Sjögren’s Disease (SjD), formerly known as Sjögren’s Syndrome, is an autoimmune condition that predominantly affects the mouth and eyes. In SjD, glands responsible for producing fluid for lubrication, known as exocrine glands are targeted. Some of these are glands that help produce tears in the eyes (lacrimal) and saliva in the mouth (salivary) [1].
Most patients suffering from SjD usually present with very non-specific symptoms in the early stages. Due to the non-specific nature of these early resting symptoms, the diagnosis of SjD is not considered and relevant investigations are therefore not requested. This can lead to a delay in a diagnosis of SjD being made. Various studies highlighted that the median delay period from the onset of symptoms to SjD diagnosis was 6-8.5 years [2,3].
Sjögren’s Disease received its new name in 2023, which was an official change in naming (nomenclature), highlighting that it is an independent autoimmune condition rather than a collection of symptoms [4]. SjD marginally affects women more than men, with approximately 90% of SjD cases being women [5].
Signs and Symptoms
Sjögren’s Disease can present in many different ways. The recognition of signs and symptoms is therefore essential for accurate diagnosis and effective management. Some of these include, but are not limited to:
- Dryness of certain areas, such as:
- Dry eyes (xerophthalmia)
- Dry mouth and/or throat (xerostomia)
- Genital dryness
- Musculoskeletal involvement, such as:
- Joint and muscle pain
- Joint swelling
- Joint stiffness
- Dental problems, such as:
- Cavities (caries)
- Oral thrush (candidiasis)
- Sores and blisters
- Skin, hair and nail issues, such as:
- Dry and/or itchy skin
- Thinning and/or loss of hair
- Brittle and/or flaky nails
While these are just a few common examples, SjD can also affect organs such as the kidneys, liver, lungs, thyroid, as well as the heart, the lymphatic system and the nervous system [6]. When these other systems are involved, it is referred to as systemic involvement.
Types
There are two main types of Sjögren’s Disease:
- Primary Sjögren’s Disease, which occurs independently of any other autoimmune conditions [7].
- Secondary Sjögren’s Disease, which often occurs as part of another autoimmune disease thus making it secondary to the primary autoimmune condition. Some of these primary autoimmune conditions can include systemic lupus erythematosus, rheumatoid arthritis, psoriatic arthritis and scleroderma [8].
Causes/Risk Factors
As with any other autoimmune disease, SjD occurs when one’s immune system mistakenly attacks healthy tissue in the body. While there are no clear explanations as to why this occurs, there are several risk factors involved, including [8] :
- A family history of SjD
- A personal history of other autoimmune diseases
- Being female (autoimmune conditions are found more commonly in females as compared to males)
Diagnosing
There is no definitive test to diagnose Sjögren’s Disease as is the case with most autoimmune diseases. However, several tests can be used together with clinical findings to help when making a diagnosis of SjD. These include, but are not limited to:
- Blood tests which are useful when evaluating patients are:
- Inflammatory markers, including:
- Erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- Inflammatory markers, including:
- Autoimmune markers, including:
- Special eye tests such as:
- Special dental tests such as:
For a closer look into diagnosing SjD, you can visit our companion article, “ 2016 ACR EULAR Classification criteria for Primary Sjogrens Syndrome (SS) ” which highlights the 2016 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for primary Sjögren’s Syndrome (formerly).
Treatment
As with all other autoimmune diseases, there is no cure for Sjögren’s Disease presently. However, patients can be managed symptomatically. If you suspect that you may have Sjögren’s Disease, it is always recommended to consult with a Rheumatologist. Further referrals can be made to an Ophthalmologist/Ears, Nose & Throat Specialist/Oral Medicine Specialist for both diagnosis and treatment.
Some of the common treatment plans for SjD can include:
- Eye drops, including:
- Artificial tear eye drops
- Anti-inflammatory eye drops
- Immunomodulating eye drops
- Oral lubricants such as:
- Saliva substitutes
- Xylitol gum
- Systemic therapies are used when SjD affects entire organs. Some of these are:
- Simple pain killers when necessary, such as paracetamol
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), which include, ibuprofen, diclofenac and naproxen, which are some of the older medications or Zerodol, Celebrex and Arcoxia, which are some of the newer medications
- Glucocorticoids (steroids)
- Disease-Modifying Anti-Rheumatic Drugs (DMARDs), including:
For a detailed breakdown of the management of SjD, refer to our companion article, “ 2019 EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies – Rheumatology TT ” which illustrates EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies.
Living with SjD
Sjogren’s Disease is a long-term condition; however, with proper management and care, a good quality of life can be maintained.
What should I do if I think I have SjD? You should seek a rheumatology consultation. Early diagnosis and management are key when treating SjD. If other systems are involved, additional referrals can be made to other medical/dental specialties.
What should I avoid? Numerous lifestyle habits can cause inflammation and further contribute to symptoms. Some are smoking, consuming alcohol, and eating highly processed and/or sugary foods. These can exacerbate symptoms and even increase the risk of dental caries. Instead, opt to limit smoking and alcohol usage, whilst maintaining a balanced, anti-inflammatory diet. Stress should also generally be avoided for any autoimmune condition, as it can lead to flare-ups.
What can I do daily? Conservative measures can be used in conjunction with traditional medications for symptom management. Some of these can include drinking more water, chewing xylitol gum, regular brushing of teeth with a fluoride toothpaste, taking screen time breaks, cardiovascular exercise, the use of a humidifier, proper sleep hygiene and stress management.
Jadon Soodoo
Incoming Year 1 DDS Student, U.W.I., St. Augustine
References
[1]S. E. Carsons and M. A. Blum, “Sjogren Syndrome,” StatPearls, Jul. 2025. https://www.ncbi.nlm.nih.gov/books/NBK431049/
[2]A. Meinecke et al., “AB0840 ASSOCIATION OF A DIAGNOSTIC DELAY AND POOR GENERAL HEALTH STATUS AND GENERAL PERFORMANCE IN PRIMARY SJÖGREN’S SYNDROME: A CROSS-SECTIONAL STUDY,” Annals of the Rheumatic Diseases, vol. 83, pp. 1717–1718, Jun. 2024, doi: 10.1136/annrheumdis-2024-eular.505. https://ard.bmj.com/content/83/Suppl_1/1717.2
[3]O. Kuryata, T. Lysunets, I. Karavanska, and V. Semenov, “Duration till diagnosis and clinical profile of Sjögren’s syndrome: Data from real clinical practice in a single-center cohort,” The Egyptian Rheumatologist, vol. 42, no. 1, pp. 41–46, Jan. 2020, doi: 10.1016/j.ejr.2019.05.003.
https://www.sciencedirect.com/science/article/pii/S1110116419300596
[4]M. Ramos-Casals et al., “2023 International Rome consensus for the nomenclature of Sjögren disease,” Nature reviews. Rheumatology, vol. 21, no. 7, pp. 426–437, Jul. 2025, doi: 10.1038/s41584-025-01268-z. https://www.nature.com/articles/s41584-025-01268-z
[5]“Sjögren’s Foundation, Inc.,” Sjögren’s Foundation. [Online]. Available: https://sjogrens.org/understanding-sjogrens/sjogrens-disease-fast-facts
[6]“Sjögren’s Foundation, Inc.,” Sjögren’s Foundation. [Online]. Available: https://sjogrens.org/understanding-sjogrens/sjogrens-disease-signs-and-symptoms
[7]N. Medicine, “Sjogren Syndrome,” Northwestern Medicine. Accessed: [Online]. Available: https://www.nm.org/conditions-and-care-areas/rheumatology/sjogren-syndrome
[8]“Sjögren’s Syndrome,” Cleveland Clinic. [Online]. Available: https://my.clevelandclinic.org/health/diseases/4929-sjogrens-syndrome
[9]“Sjögren’s Foundation, Inc.,” Sjögren’s Foundation. [Online]. Available: https://sjogrens.org/understanding-sjogrens/diagnosis
[10]“Sjogren’s syndrome – Diagnosis and treatment,” Mayo Clinic. [Online]. Available: https://www.mayoclinic.org/diseases-conditions/sjogrens-syndrome/diagnosis-treatment/drc-20353221
[11]“Sjögren’s Syndrome Diagnosis,” Johns Hopkins Medicine. [Online]. Available: https://www.hopkinsmedicine.org/health/conditions-and-diseases/sjogrens-syndrome/sjogrens-syndrome-diagnosis
[12]“Sjögren’s Foundation, Inc.,” Sjögren’s Foundation. [Online]. Available: https://sjogrens.org/blog/2021/the-lip-biopsy-its-not-as-bad-as-it-sounds
[13]E. J. Price et al., “British Society for Rheumatology guideline on management of adult and juvenile onset Sjögren disease,” Rheumatology, vol. 64, no. 2, pp. 409–439, Apr. 2024, doi: 10.1093/rheumatology/keae152. https://academic.oup.com/rheumatology/article/64/2/409/7645909
[14]“Sjögren’s Foundation, Inc.,” Sjögren’s Foundation. [Online]. Available: https://sjogrens.org/treatment-and-care/treatments-for-sjogrens-disease
[15]“Sjogren’s syndrome – Diagnosis and treatment,” Mayo Clinic. [Online]. Available: https://www.mayoclinic.org/diseases-conditions/sjogrens-syndrome/diagnosis-treatment/drc-20353221
[16]Z. Assy, J. S. van Santen, H. S. Brand, and F. J. Bikker, “Use and efficacy of dry-mouth interventions in Sjögren’s disease patients and possible association with perceived oral dryness and patients’ discomfort,” Clinical oral investigations, vol. 27, no. 9, pp. 5529–5537, Sep. 2023, doi: 10.1007/s00784-023-05172-2.