Sjögren’s Syndrome is an inflammatory disease in which the white blood cells attack the body’s moisture-producing glands. Primary Sjögren’s occurs by itself; secondary Sjögren’s occurs when another tissue disease is present. (It can develop as a complication of another autoimmune disorder.) Most complications and discomfort result from a decrease in tears and saliva although other problems – from dental cavities to kidney and thyroid gland problems – also occur. The disease typically affects those between 45 and 55 and is much more common in women than in men. Treatment, such as artificial tears to improve dry eyes, and symptom-based medications, addresses specific symptoms. Many patients remain quite healthy with few serious complications.
Sjögren’s Syndrome symptoms vary considerably, but commonly include dry eyes, dry mouth, musculoskeletal pain and dry mouth. Some patients also experience joint pain, swelling and stiffness; skin rashes; swollen salivary glands, persistent dry cough, vaginal dryness and fatigue.
While anyone can get Sjögren’s syndrome, risk factors that increase your chances are:
- Being female
- Being over 40
- A family history of RA
- Having another rheumatic disease such rheumatoid arthritis or lupus
The cause of Sjögren’s syndrome is unknown and there are no known ways to prevent it. However, those who have it can take a number of steps to relieve the symptoms. These include drinking more water, using saline spray for the nose and humidifying the air. Also, talk to your doctor about any medications you are taking (such as antihistamines for allergies) that can cause dryness.
Because the symptoms can be associated with a variety of other conditions, your WellStar rheumatologist will ask you a number of detailed questions and will look for the duration of symptoms for a prolonged period (such as dry mouth that lasts longer than three months) as well as positive lab tests.
Tools and Tests
Your doctor will conduct a number of tests that may include the following:
- Blood tests for blood glucose levels, evidence of inflammatory conditions, indicators of possible kidney and liver problems, the presence of certain antibodies associated with Sjögren’s syndrome and other autoimmune disorders
- A spit test to measure the severity of dry mouth
- Salivary gland tests including a salivary gland biopsy. This is done by removing a small bit of tissue from the inner lip and testing it
- Eye tests to assess the amount of tears being produced and to see if any area of the eye has been damaged by dryness. These tests may be performed by your rheumatologist or, if recommended, by an ophthalmologist (eye specialist). The Schirmer test involves inserting a small piece of sterile paper between the eye and the eyelid to assess wetness. The Rose Bengal test can detect scratches that may have occurred on the surface of the eye due to dryness
- Imaging possibly to include a chest x-ray to test for lung inflammation
- Urine sample to determine any impact on the kidneys
Treatment primarily address (1) dry eyes and mouth, (2) problems like eyelid irritation, acid reflux and oral yeast infections and (3) fatigue, concentration problems and impaired memory. In some cases your doctor may prescribe drugs designed to treat malaria such as hydrochloroquine and those that suppress the immune system like methotrexate.
- Artificial tears; the type will depend on your fluid production and pattern of dryness
- Night ointment for eye moisture
- Means to preserve natural tears, such as adding shields to the sides of glasses to prevent tears from evaporating in the air and wind
- Punctual occlusion, a simple procedure that keeps tears from draining into the nose
- Sucking sugar-free candy helps the flow of saliva; medicates may be recommended to increase saliva production
- Sipping water helps many people with dry mouth. For others an artificial saline spray or lozenge may be prescribes
- Special toothpastes for people with dry mouth
- Lubricants to help with dryness of the lips, skin and vagina
Other Medical Problems
Your doctor will discuss treatments depending on the results of examination and testing. Among these:
- Antifungal medications for yeast infections in the mouth
- Over-the-counter saline nasal sprays to treat dry nose due to blocked nasal passages
- Washing the eyelids to relieve eyelid inflammation (blepharitis)
- Various medications to treat reflux (heartburn), which is more common in patients with Sjögren’s
- Nonsteroidal anti-inflammatory drugs (NSAIDs) or in some cases low- dose steroids for joint pain
Fatigue, which is common with Sjögren’s, may be related to the disease. It may be a result of sleeplessness in patients who drink a lot of water for dry mouth, and as a result wake frequently through the night to urinate.
Treatment options include:
- Use a humidifier in the bedroom.
- Use good sleep habits including avoiding caffeine, avoiding daytime napping and having a quiet, comfortable bedroom.
Many effects of Sjögren’s syndrome respond well to self-care measures such as regular use of artificial tears or eye lubricants, increasing the humidity and reducing exposure to blowing air, drinking plenty of water, and avoiding overly hot showers if dry skin is a problem. As with any rheumatologic condition, living a healthy lifestyle (maintaining an appropriate weight and eating a diet rich in fruits and vegetables) is advised. If you are scheduled for surgery, make sure to inform your anesthesiologist that you have Sjögren’s syndrome, as it can increase the risks from anesthesia.