Dr Bodhisatwa Choudhuri

Sjogren's Syndrome Specialist in Kolkata, India

MRCP Acute Medicine, Dip. Rheumatology (UK),
EULAR Cert in Rheumatology, CCEBDM, FCCS

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Sjogren's Syndrome

What is Sjogren's Syndrome:

Sjogren's syndrome is an autoimmune disease that causes your immune system to go haywire and attack healthy cells instead of invading bacteria or viruses. Your white blood cells, which normally protect you from germs, attack the glands that are in charge of making moisture. When that happens, they can't produce tears and saliva, so your eyes, mouth, and other parts of your body dry out. There are treatments that bring relief, though.

It's natural to worry when you learn you've got a lifelong disease that will need regular care. Keep in mind that most people with Sjogren's stay healthy and don't have serious problems. You should be able to keep doing all the things you love to do without making many changes.

Sjogren's Syndrome Symptoms

The symptoms of Sjogren's can be different from person to person. You may have just one or two, or you may have many. By far, the most common symptoms are:

>>Dry mouth that may have a chalky feeling or feeling or feel like cotton

>>Dry eyes that may burn, itch, or feel gritty

>>Dry throat, lips, or skin

>>Dryness in your nose

>>A change in taste or smell

>>Swollen glands in your neck and face

>>Skin rashes and sensitivity to UV light

>>Dry cough or shortness of breath

>>Feeling tired

>>Trouble concentrating or remembering things


>>Dryness in the vagina in women

>>Swelling, pain, and stiffness in your joints

>>Heartburn, a sensation of burning that moves from your stomach to your chest

>>Numbness or tingling in some parts of your body


Sjogren's syndrome is an autoimmune disorder. Your immune system mistakenly attacks your body's own cells and tissues.

Scientists aren't certain why some people develop Sjogren's syndrome. Certain genes put people at higher risk of the disorder, but it appears that a triggering mechanism - such as infection with a particular virus or strain of bacteria - is also necessary.

In Sjogren's syndrome, your immune system first targets the glands that make tears and saliva. But it can also damage other parts of your body, such as:








Risk factors

Sjogren's syndrome typically occurs in people with one or more known risk factors, including:

Age. Sjogren's syndrome is usually diagnosed in people older than 40.

Sex. Women are much more likely to have Sjogren's syndrome.

Rheumatic disease. It's common for people who have Sjogren's syndrome to also have a rheumatic disease - such as rheumatoid arthritis or lupus.


The most common complications of Sjogren's syndrome involve your eyes and mouth.

Dental cavities. Because saliva helps protect the teeth from the bacteria that cause cavities, you're more prone to developing cavities if your mouth is dry.

Yeast infections. People with Sjogren's syndrome are much more likely to develop oral thrush, a yeast infection in the mouth.

Vision problems. Dry eyes can lead to light sensitivity, blurred vision and corneal damage.

Less common complications might affect:

Lungs, kidneys or liver. Inflammation can cause pneumonia, bronchitis or other problems in your lungs; lead to problems with kidney function; and cause hepatitis or cirrhosis in your liver.

Lymph nodes. A small percentage of people with Sjogren's syndrome develop cancer of the lymph nodes (lymphoma).

Nerves. You might develop numbness, tingling and burning in your hands and feet (peripheral neuropathy).

Sjogren's Syndrome Diagnosis

Because so many people with Sjogren's also have another autoimmune disease, and Sjogren's symptoms sometimes look a lot like some other diseases, like fibromyalgia or chronic fatigue syndrome, it can sometimes be hard for doctor to give you a diagnosis.

To get clues, doctor will give you a physical exam and may ask you questions such as:

Do your eyes itch or burn often?

Are you getting a lot of cavities in your teeth?

Does your mouth get dry? How about your lips?

Do you have stiff or painful joints?

Doctor may ask you to get some blood tests. They will take some blood from your vein and send it to a lab to get checked.

The blood tests measure the levels of the different types of blood cells you have and can show if you have germ-fighting proteins (antibodies) that many people with Sjogren's have. They can also measure inflammation in your body and the amount of certain proteins called immunoglobulin's that are part of your body's infection-fighting system. High levels of these can be signs that you have the disease.

Your blood tests can also give the doctor an idea of how well your liver is working and show if there might be any issues with it.

Doctor also may recommend a few tests related to your eyes and mouth:

Schirmer tear test

This measures how dry your eyes are. Your doctor will put a small piece of paper under your lower eyelid to see how much your eye tears up.

Slit lamp

Doctor uses this magnifying device to get a close look at the surface of your eye.

Dye tests.

Doctor puts drops of dye in your eyes to check for dry spots.

Salivary flow test

This measures the amount of saliva you make over a certain amount of time.

Salivary gland biopsy

Doctor will take a tiny piece of a salivary gland, usually from your lower lip, for testing. This can tell them if you have a rare condition called lymphocytic infiltrate, which is a buildup of white blood cells that look like bumps.

In some cases, they also may suggest an imaging test:


Doctor uses this to show how much saliva flows into your mouth. They'll give you a shot of dye in the salivary glands in front of your ears and use a special kind of X-ray to take pictures of its flow.

Salivary Scintigraphy

This imaging test is used to track how quickly a tiny amount of a radioactive substance gets to all of your salivary glands. Your doctor will give you a shot of the substance then track its progress over the next hour.

Sjogren's Syndrome Treatment

Treatment options include:

Medications to stimulate saliva flow: These include pilocarpine and cevimeline. They have a short-term impact, limited to a few hours only, so several doses a day are usually required.

Artificial saliva: Saliva substitutes and mouth-coating gels can relieve dryness of the mouth. They are available as sprays, pre-treated swabs, and liquids. These can be important at night, as the mouth becomes dryer during sleep.

Artificial tears: Artificial tears can help to lubricate the eyes, and are available over-the-counter (OTC). Prescription options are available that reduce the need for artificial tears, such as cyclosporine ophthalmic emulsion and hydroxypropyl cellulose pellets.

Prescription eye drops: These include cyclosporine and lifitegrast.

Moisture chamber spectacles: These are special glasses that keep out irritants and retain moisture.

Prescription expectorants and throat medications: In cases of respiratory dryness, drugs such as those used to stimulate saliva flow, as well as linseed extract, sorbitol, xylitol, or malic acid, can moisturize the area.

Nonsteroidal anti-inflammatory drugs (NSAIDs): Anti-inflammatory drugs such as aspirin, naproxen, and ibuprofen can provide relief for people with Sjogren's who are experiencing joint pain.

Disease-modifying antirheumatic drugs (DMARDs): In cases where the joint pain is accompanied by fatigue and rashes, DMARDs may relieve symptoms. Examples include hydroxychloroquine or methotrexate. If Sjogren's seems to be affecting the muscles, nerves, lungs, or kidneys, stronger DMARDs, corticosteroids, or rituximab may be prescribed.

Antifungal medication: If oral yeast infections are occurring, medication may be prescribed to combat the fungus.

Vaginal lubricants: For vaginal dryness, water-based vaginal lubricants can provide a solution, especially during sexual intercourse.

Punctual occlusion: When all conservative treatment options have been exhausted, this surgical option seals the tear ducts with small plugs to reduce the drainage of tears from the eye. This keeps the eye moist for longer. Temporary silicone plugs are likely to be used until the procedure is confirmed successful.

Autologous eye serum: In severe cases of eye dryness, eye drops can be made from the person's blood serum.

Here are some easy ways to keep the mouth lubricated.

>>Consuming more liquids.

>>Rinsing the mouth regularly to prevent infection and soothe the area

>>Maintaining excellent oral and dental hygiene

>>Topical fluoride gels or varnish

>>Quitting smoking, as smoke irritates the mouth and speeds up the evaporation of saliva

>>Chewing sugar-free gum, which stimulates the production of saliva

>>Applying coconut oil to the dry areas, as it is both moisturizing and anti-microbial

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