In the U.S., it is estimated that about 4 million people have Sjogren’s syndrome. It is not uncommon for people to be misdiagnosed at first. On average, it takes about 2.8 years for people to get an accurate diagnosis when they have this condition.

This condition is a type of autoimmune disorder. Your tissues and cells are attacked by your immune system by mistake. The exact cause is unknown, but researchers believe that some people are at a higher risk due to certain genes.

People of all ages can develop this condition, but age 40 is the average age of diagnosis.

Initially, the condition usually presents itself as dry mouth and eyes. (Learn More) As the condition progresses, there are several other symptoms that may present.

Certain complications are possible when people have this condition. The most common are associated with the mouth and eyes, but it is possible for other areas of the body to be affected as well. (Learn More)

There is no cure, but there are treatment options to help you control the condition. Certain medications might be beneficial, depending on your symptoms. (Learn More) There is also a surgical option if medications do not help your dry eyes. (Learn More)

There are alterations to your lifestyle that can be beneficial. (Learn More) You can incorporate these methods into your prescribed treatment regimen.

woman suffering from ocular migraine

Symptoms of Sjogren’s Syndrome

 

Dry mouth and dry eyes are the most common symptoms of Sjogren’s syndrome. Among those with the disorder, approximately 93 percent have dry eyes and 98 percent experience dry mouth, according to research published in Medicine.

Your mouth may feel like you have cotton in it. This can sometimes make it hard to speak or swallow.

When your eyes get dry, they may itch or burn. In some cases, they may feel gritty or like you have sand in them. If the dryness goes untreated, this increases the risk of blurry vision, light sensitivity, and corneal damage.

Dry mouth is due to reduced production of saliva when this condition affects your salivary glands. It can also affect the tear glands, resulting in fewer natural tears being produced.

Other symptoms are also possible, including:

  • Swollen salivary glands.
  • Vaginal dryness.
  • Prolonged fatigue.
  • Joint swelling, pain, and stiffness.
  • Dry skin or rashes.
  • Persistent dry cough.

Possible Complications

old man with vision problems

The complications usually affect your mouth and eyes. Reduced saliva production can increase your risk of dental cavities. This is because saliva plays an important role in protecting the oral cavity tissues and your teeth. Reduced saliva can also make mouth infections more likely.

Yeast infections in the mouth are more likely with this condition. Referred to as thrush, this infection is caused by a fungus called Candida. It can cause fever, the sensation of food getting stuck in your mid-chest or throat, and trouble swallowing or pain with swallowing.

Other complications may include:

  • Tingling or numbness.
  • Memory loss, confusion, or trouble concentrating.
  • Inflammation affecting the kidneys, pancreas, lungs, or liver.
  • Nerve irritation in the extremities (neuropathy).
  • Abnormalities of the thyroid gland.
  • Gastrointestinal issues, such as bloating, diarrhea, acid reflux, or abdominal pain.

While rare, this condition can increase your risk of developing lymphoma. This is a cancer that originates in the lymphatic system.

Treating Sjogren’s With Medications

 

There are several medications that might be considered to reduce the symptoms of this condition. Stimulating saliva is important to decrease the symptoms and possible complications of dry mouth.

Because of this, doctors might recommend cevimeline capsules or pilocarpine tablets. Both medicines work to stimulate your salivary glands.

Your doctor might also recommend a gel that coats your mouth. You will usually use these at night. Some examples include Glandosane and Oralube.

There are pellets and eyedrops that can help to ease dry eyes. Common examples include hydroxypropyl cellulose pellets and cyclosporine ophthalmic emulsion. The pellets may help to decrease your reliance on artificial tears, but your doctor may still recommend using artificial tears to help dissolve the pellets.

Some eyedrops, such as cyclosporine, work to reduce inflammation. This medicine focuses on inflammation affecting the lacrimal glands. However, it may take up to several months before you notice a reduction in dryness.

Drugs, such as cevimeline or pilocarpine hydrochloride, work to stimulate the salivary and lacrimal glands to reduce eye and mouth dryness. These medicines are referred to as cholinergic agonists. It can take about two weeks before you start to notice the results.

If you have joint pain, your doctor might recommend ibuprofen or another nonsteroidal anti-inflammatory drug. If you have joint pain along with fatigue and skin rashes, your doctor might recommend methotrexate, hydroxychloroquine, or another disease-modifying antirheumatic drug (DMARD).

For lung, nerve, kidney, or muscle involvement, corticosteroids or stronger DMARDs may be recommended. Other options include cyclophosphamide or azathioprine.

The following are other medications your doctor might recommend:

  • Guaifenesin
  • Antifungal medications to treat yeast infections
  • Duloxetine or another drug in the same class to treat pain
  • Immunosuppressive medications, especially if you also have another autoimmune disease

In addition to using the right medications, it is important to avoid any medicines that can reduce body fluids, whenever possible. If a doctor wants to prescribe a medication, make sure they are aware that you have Sjogren’s to reduce the risk of taking medications that could worsen your symptoms.

Punctal Occlusion

 

A punctal occlusion is a surgical procedure that may be performed if medications and lifestyle changes do not alleviate your dry eyes sufficiently. Your doctor can perform it on one eye or both, depending on how Sjogren’s syndrome is affecting you.

Your doctor may use a punctal plug for the procedure. These plugs are tiny devices that block drainage once they are inserted into your tear ducts. The result is increased surface moisture and tear film to reduce your dry eye. On average, the plugs are about the size of a grain of rice.

The punctal occlusion procedure does not cause any pain. Your doctor will use either a silicone or collagen plug. Once the plug is in place, the drainage of tears is slower.

Think of it like when there is something obstructing half of the drain in your bathtub. The water still drains, but at a slower pace.

Each eye has two puncta where the doctor can insert the plugs. One is on the lower lid, and one is on the upper lid.

In most cases, your doctor will start by placing plugs that dissolve in about seven days. You will then go to a follow-up visit in 10 to 14 days.

At this point, you can both decide if a semi-permanent plug is a good choice based on the results of the initial procedure.

Lifestyle Changes

 

In addition to conventional treatments, there are some lifestyle changes that may help to reduce your symptoms. The following may help to improve dry mouth:

  • Use an artificial saliva. Since they contain a lubricant, they help your mouth stay moist longer than regular water.
  • Sip fluid frequently throughout the day. Plain water is best.
  • Use a saline spray for your nose. A stuffy nose can cause mouth breathing, and this worsens dry mouth.
  • Do not smoke since this can dry out and irritate your mouth.
  • Use sugar-free candy or gum to stimulate the flow of saliva.
  • Maintain good oral hygiene.

Since your skin can also get dry, it can help to stay moisturized. Once you shower or bathe, gently pat your skin dry and apply a moisturizer.

A vaginal lubricant may be used if dryness in this area is a problem.

Your doctor may recommend an eye lubricant or artificial tears for eye dryness. In some cases, you might benefit from using both.

Keeping your home humidified can be helpful. When air is humid, it reduces dry skin, mouth, and eyes. You can use a humidifier in your home for this purpose.

There are viable treatments that can help you to be comfortable while living with Sjogren’s syndrome. Track your symptoms and be upfront with your doctor about how your treatment regimen is working. Making changes along the way may be necessary for you to maintain control over your condition.

Rear View Of Loving Couple Walking Towards House

References

 

Quick Facts: Autoimmune Disorders, Sjogren’s, and Women. Sjogren’s Syndrome Foundation.

About Sjogren’s. Sjogren’s Syndrome Foundation.

Primary Sjogren Syndrome: Clinical and Immunologic Disease Patterns in a Cohort of 400 Patients. (July 2002). Medicine.

Sjogren Syndrome. Genetics Home Reference.

Sjogren’s Syndrome. Cleveland Clinic.

Artificial Tears. ScienceDirect.

Medications for Sjogren’s Syndrome. NYU Langone Health.

Sjogren’s Syndrome Treatment. Arthritis Foundation.

Punctal Plugs for Dry Eyes. All About Vision.

Plugging Your Tear Ducts for Treating Dry Eyes. (September 17, 2018) Verywell Health.