What is Sjögren's Syndrome?
Sjögren's syndrome is an autoimmune disease that attacks the glands producing tears and saliva, causing persistent dry eyes and dry mouth. It also causes fatigue and joint pain, and can affect the lungs, kidneys and nerves. It is frequently mistaken for ordinary dryness for years before diagnosis.
Also called: Sjogren's syndrome, sicca syndrome
Who gets Sjögren's Syndrome?
It affects women around nine times more often than men, most commonly beginning between 40 and 60, though it occurs in younger adults too. It can occur alone (primary) or alongside rheumatoid arthritis, lupus or systemic sclerosis (secondary). It is one of the more common autoimmune diseases and one of the most under-diagnosed, partly because dryness is so easily attributed to age, medication or screen use.
What are the symptoms of Sjögren's Syndrome?
Not everyone has every symptom below, and having one does not confirm the diagnosis. These are the features that most often lead to assessment:
- Persistently dry, gritty or burning eyes, worse in air conditioning or wind
- Dry mouth, difficulty swallowing dry food, needing water to eat, and rapidly increasing dental decay
- Swelling of the glands in front of the ears or under the jaw
- Overwhelming fatigue
- Joint pain, usually without joint damage
- Vaginal dryness
- Dry cough or breathlessness where the lungs are involved
- Numbness, tingling or burning in the hands and feet
- Raynaud's phenomenon
- A new, persistent lump in a salivary gland
How is Sjögren's Syndrome diagnosed?
The assessment combines symptoms with objective measurement, because dryness alone is not enough.
Schirmer's test measures tear production and ocular staining assesses surface damage. Salivary flow may be measured.
Blood tests look for anti-Ro/SSA and anti-La/SSB antibodies, ANA, rheumatoid factor and raised immunoglobulins.
Where antibodies are negative but the clinical picture fits, a minor salivary gland biopsy from inside the lower lip gives an objective answer, and this is one of the situations where the biopsy genuinely changes the diagnosis.
How is Sjögren's Syndrome treated?
There is no treatment that restores gland function, so care has two aims: relieving dryness and treating systemic involvement.
For the eyes: preservative-free artificial tears used regularly rather than only when uncomfortable, gels overnight, and ciclosporin or serum drops for more severe disease. Punctal plugs help conserve tears.
For the mouth: frequent sips of water, sugar-free gum, saliva substitutes, and dental review every six months without exception — the rate of dental decay in untreated Sjögren's is high and largely preventable. Pilocarpine stimulates residual gland function.
Hydroxychloroquine helps fatigue and joint pain. More significant lung, kidney or nerve involvement is treated with immunosuppression, and rituximab is used in selected severe cases.
Living with Sjögren's Syndrome
Dental care is the single most valuable long-term investment: six-monthly reviews, fluoride toothpaste and treatment of dryness protect teeth that would otherwise decay rapidly. There is a small but real increase in the risk of lymphoma, particularly with persistent salivary gland swelling, low complement or cryoglobulins — which is why any new persistent gland lump should be reported promptly rather than watched.
When should you see a rheumatologist?
Dry eyes and dry mouth that persist for more than three months, particularly with fatigue, joint pain or rapidly worsening dental decay, deserve assessment rather than another bottle of eye drops.
Common questions about Sjögren's Syndrome
Is Sjögren's syndrome just dry eyes and dry mouth?
No. Fatigue and joint pain are frequently the most disabling features, and the disease can affect the lungs, kidneys, nerves and blood. It is a systemic autoimmune disease that happens to be most visible in the glands.
Why do I need a lip biopsy?
Because a substantial proportion of people with genuine Sjögren's have negative antibodies. When symptoms fit but blood tests do not confirm it, the biopsy provides objective evidence and settles the diagnosis.
Why is my dentist seeing so many cavities suddenly?
Saliva protects teeth. Without it, decay accelerates sharply. Six-monthly dental review, fluoride and active treatment of dry mouth prevent most of this damage.
Does Sjögren's increase the risk of cancer?
There is a small increase in the risk of lymphoma, higher in those with persistent salivary gland swelling, low complement levels or cryoglobulins. This is why a new persistent lump in a gland should always be reported.
This page is general information to support a consultation. It is not a diagnosis, and it does not replace an assessment by a doctor who has examined you.