Sjögren's syndrome (pronounced "SHOW-grins") is an autoimmune condition in which the immune system attacks moisture-producing glands, primarily the lacrimal glands (which produce tears) and the salivary glands (which produce saliva). The result is persistent, often severe dryness of the eyes and mouth.
It affects an estimated 0.5–3% of the population, with women accounting for around 90% of cases. Despite this, Sjögren's takes an average of 2–3 years to diagnose, and many patients see multiple doctors across multiple specialties before getting an answer.
The Classic Symptoms
Dry Eyes (Keratoconjunctivitis Sicca)
Sjögren's-related dry eye is often more severe than typical age-related dry eye. Characteristic symptoms include:
- Persistent gritty, sandy, or burning sensation, like something is in your eye
- Redness and irritation
- Paradoxically, watery eyes, a reflex response to irritation when basal tear production is low
- Light sensitivity (photophobia)
- Blurred vision that temporarily improves with blinking
- Discomfort or difficulty wearing contact lenses
- Eyes that feel worse in windy, air-conditioned, or heated environments
Dry Mouth (Xerostomia)
- Persistent dryness, often worse at night
- Difficulty swallowing dry foods (crackers, bread) without liquid
- Needing to sip water frequently, including during the night
- Altered taste
- Difficulty speaking for long periods without water
- Frequent dental cavities, saliva protects teeth; reduced saliva leads to rapid tooth decay
- Oral thrush (fungal infection), more common without normal saliva
- Parotid (salivary) gland swelling, puffiness at the angle of the jaw
Beyond Dry Eyes and Dry Mouth
Sjögren's is a systemic disease, it doesn't just affect the eyes and mouth. Many patients have significant symptoms elsewhere:
- Fatigue, profound, persistent tiredness is one of the most disabling features of Sjögren's
- Joint pain, arthralgia (joint pain) and sometimes inflammatory arthritis
- Brain fog, difficulty with memory and concentration
- Dry skin and vaginal dryness, dryness can affect all mucous membranes
- Raynaud's phenomenon, fingers turning white or blue in the cold
- Peripheral neuropathy, tingling and numbness in hands and feet
- Interstitial lung disease, in a minority of patients, lung involvement can occur
Primary Sjögren's occurs on its own. Secondary Sjögren's occurs alongside another autoimmune condition, most commonly rheumatoid arthritis or lupus. Up to 30% of lupus patients and 10–15% of RA patients have secondary Sjögren's.
How Is Sjögren's Diagnosed?
Diagnosis uses the 2016 ACR/EULAR criteria, which combine:
- Anti-SSA (Ro) antibodies, the most important blood test; positive in about 70–75% of primary Sjögren's patients
- Lip biopsy, a minor procedure to examine minor salivary glands for characteristic inflammatory changes (focal lymphocytic sialadenitis)
- Schirmer's test, measures tear production: a small strip of filter paper placed under the eyelid
- Unstimulated salivary flow rate, measures how much saliva is produced in a set time
- ANA, positive in around 70% of Sjögren's patients
Other Causes of Dry Eyes and Dry Mouth
Not everyone with dry eyes and dry mouth has Sjögren's. Common alternative causes include:
- Medications, antihistamines, antidepressants, bladder medications, and many others can cause dryness
- Age-related changes
- Menopause
- Low humidity environments
- Diabetes
- Radiation therapy to the head and neck
- Sarcoidosis
The combination of dryness + fatigue + joint pain, particularly in a woman of middle age, makes Sjögren's significantly more likely than dryness alone.
If you suspect Sjögren's, ask your GP for anti-SSA antibody testing as a first step. If positive (or if symptoms are suggestive despite a negative result), you need a rheumatology referral, and possibly also ophthalmology and/or dentistry input for managing complications.
Could This Be Sjögren's?
Use our Sjögren's pre-test probability tool to assess whether your symptoms warrant anti-SSA testing and a specialist referral.