that leads to Sjogren's syndrome. A number of factors may play a role, including genetics, environmental factors, sex hormones, and viral illnesses.
There are two types of Sjogren's syndrome: primary Sjogren's syndrome and secondary Sjogren's syndrome. Primary Sjogren's syndrome progresses on its own. Secondary Sjogren's syndrome develops alongside another autoimmune disorder such as RA or lupus.
Risk factors associated with Sjogren's disease include:
- Age: While anyone can get Sjogren's syndrome, most people are over 40 at the time they are diagnosed.
- Sex: Women are 9 times more likely to have Sjogren's syndrome than men.
- Another autoimmune disease: About half of all cases of Sjogren's syndrome occur alongside another autoimmune disease, such as lupus or rheumatoid arthritis.
Getting diagnosed with Sjogren's syndrome
If you’re experiencing symptoms of Sjogren's syndrome that won’t go away or that are affecting your day-to-day life, it may be time to see your doctor. These symptoms may include dry eyes or dry mouth. There’s no single Sjogren's syndrome test to diagnose the disorder.
Your doctor will take a full medical history and ask questions about your symptoms, including how long you’ve had them and whether you have difficulty swallowing or seeing clearly. Additionally, a number of tests can confirm a Sjogren's syndrome diagnosis.
Different doctors will take different paths to diagnose and treat the symptoms of Sjogren's disease. Here’s are the types of doctors you’ll need to meet with and what to expect in your visit:
What to expect in your opthamologist visit
An opthamologist (eye doctor) may run a number of tests to confirm a Sjogren's syndrome diagnosis. One such test is the Schirmer’s test, which measures the amount of tears in the eyes. Your doctor will place a small strip of paper under your lower eyelid to see how many tears are produced in five minutes.
Another test to diagnose Sjogren's syndrome is a dye test. For this test, an opthamologist will look under a microscope to see how quickly your tears dry. Finally, your eye doctor may examine your meibomian glands, or tiny glands in your eyelids which are responsible for making oil for your tears. This oil keeps tears from drying out too quickly. Blocked or swollen meibomian glands can interfere with this oil production and lead to dry eyes.
What to expect in your rheumatologist visit
A rheumatologist is a doctor with specialized training in treating autoimmune and inflammatory diseases. If you see a rheumatologist, part of your Sjogren's syndrome diagnosis may include blood tests to check for the presence of Sjogren's antibodies. These are typical markers of the disease.
These markers include anti-nuclear antibodies (ANA), anti-Sjogren's syndrome antibodies (anti-SSA), and anti-Sjogren's syndrome type B (anti-SSB). A doctor can also test for an antibody called rheumatoid factor, a marker of rheumatoid arthritis.
What to expect in your dentist visit
A dentist can run a few dental tests to determine a Sjogren's syndrome diagnosis. One is a salivary flow test, which measures how much saliva is produced over a period of time. Another test a dentist may run is a salivary gland biopsy. This involves removing tissue or cells from a salivary gland on the inside of the lip. The sample will then be checked for signs of inflammation.
Treating Sjogren's syndrome
Since Sjogren's syndrome affects people differently, each person’s treatment plan will be highly personalized. A mixture of over-the-counter treatments, prescription medication, and lifestyle changes may be recommended. An individual’s symptoms, as well as the parts of the body that are affected, will determine how Sjogren's disease is treated.
Sjogren's syndrome treatment options may include:
- Artificial tears: Over-the-counter eye drops like artificial tears or an eye lubricant can help alleviate dry eyes.
- Prescription eye drops: If over-the-counter artificial tears aren’t cutting it, a doctor can prescribe prescription-strength eye drops like cyclosporine (Restasis) or lifitegrast (Xiidra).
- Saliva producers: Chewing gum or sucking on hard candies can stimulate saliva production and help with dry mouth. Over-the-counter and prescription-strength saliva substitutes are also available and include sorbitol oromucosal solutions and sorbitol oral lozenges. Prescription medications like pilocarpine and cevimeline work to increase the natural production of saliva.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen, aspirin, and naproxen, are often used as a first-line treatment to reduce the inflammation that can come with Sjogren's syndrome. Prescription-strength NSAIDs are also available.
- Corticosteroids: Prescription steroids like prednisone act fast to reduce inflammation in affected areas of the body like joints, skin, and organs.
- Disease Modifying Antirheumatic Drugs (DMARDs): DMARDs are medications that alter the way the immune system functions, and correct abnormal immune responses. The most commonly prescribed DMARD for Sjogren's syndrome is hydroxychloroquine.
- Biologics: These are immunosuppressant drugs that slow or stop inflammation. Treating Sjogren's syndrome with biologics is currently under investigation. Early results have shown promise but more research is needed to validate the effectiveness of this therapy.
- Antifungal medications: These medications treat overgrowth of yeast in the mouth or vagina.
Certain lifestyle changes may also help alleviate Sjogren’s syndrome symptoms. These include quitting smoking, increasing the humidity in your home, staying well hydrated by drinking plenty of fluids and avoiding alcohol and caffeine, and maintaining good oral hygiene.
Symptoms of Sjogren's syndrome range in severity from uncomfortable to debilitating. A number of treatment therapies exist. Your healthcare team, which may include an opthamologist, rheumatologist, and dentist, will help determine what treatments are appropriate for you.
Talk to your doctor about using Dry Eye Drops to relieve symptoms of dry eyes like itchiness, soreness, redness, and irritation. For more details on the right treatment options for you, consider taking the Dry Eye At-Home Diagnostic Quiz.