Spotlight on Sjögren's syndrome

Sjögren's syndrome is an inflammatory autoimmune disease (like arthritis) in which white blood cells—the body's immune system—attack moisture-producing glands. Most often, this results in dry eyes and mouth, although it can also affect the joints and muscles, and organs including the liver, pancreas, kidneys, lungs, stomach, and brain.

Sjögren's syndrome affects women much more commonly than men—90% of those diagnosed are women. Though it can occur in people of all ages, it tends to strike around middle age; most commonly, people are diagnosed between the ages of 45 and 55.

Approximately half of those diagnosed with Sjögren's syndrome also have another form of arthritis, like lupus, scleroderma, or rheumatoid arthritis—this is called "secondary Sjögren's syndrome. In the other half of cases, Sjögren's syndrome appears in people with no other history of arthritis—in this case, the disease is referred to as "primary Sjögren's syndrome".

The cause of Sjögren's syndrome remains unknown, although scientists think that it may be the result of a virus or environmental trigger. Because the disease most often affects women at the end of their childbearing years, it has also been speculated that it may have a hormonal connection. Since Sjögren's syndrome is an autoimmune disorder, many researchers believe that a combination of these and other factors causes something to go wrong with the immune system, causing the body to attack its own healthy glands and organs.

Diagnosis of Sjögren's syndrome

Sjögren's syndrome has several warning signs, which may be present at the onset of disease. These include:
  • Very dry eyes, which may feel "gritty"
  • Dry mouth, sometimes making swallowing difficult
  • Dry nose and throat
  • Swollen salivary glands
  • Fatigue
  • Joint pain, swelling, and stiffness, most often in smaller joints like fingers and toes.
  • Occasionally lung, kidney and other organs can be affected by Sjögren's syndrome

The most common early symptoms of Sjögren's syndrome are dry eyes and mouth, which can make it a challenging disease to diagnose as other conditions, like hormonal disorders, can often present these symptoms as well. Dry mouth and eyes can also be associated with aging, menopause, and certain medications. As well, Sjögren's syndrome is not a particularly well-known disease, and may be overlooked by some doctors. If you think you might have Sjögren's syndrome, speak with your doctor about your symptoms.

If your doctor believes you may have Sjögren's syndrome, you will usually be referred to a rheumatologist—a specialist in the treatment of arthritis. Rheumatologists have many years of extra training on top of their regular medical schooling, and are experts at diagnosing and treating all forms of arthritis, including Sjögren's syndrome. If your eyes appear to be involved in your disease, you may be referred to an ophthalmologist—a medical doctor specializing in eyes—as well.

To get a firm diagnosis of Sjögren's syndrome, doctors may run a number of tests. These may include urine and blood tests, lip biopsy, X-ray imaging, and a special test, called a Schirmer tear test, which measures dryness in the eyes.

People with primary Sjögren's syndrome sometimes develop blood, lung or kidney problems. They are also at a higher risk for a lymph node cancer called lymphoma. Regular follow up with their physicians to monitor for kidney and lung disease as well as lymph node check ups are important.

Treatment of Sjögren's syndrome

Once your rheumatologist has diagnosed Sjögren's syndrome, there are effective treatments available to help you manage the symptoms. While there is no known cure for Sjögren's syndrome, treatments are available, and your rheumatologist is the best person to discuss these with and formulate a treatment plan to address all aspects of Sjögren's syndrome.

There are several groups of medications used to treat Sjögren's syndrome. These are:
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (for example Advil® or Motrin IB®), naproxen (or Naprosyn®), diclofenac (or Voltaren® and Arthrotec®)
  • Corticosteroids, such as prednisone
  • Disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate, sulfasalazine, hydroxychloroquine and azathioprine

These medications can work alone or, most often, in combination to reduce the pain and other symptoms associated with Sjögren's syndrome, as well as other disorders associated with secondary Sjögren's syndrome.

There are a number of strategies to treat the dryness of the eyes and mouth often associated with Sjögren's syndrome. To ease a dry mouth, try sipping water frequently throughout the day, chewing sugarless gum, and avoiding certain foods known to be drying to the mouth, such as chocolate and nuts. Mouthwashes and sprays are also available to help maintain moisture in the mouth. To care for dry eyes, artificial tears may help to reduce dryness and increase comfort. It is important to avoid medications that can cause a dry mouth, if possible.

Saliva is important to keep the teeth and gums healthy. People with Sjögren's syndrome have a much higher chance of developing tooth and gum disease. It is important to follow up regularly with a dentist to maintain oral health.

Keeping skin from getting too dry is important. Try using creams, or mineral oils to protect skin and keep it from becoming uncomfortable and dry. Using a humidifier in your home may help prevent dry skin and keep mucous membranes moist. Avoid air conditioners and electric heaters wherever possible.

As with any form of arthritis, maintaining a healthy lifestyle is also a critical part of any Sjögren's syndrome treatment plan. Poor diet, lack of exercise, and high levels of stress may make disease activity worse, so healthy eating, appropriate levels of aerobic and strengthening exercise, and relaxation are highly recommended. As well, since smoking can cause dryness in the skin, mouth, nose, and eyes, it is highly recommended that people with Sjögren's syndrome do not smoke.