Sjögren’s syndrome is a chronic (ongoing) disease in which a person’s immune system attacks their eye's lacrimal (tear) glands and the salivary glands of the mouth. The resulting inflammation and destruction of these glands leads to the symptoms of dry eyes and a dry mouth that characterise the condition.
Sjögren’s syndrome can occur as a primary condition, when it occurs by itself, or as a secondary condition, when it is associated with other established connective tissue diseases such as rheumatoid arthritis and systemic lupus erythematosus (also known as SLE or lupus).
Symptoms of Sjögren’s syndrome
As well as causing dry eyes and a dry mouth, Sjögren’s syndrome has the potential to affect almost any organ system in the body. Other symptoms can include fatigue, nosebleeds, fevers, gastric reflux, vaginal dryness, arthritis, muscle pains and skin rashes. Salivary gland enlargement is very common.
The syndrome is typically seen in women at around the time of menopause. It can also occur in men, but the female to male ratio is 9:1.
People with Sjögren’s syndrome have an increased risk of developing other diseases such as kidney disease, liver disease and, less commonly, lymphoma (cancer of the lymphatic system). It is therefore very important for people with this syndrome to have regular medical check-ups. However, people with Sjögren’s syndrome who do not develop lymphoma or connective tissue diseases have a normal life expectancy.
Several tests may be ordered by your doctor to confirm whether or not you have Sjögren’s syndrome, as having dry eyes and dry mouth could be caused by many other conditions or by medicines you may be taking.
Tests for Sjögren’s syndrome include:
- Eye examination using a slit lamp to magnify the eye - and drops of temporary dye to show up damage to your cornea (keratitis).
- A test (Schirmer's tear test) to assess whether your eye's ability to produce tears is normal.
- Blood tests to confirm the presence of antibodies found in people with Sjogren's syndrome.
- A punch biopsy of the lower lip, although this is not routine.
Treatments for Sjögren’s syndrome
There is no cure for Sjögren’s syndrome. Treatment is aimed at relieving the symptoms, so can vary widely from person to person.
For dry eyes, you can use artificial tears and night-time gels. How frequently these should be used will depend on the severity of the dryness. Using spectacles with windshields and avoiding drying environments might also be helpful. Regular eye examination by a specialist is important to check for corneal damage associated with dry eyes.
For a dry mouth, it’s best to avoid factors that may make the dryness worse, such as alcohol (including mouthwashes containing alcohol), smoking and mouth breathing. Anticholinergic medicines, which are often found in over-the-counter cold and cough medications, should also be avoided because they can cause a dry mouth and dry eyes.
Because there is inadequate saliva, people with Sjögren’s syndrome are more prone to dental problems. This can be protected against by rinsing your mouth regularly, particularly after meals, and avoiding fluids that contain sugar. A dental check-up every 3-6 months is recommended.
Artificial saliva might be useful, especially in drying environments such as on aeroplanes. Sugar-free lemon drops may help to stimulate saliva. People who don’t produce saliva might also find vitamin E oil or mouth moisturising gels (e.g. Oral Balance) helpful.
People with Sjögren’s syndrome are at increased risk of developing oral thrush. Symptoms of this include mouth or tongue burning, intolerance to spicy foods, or splitting in the corners of the mouth. Once this condition is diagnosed, it can be treated with medication available on prescription.
Dry skin can be treated with normal moisturisers, and vaginal dryness may be relieved by vaginal lubricants such as Replens or KY jelly. While dry eyes and dry mouth are the most common symptoms of Sjögren’s syndrome, many other symptoms can occur. These often require careful assessment and management by a medical professional.
If you develop more serious symptoms you might need treatment with steroids such as prednisone or drugs which suppress the immune system such as methotrexate.
2. American College of Rheumatology. SjÃ¶grenâ€™s syndrome. (Patient information). [Internet] Updated July 2012. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/sjogrens.asp (Accessed Dec 2012)
3.Mayo clinic. SjÃ¶grenâ€™s syndrome. (Website). Aug 2011. [Internet] http://www.mayoclinic.com/health/sjogrens-syndrome/DS00147 (Accessed Dec 2012).