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Sjogren's syndrome

Published by Bupa's health information team, May 2009.

This factsheet is for people who have Sjogren's syndrome, or who would like information about it.

Sjogren's syndrome (pronounced Shurgren's syndrome) is an autoimmune disorder causing damage to the secretary glands (the glands that produce tears, saliva and other secretions).

An autoimmune disease is a condition caused by antibodies from the immune system attacking the body.

About Sjogren's syndrome
Symptoms of Sjogren's syndrome
Complications of Sjogren's syndrome
Causes of Sjogren's syndrome
Diagnosis of Sjogren's syndrome
Treatment of Sjogren's syndrome
Questions and answers
Related topics
Further information
Sources

About Sjogren's syndrome

Sjogren's syndrome most commonly affects the eyes and the mouth. In Sjogren's syndrome, your immune system produces antibodies which attack the different secretary glands in your body, such as the tear glands in your eyes and the salivary glands in your mouth. This causes the glands to become inflamed and damaged, and they stop producing secretions.

It is thought there at least half a million people with Sjogren's syndrome in the UK, although there could be many more, as many people don't seek medical help for their symptoms.

There are two types of Sjogren's syndrome - primary and secondary Sjogren's syndrome.

Primary Sjogren's syndrome is not associated with any other autoimmune disease that affects the joints, such as rheumatoid arthritis.
Secondary Sjogren's syndrome occurs in people who have at least one other autoimmune condition affecting the joints, such as rheumatoid arthritis, systemic lupus erythematosus or scleroderma.

Sjogren's syndrome most commonly occurs in women between the ages of 40 and 60. It is much less common in men, and rarely affects children.

Symptoms of Sjogren's syndrome

The two main symptoms of Sjogren's syndrome are:

dry eyes - your eyes may also feel irritable or sore
dry mouth - this can cause your voice to sound hoarse, reduce your ability to taste, and may make it difficult to swallow

These may be the only symptoms you get if you have Sjogren's syndrome. However, the syndrome can sometimes cause additional symptoms such as:

swelling of the salivary glands on each side of your face
tiredness
aching and painful joints, sometimes with swelling and inflammation
vaginal dryness
dry skin
irritable bowel syndrome (which includes lower abdominal pain and disordered bowel habits), due to reduced bowel secretions

Complications of Sjogren's syndrome

Sjogren's syndrome can sometimes be associated with more serious problems. These are rare and may include:

infection and ulceration of your cornea (the clear, outer surface of your eye) - this can be a complication of dry eyes and can lead to loss of vision
tooth decay and mouth infections, due to lack of saliva in the mouth
non-Hodgkin's lymphoma - some people with Sjogren's syndrome have an increased risk of getting this type of cancer; it affects around one in 100 people with Sjogren's syndrome
peripheral neuropathy (problems affecting your nervous system) - this can lead to loss of feeling in your arms and legs
Raynaud's phenomenon - a condition in which the blood supply to your fingers and toes become restricted
problems affecting your liver and kidneys
autoimmune hypothyroidism

Causes of Sjogren's syndrome

The exact reasons why you may develop Sjogren's syndrome are not fully understood at present. However, it has been linked to several viruses, including Epstein-Barr virus and retroviruses. It is thought that the abnormal response of the immune system may be triggered by a virus infecting your body.

There may also be genetic factors that make you less able to fight off an infection and more likely to develop the condition.

Diagnosis of Sjogren's syndrome

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP may refer you to another doctor or other health professional for further tests. Depending on your symptoms, this may be:

a rheumatologist - a doctor who specialises in identifying and treating conditions that affect the musculoskeletal system, particularly the joints and surrounding tissues
a dentist
an oral surgeon
an ophthalmologist - a doctor who specialises in eye health

You may have any of the following tests to check for symptoms of Sjogren's syndrome:

Schirmer's test - in this test, a small piece of blotting paper is used to measure the amount of tears your eyes are producing
a slit lamp examination - the ophthalmologist places a dye in your eye and examines your eye through a lamp which shines light through a very narrow slot (a slit lamp)
measuring your saliva production - this may be by spitting into a paper cup, or sometimes, by having an MRI or ultrasound scan of your salivary glands
blood tests - these can detect certain antibodies (called anti-Ro and anti-La) which are common in people with Sjogren's syndrome
lip biopsy - this test involves removing one of the tiny salivary glands from your lower lip, and checking it under the microscope

Treatment of Sjogren's syndrome

Sjogren's syndrome cannot be cured. However, treatments are available that can help relieve your symptoms.

Self-help

There are many things you can do yourself to help control your symptoms.

If you have dry, irritable or sore eyes, try to avoid dry environments that will make your eyes worse, such as air-conditioned, dusty or smoky environments.
To reduce symptoms of dry mouth, don't eat too many sweet foods or drink too much alcohol, as this can make your symptoms worse. If you smoke, try to stop, because smoking also worsens symptoms. Take small sips of water throughout the day, or suck ice-cubes to keep your mouth moist.
You are more likely to have tooth decay if you have a dry mouth. Take particular care of your teeth by regularly cleaning them and using dental floss. You should also try to limit the amount of sweet food and sugary drinks you have and visit your dentist regularly. Your dentist may advise you to use a high fluoride toothpaste, or a specialist toothpaste for dry mouth.
If you get dry skin, take showers rather than baths. Avoid strong soaps, and moisturise regularly.

Treatments for dry eyes

If you have dry, irritable or sore eyes, your doctor will probably suggest using eye drops. You may need to use these several times a day. There are many different types of eye drops. Some are only available with a prescription from your doctor, while others can be bought from a pharmacy. Your doctor or pharmacist can advise you which is most suitable for you.

If your eyes are very dry, your doctor may sometimes suggest you have a minor procedure called punctual occlusion, to plug the tear ducts in your eyes. This can help keep your eyes moist.

Other non-surgical therapies that you may be advised to try include specialist spectacles or contact lenses which help to keep in moisture and reduce dryness.

Treatments for dry mouth

If you have a dry mouth, your doctor may recommend trying artificial saliva. Artificial saliva can come in the form of a mouth spray, gels or lozenges. Some products also contain fluoride.

You can also try chewing non-sugar chewing gum to increase your production of saliva.

If you get ulcers in your mouth, your doctor may prescribe an ointment to apply to the ulcers. If you get a fungal infection in your mouth, your doctor may prescribe an antifungal medicine such as amphoterican lozenges.

Your doctor may sometimes prescribe a medicine called pilocarpine to treat your symptoms of dry eyes and dry mouth. This medicine may not work for all people with Sjogren's syndrome. Your doctor may trial you with the treatment and stop it if it doesn't seem to be working.

Treatments for other symptoms

Other treatments include:

painkillers such as paracetamol or ibuprofen for painful joints
aqueous creams and emollients for dry skin
lubricants, such as KY jelly and oestrogen creams for vaginal dryness