Sjogren’s Syndrome  

If you have lupus, you are also at increased risk of developing other autoimmune diseases like Sjogren’s syndrome (SS). When you have both lupus and Sjogren’s syndrome, medical professionals consider the syndrome secondary to the disease of lupus.

Sjogren’s syndrome diagnostic criteria

Because Sjogren’s is a syndrome, it’s diagnosed based on a group of symptoms that occur at the same time, or together. If you present with dry mouth, dry eyes, reduced salivary production, and the presence of antinuclear antibodies (detected through blood work), you’ll likely be diagnosed with Sjogren’s syndrome. It’s very common to have the disease in a milder form for years before the symptoms become noticeable or intrusive enough to seek medical treatment.

Signs and symptoms of Sjogren’s disease

SS primarily affects the mouth and eyes. Some of the most common symptoms associated with the syndrome include:

• Dry mouth (xerostomia)
• Cracks on your tongue
• Burning tongue
• More frequent/severe dental cavities
• Difficulty swallowing
• Difficulty speaking
• Enlarged parotid glands (more common in those with primary SS than in those with secondary SS)
• Dry eye
• Gritty, sandy feeling in eyes
• Eye redness and irritation
• Itchy eyes
• Sensitivity to bright light (keratoconjunctivitis sicca)
• Muscle and joint pain
• Unexplained low-grade fevers
• An increase in fatigue
• Chronic dry cough related to a decrease in secretion production in the lower and upper respiratory tracts
• Dry throat, stomach problems, and difficulty swallowing related to decrease secretions in the gastrointestinal tract
• Vaginal dryness, pain during sexual intercourse

Not all patients with Sjogren’s syndrome will have all of these symptoms; if you have a few of them, you should see your rheumatologist for further evaluation.

In addition to the above signs and symptoms, patients with Sjogren’s syndrome often have abnormalities in lab values. They may test positive for antinuclear antibodies, often called ANA, or rheumatoid factor. Most patients with Sjogren’s have elevated protein levels, and some patients also have anemia, low albumin, and elevated erythrocyte sedimentation rates.

Causes and prevention

While researchers don’t yet know what causes Sjogren’s syndrome, they do know that it’s an autoimmune disorder, which means that your body’s immune system attacks healthy tissue, and they believe that onset is linked to exposure to certain viruses or bacteria prior to development of symptoms. Research continues to better understand the etiology of the syndrome, including risk factors and steps to prevent onset.

There is nothing you can do to prevent getting Sjogren’s syndrome. However, once you have the disease, there are things you can do to prevent symptoms from worsening, like avoiding dry environments, alcohol, caffeine, and certain medications.

How is Sjogren’s diagnosed?

Diagnosis of Sjogren’s usually made after the completion of an office examination and tests. Some of the tests that can help support or rule out a diagnosis of Sjogren’s syndrome include:

• The Rose-Bengal staining test, which identifies corneal injuries
• The Schirmer’s test, which measures the volume of tears produced by the eye
• Slit lamp exam to identify any areas of dryness or damage within the eye
• Tear gland biopsy to evaluate the extent of any inflammation in the gland
• Biopsy of the salivary glands in your lip or below your eyes to evaluate the extent of dryness and inflammation
• Scintigraphy, a test designed to measure saliva flow
• Solography, an x-ray using dye to detect areas of dryness in the salivary ducts
• Chest x-ray to determine whether damage has occurred to the lungs
• Lab tests include anti-nuclear antibody (ANA) test, SS-A (Ro) and SS-B (La) antibody tests, rheumatoid factor, and anti-thyroid antibodies
• Urinalysis test to evaluate the function of the kidneys, which are often affected by Sjogren’s Syndrome

Your primary care provider and your rheumatologist can assist you in exploring the underlying cause of any symptoms you’re experiencing. Be sure your care team knows that you have lupus as it increases your likelihood of other autoimmune diseases like Sjogren’s syndrome.

Sjogren’s syndrome treatment

The goal of any treatment administered for Sjogren’s syndrome is to increase hydration and lubrication of affected organs, tissues, and dry mucous membranes. This can help alleviate symptoms and prevent damage. Common steps taken to treat SS include:

• Hydroxychloroquine, an oral medication originally designed for the treatment of malaria but also effective in reducing joint pain and fatigue and impacting some lab values in a meaningful way.
• Oral gels and mouthwashes designed to alleviate dry mouth. These provide some immediate relief but results are often short-lived.
• Corticosteroids and immunosuppressants, which can reduce inflammation and limit the immune system’s attack on healthy tissue.
• Increased fluid intake during and between meals.
• Inserting collagen plugs into the tear ducts (lacrimal ducts) to increase moisture to several parts of the eye. Research is ongoing.
• Systemic medications including Evoxac and Salagen.
• Artificial tears to help replace lost moisture from the eyes.

Most of these treatments are accompanied by pros and cons, and none are able to completely alleviate the discomfort and other issues that can arise from Sjogren’s syndrome. Some patients may need treatment for their eyes but not for their mouth, and vice versa, depending on the severity of symptoms and the damage the syndrome has caused in other areas of the body.

What is my prognosis if I have lupus and Sjogren’s?

If you have both lupus and SS, your SS is considered secondary to lupus. Most patients with secondary SS have a milder form of the syndrome with a reduced likelihood of extra glandular involvement. Regardless of primary or secondary, Sjogren’s Syndrome presents differently in different patients; some have very mild signs and symptoms and might find out they have the syndrome by accident, while others have more serious symptoms that interfere with daily life.

For the best and most comfortable quality of life, visit your healthcare provider as soon as you notice signs and symptoms of Sjogren’s disease. Early diagnosis and intervention are essential for preventing damage to your major organs.

It’s also important to understand and comply with the treatment plan; know which signs and symptoms you should monitor for, and see your physician routinely to ensure your lab values and other indicators are good.