Sjogren’s is a chronic disorder of the immune system. It is an autoimmune condition, meaning that healthy tissues and cells are mistakenly attacked by the immune system.
It happens when white blood cells attack saliva glands, tear glands, and other tissues, leading to decrease in tear and saliva production. This can lead to dryness in the mouth, eyes, skin, nose, upper respiratory tract, and vagina.
It is associated with other autoimmune disorders, including rheumatoid arthritis, systemic lupus erythematosus, and primary biliary cholangitis.
Primary Sjogren’s develops alone, but secondary Sjogren’s co-occurs with another condition, such as lupus. The symptoms are similar, and both can be severe.
Sjogren’s is a serious condition, but timely treatment can mean that complications are less likely to develop, and tissue damage is less likely to occur. Once treated, an individual can usually manage the condition well.
Sjogren’s can develop at any age, but most diagnoses occur after the age of 40 years. In 90 percent of cases the patient is female, but it also affects males.
It affects around 0.1 to 4 percent of people in the United States.
Fast facts on Sjogren’s
Sjogren’s is an autoimmune disorder that affects moisture-producing glands.
The condition affects 0.1 to 4 percent of people in the U.S., and 90 percent of people with Sjogren’s are women.
It causes the eyes and mouth to dry out, and can also lead to tooth decay, recurring oral thrush, and a persistent dry cough.
Sjogren’s affects multiple systems and can be difficult to diagnosis. However, blood tests, ophthalmological testing, and measuring the salivary flow rate can identify the condition.
Prescribed eye drops, artificial tears, and moisture chamber spectacles can help to relieve dry eyes.
Other medications can help to stimulate the flow of saliva. Sucking on ice cubes and chewing sugar-free gum are other ways to lubricate the mouth.
Sjogren’s causes painful and irritating dryness of the eyes as well as other symptoms.
The most common symptom associated with Sjogren’s is the inability to produce moisture for the eyes and dry mouth.
Females may also report vaginal dryness.
Other symptoms can include:
tooth decay, and eventual loss of teeth
persistent dry cough
problems chewing and swallowing
swollen salivary glands
recurring oral thrush, a fungal infection in the mouth
The signs and symptoms associated with dry eyes include:
a sensation in one or both eyes similar to the irritation caused by foreign material, such as sand or gravel
tired-looking and heavy eyes
an itchy sensation
discharge of mucus from the eyes
photophobia, or sensitivity to light
stinging or burning eyes
swollen and irritated eyelids
Smoking, air travel, overhead fans, and air-conditioned or windy environments can exacerbate symptoms.
In some cases, the patient’s immune system attacks other parts of the body, causing the following signs and symptoms:
inflammation of joints, as well as stiffness and pain
peripheral neuropathy, or numbness and occasional pain in the arms or legs
Raynaud’s phenomenon, in which the hands feel painful, cold and numb
vasculitis, where the blood vessels become inflamed
There is no special diet for Sjogren’s, unless the doctor suggests one.
Alcohol should be avoided, however. People may also wish to avoid foods that irritate the mouth, such as spicy or acidic items.
Lozenges may help keep the mouth moist.
To make food easier to swallow:
use sauces, olive oil, or dressings to lubricate food
have a drink alongside your food
use a drinking straw to make swallowing easier
put cucumber in a sandwich, to add moisture
increase fluid intake
The best option is to choose a balanced diet that is high in fresh fruit and vegetables and low in saturated fats and sugar. Some foods are believed to trigger an inflammatory reaction, such as artificial sweeteners. These may be best avoided.
Keeping a food diary may help pinpoint any specific foods that may cause a reaction or worsen symptoms.
Eye drops and artificial tears are effective methods of managing dry eyes.
Sjogren’s treatment aims to lubricate the affected areas and prevent the onset of complications.
Treatment options include:
Medications to stimulate saliva flow: These include pilocarpine and cevimeline. They have a short-term impact, limited to a few hours only, so several doses a day are usually required.
Artificial saliva: Saliva substitutes and mouth-coating gels can relieve dryness of the mouth. They are available as sprays, pre-treated swabs, and liquids. These can be important at night, as the mouth becomes dryer during sleep.
Artificial tears: Artificial tears can help to lubricate the eyes, and are available over-the-counter (OTC). Prescription options are available that reduce the need for artificial tears, such as cyclosporine ophthalmic emulsion and hydroxypropyl cellulose pellets.
Prescription eye drops: These include cyclosporine and lifitegrast.
Moisture chamber spectacles: These are special glasses that keep out irritants and retain moisture.
Prescription expectorants and throat medications: In cases of respiratory dryness, drugs such as those used to stimulate saliva flow, as well as linseed extract, sorbitol, xylitol, or malic acid, can moisturize the area.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Anti-inflammatory drugs such as aspirin, naproxen, and ibuprofen can provide relief for people with Sjogren’s who are experiencing joint pain.
Disease-modifying antirheumatic drugs (DMARDs): In cases where the joint pain is accompanied by fatigue and rashes, DMARDs may relieve symptoms. Examples include hydroxychloroquine or methotrexate. If Sjogren’s seems to be affecting the muscles, nerves, lungs, or kidneys, stronger DMARDs or corticosteroids may be prescribed.
Antifungal medication: If oral yeast infections are occurring, medication may be prescribed to combat the fungus.
Vaginal lubricants: For vaginal dryness, water-based vaginal lubricants can provide a solution, especially during sexual intercourse.
Punctual occlusion: When all conservative treatment options have been exhausted, this surgical option seals the tear ducts with small plugs to reduce the drainage of tears from the eye. This keeps the eye moist for longer. Temporary silicone plugs are likely to be used until the procedure is confirmed successful.
Autologous eye serum: In severe cases of eye dryness, eye drops can be made from the person’s blood serum.
Here are some easy ways to keep the mouth lubricated.
consuming more liquids.
sucking on ice cubes
rinsing the mouth regularly to prevent infection and soothe the area
maintaining excellent oral and dental hygiene
quitting smoking, as smoke irritates the mouth and speeds up the evaporation of saliva
chewing sugar-free gum, which stimulates the production of saliva
applying coconut oil to the dry areas, as it is both moisturizing and anti-microbial