Sjögren's Syndrome - Medical Experts

Sjögren's syndrome is an autoimmune disease that causes inflammation of the tear and salivary glands and often leads to dry mouth and dry eyes.

Sjögren’s syndrome can occur as a standalone condition or as a symptom associated with other immune system disorders (e.g., rheumatoid arthritis, systemic lupus erythematosus). Among rheumatic autoimmune diseases, Sjögren’s syndrome is the second most common (after rheumatoid arthritis).

Dry eyes can severely damage the cornea, leading to itching and irritation in the eyes @ PheelingsMedia /AdobeStock

These tips can help with Sjögren’s syndrome in everyday life:

• Careful prevention of tooth decay is advisable. Avoid excessive sugar intake, and take fluoride supplements if necessary.
• See your dentist regularly for checkups.
• Use chewing aids such as sugar-free gum. This stimulates the salivary glands.
• Be aware of the increased risk of infection, and if in doubt, see a specialist immediately to take antibiotics if necessary.
• Ensure adequate air humidity and avoid unfavorable environmental conditions such as air conditioning or cigarette smoke.
• In strong winds, wear glasses with side protection.
• Use an eye gel or eye ointment at night.
• Use a nasal gel to prevent the formation of crusts.
• A “lethargic” fatigue is typical of SS, so treat yourself to rest breaks (afternoon naps) as often as possible.
• Talk to others who are going through the same thing.

Clinically, Sjögren’s syndrome is primarily characterized by inflammation of the tear and salivary glands. The main symptom is dryness of the mouth and eyes. As the condition progresses, this “dryness” can also affect other mucous membranes (e.g., genital organs, respiratory tract).

Sjögren’s syndrome is not merely a disease of the glands, but of the entire body. Other symptoms such as fatigue, exhaustion, or fever may also occur.

Other symptoms include:

• Swelling of the salivary glands
• Pain in the joints and muscles
• Inflammation of the blood vessels (vasculitis)

Sjögren’s syndrome leads to severe impairments and unpleasant complications, particularly in the mouth and eyes.

These include:

• Chronic inflammation and frequent infections in the oral cavity and conjunctiva
• Tooth decay and periodontal disease
• Bad breath
• Difficulty swallowing solid and dry foods
• Impaired sense of taste and smell
• Hoarseness
• Recurrent respiratory infections

In rare cases (< 8 percent), a tumor of the lymph nodes (lymphoma) may develop as Sjögren’s syndrome progresses. Since a tumor is usually located in the area of the salivary glands or cervical lymph nodes, your doctor should pay particular attention to any possible increase in size. If in doubt, your doctor will diagnose a tumor using magnetic resonance imaging (MRI) or by taking a tissue sample (biopsy).

Unfortunately, Sjögren’s syndrome is usually diagnosed late because dry eyes and a dry mouth are often misinterpreted.

1. In addition to the typical clinical findings, the doctor will first perform simple functional tests to determine insufficient tear or saliva production.
2. Further examinations of the salivary glands using imaging techniques (scintigraphy, sialography, MRI) then lead to a presumptive diagnosis.
3. A biopsy of the inner surface of the lip usually provides definitive proof.
4. Laboratory tests provide guidance but cannot confirm the diagnosis. Immunological detection of antibodies—which are found in the blood of many (but not all) patients—is useful here. The SS-A and SS-B antibodies are relevant.

Please note that there are many other causes of dry mouth and dry eyes:

• Diabetes mellitus, fibromyalgia syndrome, or viral infections (e.g., viral hepatitis) can also cause similar symptoms.
• Certain medications (e.g., for high blood pressure and mental health conditions) can also cause dry mouth.
• In healthy individuals, advancing age also reduces glandular production.

Swelling of the salivary glands can also have numerous other causes. Only a specialist can diagnose these through a thorough examination. A visit to an ophthalmologist and an ENT specialist is also recommended.

Scintigraphy is a nuclear medicine imaging technique in which the patient is administered radioactively labeled substances @ Werner /AdobeStock

Treatment for Sjögren’s Syndrome

Although the disease is incurable and there are no effective medications, there are a number of treatment options. In addition, there are promising areas of research.

In treating Sjögren’s syndrome, doctors focus on the following areas:

1. Dryness symptoms are treated with substitutes such as artificial tears, saliva, or nasal gel, as well as by ensuring adequate fluid intake. Various tear and saliva substitutes are available.
2. For the body as a whole, however, there are a number of medications available that are useful for specific purposes. However, these medications have no effect on the symptoms of dryness. If, for example, you suffer from muscle and joint pain, pain relievers such as acetylsalicylic acid and anti-inflammatory drugs such as cortisone may be helpful.
3. Immunosuppressants are the treatment of choice when there is a risk of damage to internal organs and blood vessels.

In the U.S., substances such as pilocarpine and cevimeline, which increase fluid production, have been successfully tested. Of these substances, oral pilocarpine (brand name: Salagen®) has been approved in Germany since 2000 and is therefore available by prescription.

A specialist in Sjögren’s syndrome is typically a rheumatologist, who is responsible for diagnosis and treatment. Collagen diseases, which include Sjögren’s syndrome, also fall within the rheumatologist’s area of expertise. A rheumatologist may be either a specialist in internal medicine or a specialist in orthopedics. In either case, however, they have completed additional training in the field of rheumatology.