Sjögren’s Syndrome

Normally, the immune system works to protect us from disease by destroying harmful invading organisms like viruses and bacteria. In the case of Sjögren’s syndrome, disease-fighting cells attack various organs, most notably the glands that produce tears and saliva. Damage to these glands causes a reduction in both the quantity and quality of their secretions. This results in symptoms that include dry eyes and dry mouth.

Sjögren’s syndrome is also a rheumatic disease. These are diseases characterized by inflammation (signs include redness or heat, swelling, and symptoms such as pain) and loss of function of one or more connecting or supporting structures of the body. They especially affect joints, tendons, ligaments, bones, and muscles.

Causes

Sjögren’s syndrome is classified as either primary or secondary. The primary form occurs in people who do not have other rheumatic disesaes. The secondary form occurs in people who already have another rheumatic disease, most commonly rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE). These people then develop dry eyes or dry mouth.

Researchers think Sjögren’s syndrome is caused by a combination of genetic and environmental factors. Several different genes appear to be involved, but scientists are not certain exactly which ones are linked to the disease, because different genes seem to play a role in different people.

Scientists think that the trigger may be a viral or bacterial infection. The possibility that the endocrine and nervous systems play a role in the disease is also under investigation.

Symptoms

Sjögren’s syndrome can cause many symptoms. The main ones are:

• Dry eyes. Eyes affected by Sjögren’s syndrome may burn or itch. Some people say it feels like they have sand in their eyes. Others have trouble with blurry vision, or are bothered by bright light, especially fluorescent lighting.
• Dry mouth. Dry mouth may feel chalky or like your mouth is full of cotton. It may be difficult to swallow, speak, or taste. Because you lack the protective effects of saliva, you may develop more dental decay (cavities) and mouth infections.

Sjögren’s syndrome can also affect other parts of the body, causing symptoms such as:

• multiple sites of joint and muscle pain
• prolonged dry skin
• skin rashes on the extremities
• chronic dry cough
• vaginal dryness
• numbness or tingling in the extremities
• prolonged fatigue that interferes with daily life.

Diagnosis

Your doctor will diagnose Sjögren’s syndrome based on your medical history, a physical exam, and results from clinical or laboratory tests. During the exam, your doctor will check for clinical signs of Sjögren’s syndrome, such as indications of mouth dryness or signs of other connective tissue diseases.

Depending on what your doctor finds during the history and exam, he or she may want to perform some tests or refer you to a specialist to establish the diagnosis of Sjögren’s syndrome and/or to see how severe the problem is and whether the disease is affecting other parts of the body as well.

Because there are many causes of dry eyes and dry mouth (including many common medications, other diseases, or previous treatment such as radiation of the head or neck), the doctor needs a thorough history from the patient, and additional tests to see whether other parts of the body are affected.

Blood tests can determine the presence of antibodies common in Sjogren’s syndrome, including anti-SSA and anti-SSB antibodies or rheumatoid factor. Other tests can identify decreases in tear and saliva production. Biopsy of the saliva glands and other specialized tests can also help to confirm the diagnosis.

Treatment

Treatment can vary from person to person, depending on what parts of the body are affected.

TREATMENTS FOR DRY EYES

There are many treatments you can try or your doctor can prescribe for dry eyes. Here are some that might help:

• Eye drops. Available by prescription or over the counter under many brand names, these products keep eyes moist. Some drops contain preservatives that might irritate your eyes. Drops without preservatives usually don’t bother the eyes.
• Ointments. Ointments are thicker than eye drops. Because they moisturize and protect the eye for several hours, and may blur your vision, they are most effective during sleep.
• Other therapies. Other therapies such as plugging or blocking the tear ducts, anti-inflammatory medication, or surgery may be needed in more severe cases.

TREATMENTS FOR DRY MOUTH

There are many remedies for dry mouth. You can try some of them on your own. Your doctor may prescribe others. Here are some many people find useful:

• Chewing gum and hard candy. If your salivary glands still produce some saliva, you can stimulate them to make more by chewing gum or sucking on hard candy. However, gum and candy must be sugar-free, because dry mouth makes you extremely prone to progressive dental decay (cavities).
• Water. Take sips of water or another sugar-free, noncarbonated drink throughout the day to wet your mouth, especially when you are eating or talking. Note that drinking large amounts of liquid throughout the day will not make your mouth any less dry and will make you urinate more often. You should only take small sips of liquid, but not too often. If you sip liquids every few minutes, it may reduce or remove the mucus coating inside your mouth, increasing the feeling of dryness.
• Lip balm. You can soothe dry, cracked lips by using oil- or petroleum-based lip balm or lipstick. If your mouth hurts, your doctor may give you medicine in a mouth rinse, ointment, or gel to apply to the sore areas to control pain and inflammation.
• Other therapies. Other therapies such as saliva substitutes or medications that stimulate the salivary glands to produce saliva are sometimes indicated.