Sjögren’s Disease

Sjögren’s disease is a chronic autoimmune disorder in which the immune system mistakenly attacks the body’s own tissues.

The tear and salivary glands are most commonly affected, making dry eyes and dry mouth the classic symptoms. However, Sjögren’s disease is a systemic condition and can also cause fatigue, joint pain, skin symptoms, or involvement of the lungs, kidneys, nervous system, and blood.

It may occur on its own or together with other autoimmune diseases such as rheumatoid arthritis or systemic lupus erythematosus.

Common symptoms include:

• Dry, gritty, burning, or light-sensitive eyes

• Dry mouth and frequent thirst

• Difficulty swallowing dry foods without drinking water

• Increased dental cavities or oral infections

• Recurrent swelling of the salivary glands

• Fatigue

• Joint or muscle pain

• Dry skin or purpuric skin rashes

Some patients develop systemic disease. Lung involvement may cause persistent dry cough or shortness of breath and can include interstitial lung disease. Kidney involvement may lead to renal tubular acidosis and low potassium levels. Neurologic involvement can cause numbness, tingling, sensory changes, or weakness. Blood abnormalities such as anemia or low white blood cell or platelet counts may also occur.

Dry eyes and dry mouth do not automatically mean that a person has Sjögren’s disease. Medications, aging, diabetes, thyroid disease, other autoimmune conditions, and some infections can cause similar symptoms.

Evaluation may include:

• Autoantibody testing, especially anti-SSA/Ro

• Schirmer testing to measure tear production

• Ocular surface staining

• Measurement of unstimulated salivary flow

• Minor salivary gland biopsy when needed

The widely used 2016 ACR/EULAR classification criteria are based on five objective measures: anti-SSA/Ro positivity, minor salivary gland biopsy findings, ocular staining, Schirmer testing, and unstimulated salivary flow.

Classification criteria support standardized assessment but do not replace clinical judgment by an experienced rheumatologist.

Treatment depends on the patient’s symptoms and whether there is systemic organ involvement.

For patients whose main problems are dry eyes and dry mouth, treatment focuses on symptom relief and long-term protection of the eyes and oral health.

Dry eyes may be treated with artificial tears, lubricating eye products, and, in selected patients, anti-inflammatory eye drops under ophthalmologic supervision.

Dry mouth can be managed with frequent sips of water, sugar-free gum or other measures that stimulate saliva, along with careful dental hygiene, fluoride toothpaste, and regular dental care.

If the disease affects the joints, skin, lungs, kidneys, nervous system, or blood, systemic treatment may be needed. Depending on the organ involved and disease activity, options can include corticosteroids, conventional disease-modifying antirheumatic drugs, biologic therapies, or other immunomodulatory treatments.

EULAR recommends tailoring topical and systemic treatment to the type and severity of disease involvement rather than using one treatment approach for every patient.