What are the warning signs of Sjögren syndrome?
The symptoms of Sjögren syndrome vary from person to person. The most common early symptoms are dry mouth and eyes. One form of Sjögren syndrome is associated with connective tissue disease. For these people, dry eyes and mouth may develop slowly.
If you have Sjögren syndrome, the reduced amount of saliva in your mouth may make it difficult for you to chew and swallow dry food, such as crackers. Your eyes may feel gritty or sandy. Having these symptoms does not automatically mean that you have Sjögren syndrome as dryness of the eyes and mouth can be a result of other conditions such as hormonal disorders, the use of certain medications, anxiety (dry mouth) or aging.
Sometimes swollen salivary glands are also seen with Sjögren syndrome. This occurs most commonly along the jaw line. It can be painless, or painful. It can come and go, or remain constant. It can occur on one side or both. Sjögren syndrome can cause increased cavities in the teeth because the mouth produces less saliva to wash away food and germs. Dental problems can accelerate.
Sjögren syndrome can also cause fatigue, joint pain (most often the smaller joints and usually affecting the same spot on both sides of the body) and problems in other parts of the body such as the blood vessels (red spots on the skin of the lower legs), nervous system (numb toes) and other organs.
How is Sjögren syndrome diagnosed?
Sjögren syndrome is diagnosed according to whether the patient has one or more of the following symptoms:
- Dry eye
- Dry mouth
- Swelling of salivary glands
- Diminished tear and/or saliva production
- Abnormal antibodies in the blood
- Abnormalities in the "minor salivary gland”
A 'Schirmer test' can determine the amount of tears being produced by your tear glands. This test involves putting a small strip of filter paper under the lower eyelid. A lissamine green test is often performed. This is a dye that temporarily stains the surface of the eye green if it is dry.
What are the risk factors for Sjögren syndrome?
Sjögren syndrome is an autoimmune disease. It begins when something causes the immune system (which normally protects the body from germs, viruses and bacteria) to malfunction. The immune system makes white blood cells (lymphocytes) that attack the moisture-producing glands of the body as well as other tissues. No one knows for sure what triggers the immune system to do this, though researchers suspect that several factors may be involved, including viral infections, changes in hormonal levels and stress.
There may also be a genetic factor as some people with Sjögren syndrome have other family members with related connective tissue diseases, such as lupus or RA.
How common is Sjögren syndrome?
Although hard to determine accurately, either primary or secondary Sjögren syndrome is seen in about 1% of the general population. Sjögren syndrome can be found in people of all ages and races. However, 90% of those diagnosed with Sjögren syndrome are women. Usually it occurs after age 45 years but is also seen in children and young adults.
About half the people diagnosed with Sjögren syndrome also have other rheumatic conditions or connective tissue diseases such as RA, lupus or scleroderma.
Although Sjögren syndrome is an autoimmune disease, medication taken to suppress the immune system does not usually improve the symptoms of dry eyes and dry mouth. But there are other drugs that may help with these symptoms.
People with dry mouth may respond to drugs that stimulate the salivary glands to work harder (such as pilocarpine). However, this drug can cause sweating and its use must be discussed with your doctor.
Ophthalmologists sometimes prescribe cyclosporine drops for severe dry eye. This medication can improve tear production. Artificial tear preparations or lubricating ointments may be useful for overnight or long-lasting relief. Consult your pharmacist about which medications can cause dryness, such as antihistamines and antidepressants. The use of these drugs may make your symptoms worse.
For those who suffer with complications beyond the effects of dry eyes or dry mouth, such as inflamed nerves, skin, lungs or kidneys, immune-suppressing drugs are used. These symptoms occur in fewer than 20% of people with Sjögren syndrome.
Because half the people diagnosed with Sjögren syndrome also have other types of arthritis, you may already be taking medications for your arthritis symptoms. To explore medications for the treatment of symptoms of Sjögren syndrome and other types of arthritis, The Arthritis Society has developed a comprehensive expert guide that delivers detailed information.
EXPLORE: Arthritis Medications – A Reference Guide
The optimal treatment is what is best in each individual case – so speak with your doctor and/or pharmacist about what kind of medications are most appropriate for you.
Surgery is not usually an option for managing Sjögren syndrome. Under extreme conditions a chronically-infected salivary gland or a gland that has developed lymphoma may need to be surgically removed. If your eyes are severely dry your ophthalmologist can perform a simple procedure that reversibly blocks tear drainage from the eye. This allows tears that are produced to accumulate and moisten the eyes.
Sometimes, to confirm the diagnosis of Sjögren syndrome, an Oral Surgeon or an ENT specialist will be asked to remove a small sample (biopsy) from the small minor salivary glands. This is a minor procedure.
A physiotherapist (PT) can develop an individualized program that's designed to help you increase your strength, flexibility, range-of-motion and general mobility and exercise tolerance through a wide variety of therapeutic treatments and strategies. These include exercise prescription, physical interventions, and relaxation, in addition to advising you on other techniques for increasing your overall quality of life. PTs can also refer you to other health professionals and community services for further measures that will help you adapt to your changing circumstances.
Fatigue can be a disabling complication of Sjögren syndrome. An occupational therapist (OT) can analyze everything you do in a day and develop a program to help you minimize fatigue. If necessary, they can help you redesign your home or workplace to make it easier for you to work or simply to get around. Their goal is to prepare you, using adaptive strategies, to reclaim as much of your former life as possible.
There is not yet a cure for Sjögren syndrome but there are things that you can do to prevent the damage to the teeth or the surface of the eye.
- If you have dry eyes, talk to your doctor or ophthalmologist about artificial tear preparations. Moisture chamber eyeglasses, which prevent existing tears from evaporating and protect the eyes from wind and draft, can also be useful.
- If you have a dry mouth, ask your doctor or pharmacist about saliva substitutes or mouth coating products. Stimulating saliva with sugar-free candy or sipping very small amounts of water can also help. Be sure to see your dentist regularly as the lack of saliva in your mouth can cause an increase in cavities in your teeth. Fluoride supplements and early intervention can go a long way to preserving your teeth.
- If you have a dry nose, ask your doctor or pharmacist about the different types of nasal preparations available that you can use to keep the area moist.
- If you are a woman with Sjögren syndrome and are experiencing vaginal dryness you should talk to your doctor or pharmacist about specially designed lubricants you can use.
It is important to remain active with an ongoing condition such as Sjogren’s syndrome. Doing certain exercises can help keep your muscles strong and joints moving.
There are different types of exercises:
- Range of motion exercises reduce stiffness and help keep your joints moving. A range of motion exercise for your shoulder would be moving your arm in a large circle.
- Strengthening exercises maintain or increase muscle strength.
- Endurance exercises strengthen your heart, give you energy and keep your body flexible. These exercises include walking, swimming and cycling.
- Moderate stretching exercises help relieve your pain and keep the muscles and tendons around your affected joint flexible and strong.
Always consult your doctor before beginning an exercise program.
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