Sjögren’s syndrome (SS) is a chronic, long-term autoimmune disease that affects the body’s moisture-producing glands, resulting in reduced production of tears, saliva, and other bodily fluids.

The glands most commonly affected are the tear glands and salivary glands. People with Sjögren’s syndrome often experience dry, irritated eyes that may feel gritty, as though there is sand in them, along with persistent dry mouth. These symptoms can become more noticeable as the day progresses.

Sjögren’s syndrome can also affect other glands, tissues, and organs throughout the body, leading to a wide range of additional symptoms. These may include joint pain, skin rashes, fatigue, and numbness or tingling in the hands and feet.

Diagnosing Sjögren’s syndrome can be challenging because its symptoms vary considerably from person to person and can resemble those of many other medical conditions. For this reason, diagnosis is best made by a rheumatologist or another healthcare specialist with experience in identifying and treating Sjögren’s syndrome.

Symptoms of Sjögren’s Syndrome

In Sjögren’s syndrome, the immune system primarily attacks the body’s moisture-producing glands, which are responsible for producing fluids such as tears and saliva. However, the disease can also affect other tissues and organs throughout the body.

The good news is that most people with Sjögren’s syndrome experience relatively mild symptoms. These commonly include dry eyes, dry mouth, joint discomfort, and fatigue. However, the severity of the disease can vary, and some people may develop more serious complications involving other organs.

Dry Eyes

Dry eyes are one of the most common symptoms of Sjögren’s syndrome because the immune system frequently targets the tear-producing glands.

People with the condition often experience dryness, irritation, burning, or a gritty sensation, as though there is sand in their eyes. Symptoms may become worse as the day progresses, and frequent use of artificial tears or lubricating eye drops may be necessary to provide relief.

Dry Mouth

Another common symptom of Sjögren’s syndrome is reduced saliva production, which causes persistent dry mouth.

This can make everyday activities such as speaking, chewing, and swallowing more difficult. Reduced saliva production also increases the risk of dental problems, including tooth decay, cavities, and oral infections.

Dryness and Swelling of Other Glands

Although the tear and salivary glands are most commonly affected, Sjögren’s syndrome can also involve other moisture-producing tissues and glands throughout the body.

These may include glands and tissues associated with the skin, airways, esophagus (the tube connecting the mouth to the stomach), and vagina. Reduced moisture production in these areas can cause dryness, irritation, and discomfort.

Sjögren’s syndrome can also cause glandular swelling, particularly in the salivary glands around the head and neck. The glands near the cheeks and jaw are commonly affected.

Fatigue

Fatigue is a very common symptom of Sjögren’s syndrome. The ongoing activation of the immune system and chronic inflammation can contribute to persistent tiredness and exhaustion.

For some people, fatigue can be severe enough to interfere with everyday activities, work, and quality of life.

Arthritis and Joint Pain

Some people with Sjögren’s syndrome also develop inflammatory arthritis. This occurs when the immune system attacks tissues around the joints, causing pain, swelling, and stiffness.

Joint symptoms can vary in severity and may affect several joints throughout the body.

Fibromyalgia can also occur alongside Sjögren’s syndrome, contributing to widespread pain, tenderness, sleep disturbances, and fatigue.

Less Common Symptoms and Complications

Although most people experience relatively mild symptoms, Sjögren’s syndrome can sometimes affect other organs and systems. Less common manifestations include:

• Raynaud’s phenomenon: A condition in which the small blood vessels in the fingers and toes temporarily narrow in response to cold temperatures or stress. This can cause the affected areas to turn white or blue, followed by redness as circulation returns.
• Vasculitis: Inflammation of the blood vessels. This can cause a skin rash, sometimes appearing as clusters of small red or purple spots, particularly on the lower legs.
• Neuropathy: Damage or inflammation affecting the nerves. This can cause numbness, tingling, burning sensations, or pain, particularly in the feet and sometimes the hands.
• Pulmonary fibrosis: A condition involving scarring of lung tissue, which can make breathing increasingly difficult. Significant lung involvement is uncommon.
• Kidney involvement: Sjögren’s syndrome can occasionally affect kidney function, although serious kidney complications are relatively uncommon.
• Hypothyroidism: An underactive thyroid gland that produces insufficient thyroid hormone. This can cause symptoms such as fatigue, weight gain, and sensitivity to cold.

Increased Risk of Lymphoma

Although uncommon, people with Sjögren’s syndrome have an increased risk of developing a type of cancer called lymphoma, which affects the lymphatic system.

The risk is particularly associated with certain forms of B-cell lymphoma. Most people with Sjögren’s syndrome will never develop lymphoma, but it is important for patients and their healthcare providers to be aware of this potential complication.

Regular medical follow-up helps monitor the disease, identify changes in symptoms, and detect potential complications as early as possible.

Sjögren’s syndrome is typically diagnosed by a rheumatologist, a physician who specializes in arthritis and autoimmune diseases. Other specialists with experience in diagnosing and managing Sjögren’s syndrome may also be involved.

Diagnosing Sjögren’s can be challenging because the disease causes a wide range of symptoms that can overlap with those of other medical conditions. Having a healthcare professional who is familiar with the disease is therefore particularly important.

Medical History

The diagnostic process begins with a thorough medical history. The physician will ask detailed questions about the patient’s symptoms, overall health, and medical background.

Because Sjögren’s syndrome can affect many different parts of the body, questions may cover symptoms such as dry eyes, dry mouth, fatigue, joint pain, skin problems, and numbness or tingling in the hands and feet.

Physical Examination

The physician will then perform a comprehensive physical examination to look for signs of Sjögren’s syndrome and identify any other areas of the body that may be affected.

The examination may include:

• Head and neck: Looking for signs of dry eyes, dry mouth, and swollen salivary glands.
• Eyes: Assessing eye dryness and irritation.
• Lungs and heart: Checking for signs of possible organ involvement.
• Abdomen: Looking for abnormalities that may suggest internal organ involvement.
• Joints: Checking for pain, swelling, and stiffness.
• Skin: Looking for dryness, rashes, and other signs of inflammation.

Specialized Tests

Several tests may be recommended to help confirm a diagnosis.

Schirmer’s Test

The Schirmer’s test measures tear production to determine whether the eyes are producing enough moisture. A small strip of filter paper is placed inside the lower eyelid for a few minutes to measure how much it becomes wet. Reduced tear production may indicate significant eye dryness.

Salivary Gland Biopsy

A minor salivary gland biopsy may also be recommended. This procedure involves removing a very small sample of tissue, usually from the inside of the lower lip, for examination under a microscope.

The biopsy can help identify characteristic inflammation in the salivary glands and provide additional evidence to support a diagnosis of Sjögren’s syndrome.

Blood Tests

Specialized blood tests are used to look for autoantibodies, which are antibodies that mistakenly target the body’s own tissues.

Common tests include:

• Anti-SSA (Ro) antibodies: Frequently found in people with Sjögren’s syndrome and an important marker used in diagnosis.
• Anti-SSB (La) antibodies: May also be present and can provide additional diagnostic information.
• Antinuclear antibodies (ANA): These antibodies can indicate an autoimmune process and are frequently found in people with Sjögren’s syndrome.
• Rheumatoid factor (RF): May also be elevated in people with Sjögren’s syndrome.

No single blood test can confirm or exclude Sjögren’s syndrome in every patient. Results must be interpreted alongside symptoms, physical examination findings, and other specialized tests.

Monitoring for Lymphoma

Although uncommon, people with Sjögren’s syndrome have an increased risk of developing lymphoma, a type of cancer that affects the lymphatic system.

Patients should have regular medical follow-up so that their healthcare providers can monitor for potential complications. Routine evaluation is particularly important if new symptoms develop, such as persistent swelling of the salivary glands, enlarged lymph nodes, unexplained weight loss, night sweats, or persistent fevers.

The approach to monitoring should be individualized based on the patient’s symptoms, examination findings, and overall risk factors.

The Schirmer’s test measures how much tear fluid the eyes produce over a specific period of time. It is commonly used to assess eye dryness in people suspected of having Sjögren’s syndrome (SS).

Because Sjögren’s causes the immune system to attack the tear-producing glands, people with the condition often have reduced tear production and significant eye dryness. The Schirmer’s test helps doctors determine whether the eyes are producing enough tears to stay properly lubricated.

A low test result may indicate reduced tear production and provide important evidence to support a diagnosis of Sjögren’s syndrome.

When the body’s immune system is “activated” and busy attacking the spine and joints, it can make a person feel very tired, similar to when they have the flu.

A salivary gland biopsy involves removing a very small sample of tissue, usually from the minor salivary glands inside the lower lip. The tissue is then examined under a microscope for signs of inflammation associated with Sjögren’s syndrome (SS).

In people with Sjögren’s, the immune system attacks the salivary glands, causing white blood cells called lymphocytes to accumulate within the glandular tissue. This process is known as lymphocytic infiltration.

Identifying these clusters of lymphocytes can provide important evidence to support a diagnosis of Sjögren’s syndrome.

Blood tests play an important role in diagnosing Sjögren’s syndrome (SS). They help identify antibodies that target the body’s own tissues, detect signs of immune system overactivity, and assess whether inflammation or other organs are affected.

Looking for Antibodies That Attack the Body – Antinuclear Antibody (ANA)

The antinuclear antibody (ANA) test is an important initial blood test when Sjögren’s syndrome or another autoimmune disease is suspected.

This test looks for antibodies that mistakenly target components within the body’s own cells, particularly structures found in the cell nucleus.

A positive ANA result may indicate an autoimmune condition. However, positive results can also occur in healthy individuals and people with other medical conditions. Therefore, a positive ANA test alone cannot confirm Sjögren’s syndrome.

A negative ANA result makes certain autoimmune conditions less likely, but it does not completely rule out Sjögren’s syndrome. If symptoms suggest the disease, additional testing may still be appropriate.

Looking for Antibodies That Target Specific Proteins – Extractable Nuclear Antigen (ENA) Panel

The Extractable Nuclear Antigen (ENA) panel is a group of blood tests that looks for antibodies directed against specific proteins in the body’s cells.

Depending on the laboratory, the panel may include tests for:

• Anti-Ro (SSA): Commonly found in people with Sjögren’s syndrome and an important marker used in diagnosis.
• Anti-La (SSB): Another antibody that may be present in people with Sjögren’s syndrome.
• Anti-Sm (Smith): An antibody associated primarily with lupus.
• Anti-RNP: An antibody associated with mixed connective tissue disease and other autoimmune conditions.
• Anti-Jo-1: An antibody associated with certain inflammatory muscle diseases.
• Anti-Scl-70: An antibody associated with systemic sclerosis (scleroderma).
• Anti-centromere: An antibody commonly associated with certain forms of systemic sclerosis.

Anti-Ro (SSA) and anti-La (SSB) are particularly relevant when investigating Sjögren’s syndrome. However, not everyone with the disease will test positive for these antibodies.

Interpreting ENA results can be complicated, so patients should discuss their results with a rheumatologist who is familiar with autoimmune diseases.

Rheumatoid Factor (RF)

Rheumatoid factor (RF) is an autoantibody that can be found in people with several autoimmune conditions, including rheumatoid arthritis and Sjögren’s syndrome.

Some patients with Sjögren’s syndrome have elevated RF levels, even if they do not have rheumatoid arthritis.

A positive RF result can provide additional evidence of immune system activity, but it is not specific to Sjögren’s syndrome and must be interpreted alongside other test results and clinical findings.

Looking for Increased Antibody Production – Immunoglobulin Levels

An immunoglobulin test measures the levels of antibodies circulating in the blood.

People with Sjögren’s syndrome can develop increased activity of B-lymphocytes (B-cells), a type of white blood cell responsible for producing antibodies. This increased immune activity can lead to excessive antibody production, a condition known as hypergammaglobulinemia.

As a result, blood tests may show elevated levels of immunoglobulins, particularly IgG.

These findings can provide additional evidence of immune system activation and help doctors assess disease activity.

Looking for Inflammation

Sjögren’s syndrome is an inflammatory autoimmune disease, so blood tests may show changes associated with inflammation.

Common tests include:

• Complete Blood Count (CBC): Measures different types of blood cells and can identify abnormalities such as anemia or reduced white blood cell counts.
• Erythrocyte Sedimentation Rate (ESR): Measures how quickly red blood cells settle in a test tube. An increased rate can indicate inflammation.
• C-Reactive Protein (CRP): Measures a protein produced by the liver in response to inflammation. Levels may increase when inflammation is present, although CRP can remain normal in some people with Sjögren’s syndrome.

These tests help doctors assess inflammation and identify other abnormalities that may be associated with the disease.

Looking at Kidney Function – Creatinine

Sjögren’s syndrome can occasionally affect the kidneys, making it important to monitor kidney function.

Creatinine is a waste product produced by normal muscle activity and removed from the blood by the kidneys. A blood creatinine test helps doctors assess how effectively the kidneys are working.

Elevated creatinine levels may indicate reduced kidney function and could suggest kidney involvement.

Additional tests, such as estimated glomerular filtration rate (eGFR), urine analysis, and urine protein measurements, may be recommended to provide a more complete assessment of kidney health.

Sjögren’s syndrome is an autoimmune disease in which the body’s immune system mistakenly attacks its own moisture-producing glands, particularly the glands responsible for producing tears and saliva.

The exact reason why the immune system becomes overactive in people with Sjögren’s syndrome is not yet fully understood. However, researchers know that a type of white blood cell called a B lymphocyte (or B-cell) plays an important role in the disease.

In people with Sjögren’s syndrome, B-cells can become overactive and produce excessive amounts of antibodies. Some of these antibodies mistakenly target the body’s own healthy tissues, contributing to inflammation and damage to the moisture-producing glands. This abnormal immune response is responsible for many of the symptoms associated with Sjögren’s syndrome.

Sjögren’s syndrome is an autoimmune disease in which the body’s immune system mistakenly attacks its own healthy cells and tissues, particularly the glands responsible for producing moisture. Although the exact reason this happens is not fully understood, this abnormal immune response causes inflammation and can interfere with the normal function of these glands.

When the immune system becomes overactive in this way, it can also affect the body more broadly, causing symptoms such as persistent fatigue and exhaustion. Some people describe this tiredness as feeling similar to having the flu, even when they are not sick.

Sjögren’s syndrome is a relatively uncommon autoimmune disease, affecting approximately 0.5% of the population, or about 1 in every 200 people. It occurs approximately ten times more frequently in women than in men.

Although Sjögren’s syndrome can develop at any age, most people begin experiencing their first symptoms between the ages of 30 and 50.

There is no specific diet proven to stop AS or reverse spinal changes. A Mediterranean-style pattern—vegetables and fruit, whole grains, legumes, nuts, fish, and unsaturated fats—is a reasonable approach for overall health. Foods such as tomatoes and bell peppers can be included, but they shouldn’t be considered treatments for AS.

Tomatoes and Sjögren’s Syndrome Education

Tomatoes can be a nutritious addition to an arthritis-friendly diet, although they do not cure arthritis or directly reverse joint damage.

• Lycopene: Tomatoes are particularly rich in lycopene, an antioxidant that helps protect cells from oxidative stress. Cooked tomatoes and tomato products can provide especially well-absorbed lycopene.

• Vitamin C: Supports collagen formation and normal connective-tissue function.

• Antioxidants: Tomatoes contain vitamin C, carotenoids, and other plant compounds that contribute to overall antioxidant intake.

• Potential anti-inflammatory effects: Laboratory and observational research suggests that compounds in tomatoes may influence inflammatory pathways, but evidence that eating tomatoes significantly reduces arthritis pain or inflammation in people is still limited.

• Heart health: Tomatoes can contribute to a heart-healthy diet, which is particularly relevant for people with Sjögren’s Syndrome Education, because Sjögren’s Syndrome Education is associated with increased cardiovascular risk.

Some people with arthritis report that tomatoes or other nightshade vegetables worsen their symptoms. There isn’t strong scientific evidence that tomatoes generally cause arthritis inflammation or should routinely be avoided. If you consistently notice symptoms after eating a particular food, discussing this pattern with a healthcare professional or dietitian can be more useful than eliminating foods unnecessarily.

For osteoarthritis, tomatoes are best viewed as part of an overall nutritious eating pattern. For rheumatoid arthritis, diet can complement medical treatment but shouldn’t replace disease-modifying medication when it is prescribed.

Sjögren’s Syndrome Education management

Management of Sjögren’s Syndrome Education is usually long-term and focuses on controlling inflammation, maintaining spinal mobility, reducing pain and stiffness, and preventing loss of function.

Main approaches

• Regular exercise and physiotherapy: This is a cornerstone of management. Programs commonly include spinal mobility, stretching, posture, strengthening, aerobic exercise, and breathing/chest-expansion exercises.

• NSAIDs: Medicines such as naproxen or ibuprofen are commonly used for pain and stiffness when appropriate. A clinician should consider stomach, kidney, heart, and other risks before long-term use.

• Biologic medicines: If inflammation remains active despite appropriate treatment, a rheumatologist may use TNF inhibitors or IL-17 inhibitors.

• JAK inhibitors: These are another targeted option for some people with active disease.

Treatment of Sjögren’s syndrome (SS) usually involves a combination of good self-care practices, preventive measures, and medications. Because the disease can affect people differently, treatment plans are individualized according to each patient’s symptoms, disease severity, and the organs involved.

Although there is currently no cure for Sjögren’s syndrome, treatments are available to relieve symptoms, manage inflammation, prevent complications, and improve quality of life.

Managing Fatigue

Fatigue is one of the most common symptoms of Sjögren’s syndrome and can also be one of the most difficult to treat.

Patients are encouraged to learn how to balance their daily activities with their need for rest. Pacing activities, maintaining a regular sleep schedule, and avoiding overexertion can help manage fatigue.

It is also important to investigate other potential causes of tiredness, such as anemia, thyroid problems, sleep disturbances, and medication side effects.

In some cases, medications such as prednisone may help reduce fatigue when it is associated with active inflammation or organ involvement. However, prednisone is not routinely recommended for fatigue alone because of its potential side effects, particularly with long-term use.

Medications for Sjögren’s Syndrome

The medications used to treat Sjögren’s syndrome depend on the patient’s specific symptoms and the severity of the disease.

Although these medications cannot cure the condition, they can help control symptoms, reduce inflammation, and make living with the disease more comfortable.

Pilocarpine for Dry Eyes and Dry Mouth

Pilocarpine (Salagen) is a medication that stimulates certain glands to produce more fluids. It may be prescribed to help people with Sjögren’s syndrome who experience significant dryness, particularly dry mouth.

Pilocarpine is taken orally as a tablet and works by stimulating the salivary and tear glands to increase fluid production.

One of the most common side effects is excessive sweating because the medication stimulates other moisture-producing glands throughout the body. Some people may also experience flushing, increased urination, or gastrointestinal discomfort.

Pilocarpine has been used in medicine for many years and was historically used to treat glaucoma. Today, it is also an established treatment for reduced saliva production in people with Sjögren’s syndrome.

Pain Medications

Chronic pain is another common problem for people with Sjögren’s syndrome and can be managed with different types of medications.

Analgesics are medications that relieve pain but do not treat the underlying autoimmune disease or prevent damage to the glands.

These medications range from commonly used pain relievers, such as acetaminophen (paracetamol), to stronger prescription medications, including opioids such as morphine.

The choice of pain medication depends on the severity and cause of the pain, as well as the patient’s overall health.

Corticosteroids (Prednisone)

Corticosteroids such as prednisone are powerful anti-inflammatory medications that can help control symptoms associated with Sjögren’s syndrome.

They may be prescribed when patients develop significant inflammation, particularly when the disease affects the joints, blood vessels, or internal organs.

Prednisone can be effective in treating certain inflammatory complications, including arthritis and vasculitis. Higher doses may be required when there is significant organ involvement.

Although prednisone can provide rapid relief, long-term use can cause important side effects, including osteoporosis, weight gain, diabetes, high blood pressure, and an increased risk of infection.

For this reason, doctors generally aim to use the lowest effective dose for the shortest possible time.

Patients should discuss the potential risks and benefits of prednisone with their rheumatologist. Some people with joint involvement may also benefit from corticosteroid injections directly into affected joints.

Medications for Arthritis and Vasculitis Symptoms

Some people with Sjögren’s syndrome develop inflammatory arthritis, causing painful, swollen, and stiff joints. Others may develop vasculitis, which is inflammation of the small blood vessels.

These complications may require medications that target the immune system and reduce inflammation.

Depending on the severity of the symptoms, treatment options may include corticosteroids and disease-modifying anti-rheumatic drugs (DMARDs).

Examples of DMARDs include:

• Methotrexate: Helps suppress the immune response and reduce joint inflammation.
• Sulfasalazine: Helps control inflammatory joint symptoms.
• Hydroxychloroquine (Plaquenil): Commonly used for certain inflammatory joint and skin symptoms.
• Leflunomide (Arava): Helps reduce immune system activity and inflammation.
• Azathioprine (Imuran): Suppresses immune activity and may be used for certain systemic complications.
• Mycophenolate mofetil (CellCept): An immunosuppressive medication that may be used when certain internal organs are affected.

Gold-based medications, such as Myochrysine, were historically used to treat inflammatory arthritis but are now rarely prescribed.

The choice of medication depends on which parts of the body are affected and how active the disease is.

Treating Vasculitis

Vasculitis, or inflammation of the blood vessels, is a less common but potentially serious complication of Sjögren’s syndrome.

Treatment depends on the severity of the inflammation and whether important organs are involved.

Prednisone and other immunosuppressive medications may be used to control the immune response and reduce damage to blood vessels and surrounding tissues.

In more severe cases, additional specialized treatments may be required.

Regular follow-up with a rheumatologist is important to monitor treatment effectiveness, manage potential side effects, and adjust medications as needed.