Sjogren syndrome

Overview

Sjogren syndrome (pronounced SHOW-gren) is a long-term autoimmune condition where the body's immune system mistakenly attacks its own moisture-producing glands, such as the tear glands and salivary glands. This leads to extreme dryness of the eyes and mouth, and can also affect other parts of the body like the joints and skin.

Sjogren syndrome is fairly common. It affects about 1 in 100 people worldwide, though many cases are undiagnosed because symptoms can be mild or mistaken for other conditions.

It affects women much more often than men (about 9 out of 10 cases are in women). It can occur at any age, but most people are diagnosed after age 40. It affects people of all ethnic backgrounds.

Symptoms

Common symptoms

• Eyes that feel dry, gritty, or burning, as if there is sand in them
• Dry mouth that feels sticky or like cotton, making it hard to swallow or speak
• Difficulty tasting or swallowing food
• Dry cough that won't go away
• Swollen salivary glands (the glands that make spit)
• Joint pain, stiffness, or swelling
• Extreme tiredness (fatigue)
• Dry skin or skin rashes
• Vaginal dryness in women

Symptoms in children

• In children, symptoms can be more subtle and may include chronic tiredness, recurrent swelling of the glands in the face or neck, and dry eyes or mouth.
• Children may also have trouble with dental cavities because of dry mouth, or complain of joint aches.

Symptoms in older adults

• Older adults may experience more intense dryness and are at higher risk for complications like eye infections or severe dental problems.
• Fatigue and joint pain can be more pronounced and may be mistaken for other age-related conditions.

Causes

Main causes

• The exact cause is not known, but it is thought to involve a combination of genetic factors (certain genes make you more likely to develop it) and a trigger (like a viral or bacterial infection) that activates the immune system.
• In Sjogren syndrome, the immune system attacks the glands that produce tears and saliva, causing inflammation and damage.

Risk factors

• Being a woman (especially between ages 40 and 60)
• Having a family member with Sjogren syndrome or another autoimmune disease
• Already having another autoimmune condition like rheumatoid arthritis, lupus, or scleroderma
• Certain infections (like Epstein-Barr virus or hepatitis C) may increase the risk.

When to see a doctor

See a doctor urgently if:

• If you have sudden changes in vision, severe eye pain, or a painful, swollen gland in your face or neck.
• If you have trouble swallowing or a high fever.

Book a routine appointment if:

• If you have dry eyes or dry mouth that lasts for more than a few weeks and affects your daily life.
• If you have joint pain, fatigue, or swollen salivary glands that you cannot explain.
• If you get frequent cavities or eye infections.

Diagnosis

Diagnosis is based on your symptoms, a physical exam, and a combination of tests. Because symptoms can overlap with other conditions, it often takes time to get a clear diagnosis. A rheumatologist (joint and autoimmune specialist) usually makes the final diagnosis.

Tests that may be done

• Blood tests: to check for certain antibodies (like anti-SSA and anti-SSB) that are common in Sjogren syndrome.
• Eye tests: such as the Schirmer test (placing a small strip of paper under the eyelid to measure tear production) and a slit-lamp exam (looking at your eyes under magnification).
• Saliva flow test: measures how much saliva you produce in a given time.
• Lip biopsy: taking a tiny sample of tissue from your inner lip to look for clusters of immune cells.
• Imaging tests: like an ultrasound or sialogram (X-ray with dye) of your salivary glands.

What to expect at your appointment

Your doctor will ask about your medical history, do a physical exam, and likely order blood tests and eye tests. You may be referred to a specialist (rheumatologist, eye doctor, or dentist). The tests are usually not painful, though a lip biopsy may cause mild discomfort. Results may take a few days to weeks.

Treatment

There is no cure for Sjogren syndrome, but treatments can help relieve symptoms and prevent complications. Most treatments focus on managing dryness, reducing inflammation, and supporting overall health. Your doctor will work with you to create a plan that fits your needs.

Self-care at home

• Use artificial tears (preservative-free) and lubricating eye ointments to keep your eyes moist.
• Sip water often or chew sugar-free gum to keep your mouth wet. Avoid sugary drinks and snacks.
• Use a humidifier in your bedroom, especially in dry climates or during winter.
• Practice good oral hygiene: brush and floss daily, use fluoride toothpaste, and see your dentist every 6 months.
• Avoid smoking and limit alcohol and caffeine, as they can worsen dryness.
• Wear protective sunglasses or moisture chamber glasses to shield your eyes from wind and dry air.

Medical treatments

Doctors may prescribe medications that help increase saliva and tear production, or reduce inflammation. These include drugs that stimulate moisture production, non-steroidal anti-inflammatory drugs (NSAIDs) for joint pain, and in more severe cases, medicines that suppress the immune system. Eye drops that reduce inflammation may also be used. A dentist can prescribe high-fluoride toothpaste or mouth rinses to prevent cavities. Do not start or stop any medication without talking to your doctor.

When is surgery considered?

Surgery is rarely needed for Sjogren syndrome. In very severe cases, tiny plugs (punctal plugs) may be placed in the tear ducts to keep tears on the eye longer. This is a minor office procedure. Joint surgery is not usually needed.

Living with this condition

Living with Sjogren syndrome means being mindful of dryness and fatigue. Keep water with you at all times, use eye drops regularly, and plan rest breaks to manage tiredness. Many people also find it helpful to avoid very dry environments and to use mild, fragrance-free soaps and lotions.

Lifestyle tips

• Stay well hydrated throughout the day.
• Take breaks when reading or using screens to reduce eye strain.
• Use preservative-free lubricating eye drops as often as needed.
• If joint pain bothers you, try gentle exercises like walking or swimming.
• Talk to your doctor about stress management techniques, as stress can make symptoms worse.

Diet and exercise

A balanced diet rich in fruits, vegetables, lean proteins, and healthy fats supports overall health. Some people find that eating soft, moist foods is easier. Avoid very dry, salty, or sugary foods that can irritate your mouth. Regular mild exercise, such as walking or yoga, can help with fatigue and joint stiffness.

Mental health and emotional wellbeing

Living with a chronic condition can be frustrating and stressful. Dryness and fatigue can affect your mood, social life, and work. It is common to feel anxious or down. If you are struggling, talk to your doctor or a counselor. You don't have to manage this alone.

Prevention

There is no known way to prevent Sjogren syndrome because the exact cause is not clear. However, early diagnosis and treatment can help prevent complications and improve quality of life. If you have risk factors, talk to your doctor about monitoring symptoms.

Complications

If left untreated

• Dental cavities and tooth loss from chronic dry mouth
• Eye infections, corneal ulcers, or vision loss from severe dry eyes
• Difficulty swallowing or speaking due to mouth dryness
• Oral yeast infections (thrush)
• Inflammation of joints, lungs, kidneys, or blood vessels (vasculitis)
• Lymphoma (a type of cancer of the immune system) occurs in a small number of people with Sjogren syndrome.

Long-term outlook

Most people with Sjogren syndrome live full, active lives. With proper treatment and regular care, symptoms can be well-managed. Serious complications are uncommon but possible, so staying in touch with your healthcare team is important. Many people find ways to adapt and thrive despite the condition.

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