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    Sjogren syndrome

    Xerostomia-Sjogren syndrome; Keratoconjunctivitis sicca - Sjogren; Sicca syndrome

    Sjogren syndrome is an autoimmune disorder in which the glands that produce tears and saliva are destroyed. This causesdry mouth and dry eyes. The condition may affect other parts of the body, including the kidneys and lungs.

    Causes

    The cause of Sjogren syndrome is unknown. It is an autoimmune disorder. This means the body attacks healthy tissue by mistake. The syndrome occurs most often in women ages 40to 50. It is rare in children.

    Primary Sjogren syndrome is defined as dry eyes and dry mouth without another autoimmune disorder.

    Secondary Sjogren syndrome occurs along with another autoimmune disorder, such as:

    • Polymyositis
    • Rheumatoid arthritis
    • Scleroderma
    • Systemic lupus erythematosus

    Symptoms

    Dry eyes and dry mouth are the most common symptoms of this syndrome.

    Eye symptoms:

    • Itching eyes
    • Feeling that something is in the eye

    Mouth and throat symptoms:

    • Difficulty swallowing or eating
    • Loss of sense of taste
    • Problemsspeaking
    • Thick or stringy saliva
    • Mouth sores or pain
    • Hoarseness

    Other symptoms may include:

    • Fatigue
    • Fever
    • Change in the color of hands or feet
    • Joint pain or joint swelling
    • Swollen glands

    Exams and Tests

    A physical exam reveals dry eyes and mouth. There may be mouth sores because of the mouth dryness.

    You may have the following tests:

    • Schirmer's test of tear production
    • Antinuclear antibodies (ANA) test
    • Salivary gland biopsy
    • Rheumatoid factor (possible)
    • Tear test
    • Slit lamp examination of the eyes

    Treatment

    The goal is to relieve symptoms.

    • Dry eyes may be treated with artificial tears, eye-lubricating ointments, or cyclosoporine liquid.
    • Tiny plugs can be placed in the tear drainage ducts to help the tears stay on the surface of the eye.

    Disease modifying drugs (DMARDs) similar to those used for rheumatoid arthritis may improve the symptoms of Sjogren syndrome. These include tumor necrosis factor (TNF) inhibiting drugs such as Enbrel, Humira or Remicaide.

    Some things you can do to ease symptoms include:

    • Sip water throughout the day
    • Chew sugarless gum
    • Avoid medicines that can cause mouth dryness such as antihistamines and decongestants
    • Avoid alcohol

    Talk with your dentist about:

    • Mouth rinses to replace minerals in your teeth
    • Saliva substitutes
    • Drugs that help your salivary glands make more saliva

    To prevent dental decay that can be caused by mouth dryness:

    • Brush and floss your teeth often
    • Visit the dentist for regular checkups and cleanings.

    Outlook (Prognosis)

    The disease is usually not life-threatening. The outcome depends on what other diseases you have.

    There isa higherrisk of lymphomawhen Sjorgens has been very active for a long time.

    Possible Complications

    • Damage to the eye
    • Dental cavities
    • Kidney failure (rare)
    • Lymphoma
    • Pulmonary infections
    • Vasculitis (rare)

    When to Contact a Medical Professional

    Call your health care provider if you develop symptoms of Sjogren syndrome.

    References

    St. Clair WE. Sjogren’s syndrome. In: Firestein GS, Budd RC, Gabriel SE, et al, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 73.

    Kruszka P, O'Brian RJ. Diagnosis and management of Sjogren syndrome. Am Fam Physician. 2009;79:465-470.

    Wu AJ. Optimizing dry mouth treatment for individuals with Sjögren's syndrome. Rheum Dis Clin North Am. 2008 Nov;34(4):1001-10, x.

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            Review Date: 4/20/2013

            Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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