Sjögren's Syndrome

Symptoms

Symptoms of Sjögren's syndrome include having extremely dry eyes and mouth that has lasted for at least 3 months. You may have itching and burning in your eyes, and your mouth may feel as though it is full of cotton.

Dry eyes and dry mouth (sicca syndrome)

Dry eyes (xerophthalmia):	Dry mouth (xerostomia):
Dry, gritty, sandy, or itchy feeling in your eyes Thick, rope-like strands of dried mucus in your eyes when you wake up Redness and less tearing A "filmy" feeling in your eyes that interferes with vision Bright lights may bother your eyes. Inflamed eyelids (blepharitis) Eye fatigue	Less saliva than usual Trouble swallowing food without also drinking a liquid Abnormal sense of taste Sores (fissures) on the tongue and lips Many cavities and gum disease caused by rapid tooth decay Decreased sense of taste and smell Mouth may feel full of cotton

Commonly, people with Sjögren's syndrome may notice:

• Joint or muscle pain or both.
• Dry skin with less sweat production.
• Vaginal dryness, causing discomfort, itching, and painful intercourse.
• Burning feeling (heartburn) in the chest or throat caused by abnormal backflow of acid and other digestive juices.
• Dry nose and throat, which can lead to sinus infections, bronchitis, and pneumonia.
• A yeast infection in the mouth (thrush).
• Increased fatigue.
• Skin rashes, bumps, and bruises that can be sensitive to light.

Less commonly, people with Sjögren's syndrome may notice:

• Enlarged saliva glands under the chin (submandibular glands) and in front of the ears (parotid glands) that can be sore and tender.
• Pain and difficulty with dentures, which may lead to dental restorations.⁴
• Thyroid problems such as hypothyroidism or hyperthyroidism, which are not caused by Sjögren's syndrome but are associated with it.
• Allergic reactions to medications, particularly to penicillin and sulfur compounds.² These allergic symptoms are not caused by Sjögren's syndrome but are associated with it.
• Cold, numb, painful fingers and hands (Raynaud's phenomenon).
• A yeast infection.
• Skin rashes.

Much less commonly, people with Sjögren's syndrome may notice nervous system problems, such as numbness or tingling in extremities, or peripheral neuropathies.

Sjögren's syndrome may develop in a person who has a connective tissue disorder, such as rheumatoid arthritis, lupus, or scleroderma, and is then called secondary Sjögren's syndrome. Symptoms of primary (no associated disorder) and secondary Sjögren's syndrome are the same. However, it may be difficult to tell the difference between symptoms caused by secondary Sjögren's syndrome and those caused by another connective tissue disorder.

If you have symptoms other than or along with those identified, it is possible you may have another autoimmune disease in addition to Sjögren's syndrome. Discuss all of your symptoms with your health professional so that you can be accurately diagnosed.

Progression of Sjögren's syndrome varies by individual. Some people develop symptoms in other parts of the body, while about 12% spontaneously improve. Most people with Sjögren's syndrome have chronic dryness of the eyes and mouth that stays with them throughout their lives.²

While not common, serious complications involving major body organs (such as the lungs, nerves, kidneys, and liver) may develop as the disease progresses. A small percentage of people with Sjögren's—those with parotid gland enlargement or a positive rheumatoid factor blood test—have a slightly higher chance of developing cancer involving the lymphatic system, such as non-Hodgkin's lymphoma.³

There are many other conditions with similar symptoms. Your health professional will review your symptoms and do laboratory tests to confirm a diagnosis of Sjögren's syndrome.

Who to See

Sjögren's syndrome can affect many different body systems. Your family doctor or general practitioner can diagnose this disorder. Depending on your symptoms, you may be referred to a specialist or other health professional:

• Rheumatologist
• Ophthalmologist
• Dentist
• Internist

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Author:	Carrie Henley Jan Nissl, RN, BS	Last Updated: July 27, 2006
Medical Review:	Adam Husney, MD - Family Medicine Tom Bailey, MD - Family Medicine Stanford M. Shoor, MD - Rheumatology
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