Sjogrens syndrome

Overview

Sjögren's syndrome is a long-term condition where the body's immune system mistakenly attacks its own moisture-producing glands, leading to dry eyes and dry mouth. It can also affect other parts of the body.

Sjögren's syndrome is not rare, but it is not extremely common either. It affects about 1 in 100 to 1 in 500 people worldwide.

It can affect anyone, but it is most common in women over 40. Women are about 9 times more likely to develop it than men.

Symptoms

Common symptoms

• Persistently dry eyes (feeling gritty or burning)
• Dry mouth (difficulty swallowing or speaking, increased cavities)
• Dry skin and vaginal dryness
• Joint pain and stiffness
• Fatigue that doesn't improve with rest

Symptoms in children

• In children, the main symptoms are often recurrent parotid gland swelling (swollen cheeks) and persistent fatigue, with dry eyes and mouth less common.

Symptoms in older adults

• Older adults may experience more severe dry mouth and eyes, and are at higher risk for dental decay and oral infections. They also may have more fatigue and joint symptoms.

Causes

Main causes

• The exact cause is unknown, but it involves the immune system attacking the glands that produce tears and saliva.
• Genetics may play a role – certain gene patterns increase risk.
• A trigger, such as a viral or bacterial infection, might start the immune response.

Risk factors

• Being female (especially after age 40)
• Having a family history of Sjögren's or other autoimmune diseases
• Having another autoimmune condition like rheumatoid arthritis, lupus, or scleroderma

When to see a doctor

See a doctor urgently if:

• If you have sudden vision loss or severe eye pain
• If you have trouble breathing or swallowing
• If you develop a high fever with severe joint swelling

Book a routine appointment if:

• If you have persistent dry eyes or dry mouth that affects daily life
• If you have ongoing fatigue or joint pain without a clear cause
• If you notice recurrent swollen glands in your neck or under your jaw

Diagnosis

Diagnosis is usually made by a rheumatologist based on your symptoms, a physical exam, and a combination of tests. There is no single test for Sjögren's syndrome.

Tests that may be done

• Blood tests to check for antibodies common in Sjögren's (anti-Ro/SSA and anti-La/SSB)
• Eye tests like Schirmer's test to measure tear production
• Salivary gland biopsy (taking a small sample of a gland from your lip to look for inflammation)
• Saliva flow measurement tests

What to expect at your appointment

You may see several specialists, including an eye doctor, a dentist, and a rheumatologist. The process may take several weeks. Be prepared to describe your symptoms in detail, especially how dry your eyes and mouth feel and how they affect your day.

Treatment

Treatment focuses on relieving symptoms and preventing complications like dental decay or eye damage. It is tailored to each person and may involve eye drops, mouth moisturizers, and medicines that help control the immune system.

Self-care at home

• Use artificial tears and eye gels regularly to keep eyes moist
• Sip water frequently and use sugar-free lozenges or gum to stimulate saliva
• Practice good oral hygiene – brush with fluoride toothpaste, floss, and see a dentist regularly
• Use a humidifier at night to reduce dryness
• Avoid medications that cause dryness, such as some antihistamines or decongestants

Medical treatments

Doctors may prescribe medications to reduce inflammation or suppress the immune system, such as hydroxychloroquine or methotrexate. For more severe symptoms, other immunosuppressants or biologic therapies may be considered. All treatments should be discussed with your rheumatologist.

When is surgery considered?

Surgery is rarely needed for Sjögren's syndrome itself. However, if severe dry mouth leads to dental infections or decay that cannot be treated otherwise, dental surgery may be required. In some cases, surgery to repair blocked salivary glands is considered.

Living with this condition

Living with Sjögren's means managing dryness and fatigue. You may need to carry water and eye drops with you, plan rest breaks, and adapt your diet to softer foods if your mouth is very dry.

Lifestyle tips

• Stay hydrated – drink plenty of fluids throughout the day
• Use preservative-free artificial tears as often as needed
• Avoid dry, smoky environments and wear sunglasses outdoors
• Get regular, moderate exercise to reduce fatigue and joint stiffness

Diet and exercise

Eat a balanced diet rich in omega-3 fatty acids (like fish, nuts, seeds) which may help reduce inflammation. Avoid very dry or crunchy foods if your mouth is dry. Gentle exercise like walking, swimming, or yoga can help maintain joint flexibility and improve energy levels.

Mental health and emotional wellbeing

Living with a chronic condition can be emotionally draining. You may feel frustrated, sad, or anxious about the future. Talk to your doctor if these feelings affect your daily life. Many people benefit from counselling or support groups.

Prevention

There is no known way to prevent Sjögren's syndrome because the exact cause is not known. However, early diagnosis and treatment can prevent many complications from developing.

Vaccines

People with Sjögren's should receive recommended vaccinations, including the flu vaccine and pneumococcal vaccine, to reduce infection risk. Discuss with your doctor before getting any live vaccines if you are on immunosuppressant medications.

Screening programmes

No routine screening is recommended for Sjögren's in the general population. If you have symptoms, see your doctor for evaluation.

Complications

If left untreated

• Severe dental cavities and tooth loss due to lack of saliva
• Eye damage, including corneal ulcers or infections
• Increased risk of lymphoma (a type of blood cancer)
• Lung problems (like bronchitis or pneumonia) from dryness
• Nerve damage causing numbness or tingling

Long-term outlook

With proper care, most people with Sjögren's can manage their symptoms and lead a full life. Treatment can greatly reduce discomfort and prevent serious complications. Regular follow-up with your healthcare team is key to maintaining good health.

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