Sjogren's syndrome

Sjogren's syndrome is a relatively common condition that mainly affects the eyes and salivary glands, but can affect different parts of the body.

Sjogren's syndrome is an autoimmune condition, which means it occurs as a result of a malfunctioning immune system.

Your immune system is designed to identify foreign bodies (such as bacteria and viruses) and attack them to keep you healthy. However, in the case of Sjogren's syndrome your immune system attacks the glands that make tears and saliva. This prevents the glands from working properly and causes dryness of the mouth, eyes or other tissues.

The condition may progress slowly, so the typical symptoms of dry eyes and mouth may take years to show. However, rapid onset can also occur. Symptoms can be mild, moderate or severe, and the progression is often unpredictable.

Women are most commonly affected by Sjogren's syndrome. There is no cure, but it can be managed effectively.

In rare cases, organs such as the liver and kidneys may be involved, which can increase the severity of the condition.

In a small number of people, Sjogren's syndrome may be associated with lymphoma (cancer of the lymph glands).

Cause of Sjogren's syndrome

It is not known what causes Sjogren's syndrome. It appears that your genes may play a role, combined with an outside trigger such as a bacteria or virus.

It’s also more likely to affect people who have conditions such as rheumatoid arthritis, scleroderma and lupus.

Symptoms of Sjogren's syndrome

The more common symptoms of Sjogren's syndrome include:

• dry eyes (irritation, feeling gritty or itchy, burning)
• dry mouth (or difficulty chewing or swallowing).

Other areas can be affected

Sjogren's syndrome is a systemic condition, which means it can affect the entire body.

Other symptoms can include:

• swelling and tenderness of the glands around your face, neck, armpits and groin
• tiredness (fatigue)
• dry skin or rashes
• joint pain and general achiness
• dryness of the nose, ear and throat
• vaginal dryness
• bowel irritation.

Complications can include:

• increased risk of dental decay
• increased risk of developing thrush infections in the mouth
• vision problems
• inflammation of internal organs (such as the kidneys, lungs or liver)
• problems with the circulatory and nervous system.

See your doctor straight away if you notice excessive redness and pain in the eyes as this could be a sign of infection.

Diagnosing Sjogren's syndrome

Early diagnosis and treatment are important for preventing future complications.

It can be difficult to diagnose Sjogren's syndrome as the symptoms can imitate those of other conditions such as lupus and fibromyalgia. Dry mouth and eyes can also be the side effects of medications for other problems, such as depression and high blood pressure.

Diagnosing Sjogren's syndrome is often done by a rheumatologist (a specialist who treats conditions that affect joints, muscles, and bones) and involves a number of tests, which may include:

• Schirmer's test – special blotting paper held to the eye is used to assess the degree of tear production
• eye examination – including the use of special dyes
• biopsy – a small piece of salivary gland tissue is removed (usually from the lip) and examined under a microscope
• blood tests – may be used to check the levels of particular immune system cells in the blood, and to check for any problems with your kidneys or liver.

Treating Sjogren's syndrome

There is no cure for Sjogren's syndrome, but it can be managed effectively. Treatment may include:

• artificial tears and lubricating ointments for the eyes
• artificial saliva
• mouth rinses and lozenges
• nasal sprays
• vaginal lubricants
• moisturising lotion for the skin
• non-steroidal anti-inflammatory drugs (NSAIDs) – these medications (for example naproxen and ibuprofen) help control inflammation and provide temporary pain relief
• corticosteroid medications – may be used as a temporary treatment for joint pain
• immunosuppressive medications (for example hydroxychloroquine and methotrexate) – may be used to help control your overactive immune system.

Self-management of Sjogren's syndrome

There are many things you can do to manage your Sjogren's syndrome including:

• Avoid dry and dusty environments.
• Avoid air drafts or windy weather.
• Wear protective glasses when outside in the wind and sun.
• Sip water regularly or suck ice cubes.
• Avoid strong soaps that may dry out your skin.
• Try to increase the humidity in your home.
• Exercise regularly, eat a healthy diet, stop smoking and reduce stress to help your overall health and wellbeing.
• Eat soft, moist foods if you have trouble swallowing.
• Eat smaller, more frequent meals to stimulate saliva flow.
• Use warm (not hot) water when taking a shower or bath.
• Chew sugarless gum to stimulate saliva.
• Avoid salty, acidic or spicy foods and carbonated drinks that may be painful if your mouth is dry.
• Practice good dental hygiene and visit your dentist often.

Where to get help

• Your GP (doctor)
• Rheumatologist
• Ophthalmologist (eye doctor)
• Dentist
• Musculoskeletal Health Australia B.A.M Helpline Tel. 1800 263 265 or email helpline@muscha.org
• Arthritis Australia Tel. 1800 011 041.