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Table of Contents

Magill’s Medical Guide, 9th Edition

Sjögren’s syndrome

by Michael A. Buratovich, PhD

Category: Disease/Disorder

Also known as: Dry eye/dry mouth or sicca syndrome

Anatomy or system affected: Eyes, immune system, mouth

Specialties and related fields: Dentistry, family medicine, rheumatology

Definition: An autoimmune disorder resulting in the loss of tears and saliva.

Key terms:

Sicca syndrome: a condition characterized by dryness of the mouth and eyes

xerophthalmia: dry eyes

xerostomia: dry mouth

CAUSES AND SYMPTOMS

Sjögren’s (pronounced SHOW-grins) syndrome is a chronic autoimmune disease. The body’s immune cells attack and eliminate the glands that produce tears and saliva. This condition causes dryness of the eyes and mouth and is referred to as sicca syndrome. The causes of Sjögren’s syndrome are unknown, although evidence suggests that viral infection, heredity, and hormones may be involved. Sjögren’s syndrome is one of the more prevalent autoimmune disorders, affecting as many as four million Americans. Nine of ten patients with Sjögren’s syndrome are female.

Information on Sjögren’s Syndrome

Causes: Unknown; possibly viral infection, heredity, hormones

Symptoms: Dry eyes, dry mouth, blurred vision, eye discomfort, recurrent mouth infections, swollen salivary glands, hoarseness, difficulty swallowing and eating, extreme fatigue

Duration: Chronic

Treatments: Moisture replacement (eyedrops, saliva-stimulating drugs, salivary packets); immunosuppressive drugs or nonsteroidal anti-inflammatory drugs (NSAIDs)

Sjögren’s syndrome can be challenging to diagnose because the symptoms are similar to those caused by other diseases. The symptoms can also mimic the side effects of several medications and may vary from individual to individual. Even when the symptoms are reported to a physician, dentist, or eye specialist, the proper diagnosis can be overlooked.

The classic symptoms are dry eyes (xerophthalmia) and dry mouth (xerostomia). Individuals with Sjögren’s syndrome often have blurred vision, constant eye discomfort, recurrent mouth infections, swollen parotid (salivary) glands, hoarseness, and difficulty swallowing and eating. Dryness of other mucous membranes of the body, such as the intestines, lungs, and reproductive system, may also occur. Extreme fatigue can also seriously alter the quality of life.

Sjögren’s syndrome is most commonly diagnosed in people in their mid-forties. In some individuals, primary Sjögren’s syndrome affects only the tear ducts and salivary glands. In other patients, it is present in conjunction with other diseases such as rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis (scleroderma), or polymyositis/dermatomyositis (secondary Sjögren’s syndrome).

Sjögren’s syndrome also adversely affects dental hygiene. Saliva contains many different compounds that discourage cavity formation in the teeth. Also, the constant washing of the teeth keeps them clean. The xerostomia experience by Sjögren’s syndrome patients increases tooth sensitivity and the risk of dental caries and periodontal disease.

TREATMENT AND THERAPY

Once Sjögren’s syndrome is suspected, a doctor will order blood tests for autoantibodies against nuclear or cytoplasmic proteins. Other tests for Sjögren’s syndrome include the Schirmer’s test, which measures tear production, and salivary scintigraphy, which determines salivary gland function, may also be performed. A lower lip biopsy to determine the extent of inflammation may also be needed.

Characteristic dryness appears at multiple locations: the tongue, face, and eyes.

MMG2022_p2654_001.jpg

Image by Scientific Animations, via Wikimedia Commons.

Moisture replacement therapies are designed to ease the symptoms of dryness. Routine use of over-the-counter artificial tears effectively wets the eyes and temporarily relieves the pain of dry eyes. Many artificial tears preparations are available. They usually contain some form of cellulose as a lubricant and polyethylene glycol or polyvinyl alcohol to prevent evaporation. Some artificial tear formulations contain preservatives that may irritate the eyes, but other preparations are preservative-free. Lacrisert, a daily insert, gradually releases hydroxypropylcellulose, a lubricant, after placement.

Other ocular medications diminish eye inflammation. These include ocular cyclosporine preparations: 0.05 percent (Restasis) and 0.09 percent (Cequa) formulations. These drugs help tear formation and reduce inflammation at the eye surface. Another ocular anti-inflammatory is the 5 percent ophthalmic solution of lifitegrast (Xiidra).

The everyday use of eyedrops controls dryness of the eyes, and saliva-stimulating drugs and salivary packets help with difficulties in chewing and swallowing food. Their doctors may prescribe immunosuppressive or nonsteroidal anti-inflammatory drugs (NSAIDs).

Dentists and dental hygienists treat Sjögren’s syndrome patients with local anesthetics to mitigate tooth sensitivity during dental cleanings. Additionally, dentists treat Sjögren’s syndrome patients’ teeth with fluoride applications to strengthen the tooth enamel and discourage tooth decay. Sjögren’s syndrome patients have difficulty wearing dentures due to dry and sensitive gums. Consequently, tooth implants seem to be a better choice for these patients than dentures.

PERSPECTIVE AND PROSPECTS

Sjögren’s syndrome is named after the Swedish eye doctor Henrik Sjögren, who first identified the syndrome in 1933. There is no known cure for Sjögren’s syndrome or a current treatment to restore gland secretion. The outlook for individuals with this condition is usually good because Sjögren’s syndrome is generally not life-threatening.

For Further Information:

1 

Masterson, Susan. You Mean It Isn’t in My Head?: What Sjogren’s Syndrome Is and What You Can Do About It. Independently published, 2021.

2 

Ng, Wan-Fai, editor. Sjögren’s Syndrome. Oxford UP, 2016.

3 

Sjögren Disease. Oral Health Topics, American Dental Association, 16 May 2019, www.ada.org/en/member-center/oral-health-topics/sjogren-disease. Accessed 28 Aug. 2021.

4 

Sjögren Syndrome. American College of Rheumatology, Dec. 2021, www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Sjogrens-Syndrome. Accessed 5 Apr. 2022.

5 

Understanding Sjögren’s. Sjögren’s Foundation, n.d., www.sjogrens.org/understanding-sjogrens. Accessed 5 Apr. 2022.

6 

Wallace, Daniel J., et al., eds. The New Sjogren’s Syndrome Handbook. 3rd ed., Oxford UP, 2005.

Citation Types

Type
Format
MLA 9th
Buratovich, Michael A. "Sjögren’s Syndrome." Magill’s Medical Guide, 9th Edition, edited by Anubhav Agarwal,, Salem Press, 2022. Salem Online, online.salempress.com/articleDetails.do?articleName=MMG2022_1240.
APA 7th
Buratovich, M. A. (2022). Sjögren’s syndrome. In A. Agarwal, (Ed.), Magill’s Medical Guide, 9th Edition. Salem Press. online.salempress.com.
CMOS 17th
Buratovich, Michael A. "Sjögren’s Syndrome." Edited by Anubhav Agarwal,. Magill’s Medical Guide, 9th Edition. Hackensack: Salem Press, 2022. Accessed September 16, 2025. online.salempress.com.