Today I’ll just share some of the key features of Sjögren’s syndrome (pronounced sho-grens), an autoimmune disease that turns out to be a major nuisance for a large proportion of individuals, but for an unfortunate smaller number of individuals it can become much, much more than that nuisance.
We’ll cover just some of the top, key features that should make one consider Sjögren’s syndrome. These aren’t necessarily the only symptoms it can produce nor are they specific meaning that a host of other causes can lead to the symptoms below, i.e. dry eye, dry mouth, etc. When in doubt, these symptoms should always be brought up to your primary doctor and likely considered by a specialist like a rheumatologist or eye doctor who deals with Sjögren’s syndrome.
What is Sjogren’s Syndrome?
Sjögren’s syndrome is an autoimmune disease – autoimmune diseases happen when our immune system goes the wrong direction and develops an immune response against our own tissues. These autoimmune diseases differ by which organs or systems they target. For example, Hashimoto’s thyroiditis is the disease that results when the thyroid gland is attacked by antibodies or say multiple sclerosis that’s the result of neurons and the spinal cord being attacked.
In Sjögren’s case, the main targets tend to be the glands around our eyes (those that create tears for us and ultimately keep our external eye lubricated), and the glands in our mouth which produce saliva. For the majority of folks, this is all that occurs. We end up with the consequences of those glands being slowly degraded, and little else.
On the other hand, there’s a smaller number of individuals that end up experiencing more diffuse, systemic problems – these are largely consequences that occur from ongoing stimulation of the immune system that goes unchecked.
1. Dry Eyes
This is the result of the lacrimal glands, the glands around the eyes that produce tears and lubrication on the outside of the eye, being attacked and degraded over time.
The result is dry, scratchy eyes. I don’t mean dry weather, Arizona-climate type of eyes. This is more about scratchy, dry, even red eyes that need eye drops up to four times a day, gel under the eyes at bedtime, and even then, in the more severe cases, we’ll be living in a state of perpetual annoyance and discomfort. Some folks don’t make it to the point of requiring that intense of therapy, but many do. Most folks will tend to just require drops a few times a day.
2. Dry Mouth
This is a result of salivary glands being damaged in the mouth. These glands produce saliva, and therefore when these are slowly degraded, we end up with a dry, patchy mouth. This manifests as trouble swallowing food, particularly dry food (think meats, crackers especially), and can lead to trouble speaking (moving the tongue around to pronounce words with a dry mouth is tricky to say the least!), especially in more prolonged situations where you don’t have easy access to water. Most who are affected like this also end up with cavities since saliva in our mouths help us fight off bacteria that cause cavities to begin with. We’ll see a lot of premature tooth decay as a result.
3. Inflammatory arthritis
Although less common than glandular damage, Sjogren’s can also cause an inflammatory arthritis not all that different from rheumatoid arthritis. More often, it’s the smaller joints that can be affected, like the hands, feet, ankles, or wrists, but it can involve larger joints as well less frequently. We treat this very similarly to rheumatoid arthritis in many cases; anti-inflammatories can make a world of difference to control the underlying inflammation and relieve the associated pain.
4. Peripheral Neuropathy
Neuropathy is a description of something wrong with the nerves. More typically for us who experience this, this is characterized by tingling, numbness, or burning, and most frequently in our extremities. Sjogren’s can cause neuropathy in a few different ways; this can range from one leg or arm being affected, it can be both sides, and in fewer cases, there can even be a painful loss of nerve sensation.
5. Abnormal tests
Lastly for the top 5, Sjögren’s syndrome usually presents with some abnormal blood tests. The most common is a positive ANA (antinuclear antibody) which itself is made positive by two types of antibodies known as SSA and SSB (formerly known as anti-Ro and La). However, up to about 40% of individuals with Sjögren’s will not have *any* abnormal blood tests and so we can’t and don’t rely on these fully. We’ll also very frequently see a positive rheumatoid factor – this is a test we tend to initially associate with rheumatoid arthritis but is actually a manifestation of long-standing, usually intensive immune system stimulation, particularly over long periods of time, which Sjögren’s classically does (in addition to rheumatoid arthritis and its other causes).
For the individuals that don’t have abnormal tests, we can still make the diagnosis by measuring tear production or saliva production but the process by which we do those tests is a bit awkward (we’ll put a piece of paper inside your eyelid or ask you to drool into a cup for several minutes, in fact, respectively). A relatively simple biopsy can also be done of the salivary glands inside of our lower lips which can confirm inflammation and destruction of the glands to lock in the diagnosis as well.
Other symptoms?
Like I said, this isn’t the exhaustive list. Rashes, kidney disease, lung disease, blood abnormalities, even lymphoma can be associated. Like most rheumatologic diseases, the vast, overwhelming majority of us affected will have only a few of these symptoms, not the whole list.
Conclusion
Those are the top five! These aren’t the only features of Sjögren’s, again, and keep in mind most autoimmune diseases can have a really surprisingly wide possibility of symptoms across multiple systems. The above five tend to be the most common but even these are not universally present in everyone.
It’s always best to discuss with your primary doctor whether some of the above symptoms you may be experiencing could be related to Sjögren’s or another cause. This often is helped by an evaluation by a rheumatologist, or, in many cases when dry eyes are involved, an ophthalmologist or optometrist.
For more information, check out the Sjögren’s Foundation here: https://sjogrens.org/