Sjögren's Syndrome

Sjögren’s syndrome is a chronic autoimmune disease where the immune system attacks the body’s own tissues, particularly the glands that produce saliva and tears. When the immune system mistakenly identifies these glands as threats, it triggers a misdirected immune response. As a result, certain immune cells, known as lymphocytes, move into the glandular tissue and begin to attack it. This leads to ongoing inflammation and impaired function of the affected glands. The salivary and tear glands are primarily affected, reducing the production of saliva and tears due to the inflammation. Typical early symptoms include pronounced dry mouth and dry eyes, which feel like having constant “sand in the eyes.” Additionally, difficulty swallowing may occur, partly due to a dry tongue.

Sjögren’s syndrome can occur either as a primary condition on its own or secondarily in combination with other autoimmune diseases such as rheumatoid arthritis or systemic lupus erythematosus. With a prevalence of approximately 1 in 200 people, it’s one of the more common connective tissue diseases, mostly affecting women between the ages of 50 and 70.

Because Sjögren’s Syndrome is a systemic condition, it can also affect other organ systems, such as the joints, peripheral nerves, or the skin. For this reason, early diagnosis and coordinated treatment are essential.

Sjögren’s Syndrome is classified into two types: as a primary, standalone disease or as a secondary form that occurs in connection with other autoimmune diseases. Both forms share the same underlying mechanism—an autoimmune reaction that leads to the gradual destruction of the glands. As a result, the early symptoms are often the same in both types: dry mouth, a dry tongue, and dry eyes.

The most important difference in the secondary form of Sjögren’s syndrome is the presence of other autoimmune diseases at the same time, such as systemic lupus erythematosus or rheumatoid arthritis. In these cases, Sjögren’s syndrome may be accompanied by additional systemic symptoms, which can be related to the underlying condition.

The symptoms of Sjögren’s syndrome can vary greatly, both in how many there are and how severe they become. This means the course of the disease can differ greatly from person to person. For many patients, the condition often progresses in flares, with periods of improvement alternating with sudden worsening of symptoms.

Sjögren’s syndrome primarily affects the salivary and tear glands, but can also attack other organ systems. This is due to the activity of autoreactive lymphocytes, which can spread to other parts of the body and trigger inflammatory reactions there.

The symptoms often persist throughout life but can be well-controlled with an individually tailored treatment. In many cases, this allows patients to maintain a high quality of life. As a result, life expectancy is generally not reduced and is comparable to that of the healthy population, as long as no serious complications occur.

The first signs that may indicate Sjögren’s syndrome typically include reduced tear production and a persistent sensation of having something in the eye. In this condition, the immune system attacks the tear glands, which then produce less tear fluid. This disrupts the tear film and can lead to dryness, redness, burning, and the characteristic foreign body sensation. If it’s left untreated, more severe cases can lead to the damage of the cornea.

Pronounced dryness of the mouth and tongue is also very common. This is caused by reduced saliva production and is due to a similar underlying mechanism as that affecting the tear glands.

Sjögren’s syndrome can be accompanied by a range of neurological symptoms that can significantly impact a patient’s quality of life if it is left untreated. These symptoms most often occur secondary to an underlying condition, such as rheumatoid arthritis or systemic lupus erythematosus, but they can also appear in primary Sjögren’s syndrome.

The distinctive symptoms in the mouth and tongue area are characteristic of Sjögren’s syndrome, resulting from autoimmune damage to the salivary glands and changes in the mucous membranes. These symptoms often appear early in Sjögren’s syndrome, typically alongside dry eyes, and should be carefully evaluated if they persist. Reduced saliva production can lead to a range of uncomfortable complications, as saliva plays a crucial role in oral health: it keeps the mouth moist, helps mechanically cleanse it, supports digestion, and contains protective antibodies and enzymes.

Sjögren’s syndrome is an autoimmune condition in which the immune system mistakenly attacks the body’s own tissues, particularly the glands. This also affects the sweat and oil (sebaceous) glands in the skin, leading to various skin changes.

The oily layer produced by the sebaceous glands normally acts as a natural protective barrier that shields the skin from drying out and prevents germs from entering. Without sufficient sebum (oil), the skin loses moisture more quickly, becomes dry, and develops cracks, which also increases the risk of infection. Sweat plays a key role in regulating body temperature by cooling the skin through evaporation, helping to prevent the body from overheating.

In Sjögren’s syndrome, digestive problems can occur as a result of autoimmune inflammation that may also affect internal organs and digestive glands. When glandular tissue is affected, it produces less secretion. For example, damaged salivary glands produce less saliva, which significantly impairs the initial digestion of food in the mouth.

The pancreas may also be involved. If it produces fewer digestive enzymes, the breakdown of food components is disrupted. This can lead to insufficient digestion and place extra strain on the intestines.

Reduced saliva production can contribute to gastroesophageal reflux, as saliva normally helps neutralize stomach acid. Additionally, lymphocytic infiltration of the esophagus can increase the sensitivity of the mucosal lining.

In Sjögren’s syndrome, autoimmune inflammation can affect the pancreas, leading to insufficient production of digestive enzymes. As a result, food is not properly digested, and undigested components pass through the intestines more quickly, causing diarrhea.

When undigested food reaches the large intestine, gut bacteria ferments it, leading to gas production. This can cause a sensation of fullness and abdominal bloating.

In addition to the typical symptoms, such as dry eyes and dry mouth caused by the autoimmune attack on exocrine glands, other parts of the body can also be affected.

In many patients, the autoimmune response in Sjögren’s syndrome extends to the joints, muscles, and lymphatic system.

The exact cause of Sjögren’s syndrome is still not fully understood, despite ongoing research. However, it is believed that a combination of genetic, immune-related, and environmental factors plays a role in the development of the disease.

Certain pathogens have been linked to disease development. Infection could trigger a misdirected immune response in genetically predisposed individuals, causing the immune system to attack the body’s own exocrine glandular tissue, such as the salivary and tear glands.

This is a possible risk factor and trigger – family members of Sjögren’s syndrome patients have a higher risk of developing the disease. Certain genetic variants appear to increase disease risk, and there is evidence of a hereditary component in immune regulation.

The disease typically manifests between the ages of 40 and 60. Age-related changes in the immune system (so-called immunosenescence) are discussed in science as a possible factor that could contribute to a dysregulation of the immune response.

Women are significantly more affected by Sjögren’s syndrome than men, with a ratio of 9:1. This possible connection can be explained by hormonal modulation of the immune system, particularly sex hormones like estrogen.

Sjögren’s syndrome often occurs alongside other autoimmune diseases. In such cases, it is referred to as secondary Sjögren’s syndrome. It is most commonly associated with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). These immune diseases share similar immune system characteristics, including the production of autoantibodies and chronic inflammatory processes, which could then lead to the development of Sjögren’s syndrome.

Diagnosing Sjögren’s syndrome can be particularly challenging due to its often non-specific symptoms—such as dry eyes and mouth, fatigue, or joint pain. Currently, there is no single definitive test that can reliably confirm the diagnosis. As a result, diagnosing Sjögren’s syndrome is often multimodal, meaning it involves a combination of clinical evaluation, laboratory tests, and tissue analysis (histology). Early and accurate diagnosis is crucial for improving quality of life and detecting and treating potential systemic complications in a timely manner.

Detecting clusters of lymphocytes (a type of immune cell) in glandular tissue is strong evidence for Sjögren’s syndrome. This is typically done through a lip biopsy, where a tissue sample is taken from the inside of the lower lip, an area containing small salivary glands.

In patients with Sjögren’s syndrome, histological methods often reveal an accumulation of immune cells, indicating inflammation of the salivary glands.

Laboratory tests focus on detecting autoantibodies that are commonly associated with the disease—particularly anti-Ro/SSA and anti-La/SSB antibodies, which are present in most affected individuals. There are also other, less specific laboratory findings that could indicate the disease. This includes positive ANA (antinuclear antibodies), rheumatoid factors, elevated inflammatory markers, as well as signs of insufficient secretory glands.

Changes in the tear film or damage to the cornea may indicate Sjögren’s syndrome, but these are not visible to the naked eye. To make these visible, ophthalmologic examinations are used: the slit-lamp examination with fluorescein staining, which allows for a detailed evaluation of the tear film and detection of any possible corneal damage.

The diagnosis of Sjögren’s syndrome is primarily based on the classification criteria of the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR). The most important indicators are positive Anti-Ro antibodies, positive lip biopsy, reduced tear or saliva production, and other pathological findings consistent with Sjögren’s syndrome.

Patients with Sjögren’s syndrome typically have a normal life expectancy. Only in rare cases, where other organs such as the lungs, kidneys, or central nervous system are significantly affected, could life expectancy be impacted. Regular medical check-ups are essential to detect possible complications at an early stage.

Although Sjögren’s syndrome is generally not life-threatening, it is a lifelong persistent condition that can cause significant impairment to quality of life, particularly due to ongoing dryness of mucous membranes, chronic fatigue, and joint pain. Many patients report a noticeable decline in well-being when symptoms worsen, as the condition often follows a relapsing pattern. Symptoms can appear suddenly and disappear just as quickly. These flares are often unpredictable, with possible triggers including stress, infections, or hormonal changes. This unpredictability also contributes to increased psychological stress. Sjögren’s syndrome can also be recognized as a disability in the legal sense, but it depends on the severity of the symptoms, the involvement of internal organs, the duration and frequency of attacks, and limitations in daily activities.

Currently, there is no clear therapy that can permanently stop the autoimmune reaction. Therefore, treatment mainly focuses on relieving symptoms. Both conventional medical treatments and alternative and complementary healing methods are used, depending on each individual case. The choice of therapy depends on the severity of symptoms, whether organs are involved, and the patient’s personal preferences. With a well-adjusted treatment plan, it is possible to stabilize patients’ quality of life long-term.

Conventional treatment for Sjögren’s syndrome is primarily medication-based and is tailored to each patient’s specific symptoms. The goal is always to improve symptoms and maintain quality of life.

Many people affected by Sjögren’s syndrome use alternative and complementary therapies to help manage their symptoms holistically and support their immune system. Patients often report noticeable improvements in their overall well-being, particularly regarding symptoms such as dryness, inflammation, and fatigue.

A balanced diet rich in omega-3 fatty acids, fresh fruits and vegetables, whole grains, and plant-based oils can help reduce inflammation. Drinking plenty of fluids and occasionally chewing gum to stimulate saliva production also helps keep the mucous membranes moist. At the same time, it is advisable to avoid consuming sugar and highly processed foods as much as possible. Alcohol and tobacco use should also be reduced to further support health.

For complaints about dry mouth and lips, gels or oils containing vitamin E are often recommended. They help keep the mucous membranes soft and can soothe small cracks. Additionally, other moisturizing creams and nasal ointments can be used for skin care.

A balanced vitamin D level plays an important role in general immune regulation. If a deficiency is proven, targeted supplementation can be used as a supportive measure to help maintain the normal function of the immune system.

Turmeric, ginger, chamomile, and cinnamon are often used as complementary remedies in naturopathy because they have been proved to have anti-inflammatory effects. However, it is important to be aware of possible interactions with medications.

Relaxation techniques such as progressive muscle relaxation, yoga, mindfulness training, or autogenic training contribute to having psychological stability. Since stress is considered a potential trigger for flare-ups, these methods may have a positive impact on the course of the disease.

Acupuncture is a core component of Traditional Chinese Medicine (TCM) and has been used for centuries to treat a wide range of health conditions. It can be a valuable supportive therapy, especially for managing pain, inner restlessness, sleep disorders, or digestive problems.

Gut restoration or intestinal cleanse is a therapeutic approach aimed at supporting intestinal health by strengthening and normalizing the balance of the gut microbiota. From the perspective of integrative medicine, such measures – often in combination with probiotics – can be used supportively to alleviate potential digestive complaints and gently promote the general balance of the immune system.”

In particularly severe cases of the disease, INUSpheresis, which is a therapeutic blood purification procedure, along with micronutrient infusion therapy may be considered. However, this can only be performed in close coordination with specialists in specific clinics and is generally only an option for treatment-resistant disease cases.

Sjögren’s syndrome continues to be intensively researched, even though it still receives less attention compared to other autoimmune diseases like systemic lupus erythematosus or rheumatoid arthritis. Nevertheless, significant progress is being made in the areas of diagnostics, therapy research, and patient support.

Below, we’ll address your most common questions about Sjögren’s syndrome in more detail.

The information listed contains relevant topics and serves to improve understanding.