Sjogren’s Syndrome

Sjogren's syndrome is a long-term autoimmune disease in which the immune system attacks the glands that produce tears and saliva, causing persistently dry eyes and a dry mouth. It can also cause fatigue and joint pain and, in some people, affect the nerves, lungs, kidneys or blood.

It occurs alone, as primary Sjogren's, or together with rheumatoid arthritis, lupus or scleroderma. Nine in ten of those affected are women, usually diagnosed in their forties or fifties. It cannot be cured, but symptoms and complications can be managed, and most people have a normal life expectancy.

Symptoms

• Dry, gritty or burning eyes and sensitivity to light
• A dry mouth, with difficulty swallowing dry food or talking for long
• Rapid tooth decay and oral thrush
• Swelling of the glands in front of the ears or under the jaw
• Marked tiredness
• Joint and muscle aches
• Dryness of the skin, nose and vagina
• A dry cough
• Numbness, tingling or burning in the feet or hands

Causes and risk factors

The cause is unknown. Genetic susceptibility, female hormones and probably a viral trigger lead to immune cells infiltrating and damaging the moisture-producing glands. Overactive B lymphocytes produce the characteristic anti-Ro (SSA) and anti-La (SSB) antibodies. This long-term B cell stimulation explains the main serious complication, a raised risk of lymphoma, which affects about 5 in 100 patients over a lifetime. Many medicines, age, diabetes and radiotherapy also cause dryness and need to be excluded.

How it is diagnosed

• Schirmer test and ocular surface staining: Measure tear production and damage to the surface of the eye.
• Salivary flow measurement: Unstimulated saliva is collected over a set time.
• Blood tests: Anti-Ro and anti-La antibodies, ANA, rheumatoid factor, immunoglobulins, complement levels and blood count.
• Minor salivary gland biopsy: A small sample taken from inside the lower lip under local anaesthetic shows clusters of lymphocytes. It is important when antibodies are negative.
• Salivary gland ultrasound: Shows a typical patchy texture and is increasingly used.
• Screening for organ involvement: Urine, kidney tests, chest imaging or nerve studies, as symptoms suggest.

Treatment options

• Eye care: Preservative-free artificial tears and gels, ciclosporin eye drops, punctal plugs and, in severe cases, serum tears.
• Mouth care: Frequent sips of water, sugar-free gum, saliva substitutes, high-fluoride toothpaste and dental checks every 3 to 6 months.
• Pilocarpine or cevimeline: Tablets that stimulate the glands that still function. Sweating is the main side effect.
• Hydroxychloroquine: Often used for joint pain, fatigue and rashes, although trial evidence is modest.
• Immunosuppressants and rituximab: For significant involvement of the nerves, lungs, kidneys or blood vessels.
• Monitoring for lymphoma: Persistent gland swelling, enlarged lymph nodes, low complement or unexplained weight loss lead to investigation.

When it is urgent

A salivary gland that becomes persistently hard and enlarged, drenching night sweats with weight loss, a sudden painful red eye with reduced vision, or new weakness or difficulty breathing should be assessed promptly by a doctor near you.

Travelling to Türkiye for treatment

Sjogren's is managed over a lifetime by your own rheumatologist, eye doctor and dentist. A visit can help to secure the diagnosis, since a lip biopsy, the antibody profile and eye tests can be completed in 2 to 3 days. It can also provide procedures such as punctal plugs, or extensive dental restoration for damage caused by a dry mouth. If you travel for dental work, tell the dentist about the diagnosis, because dryness affects which materials are used and how well implants are maintained.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions