What is Sjogren’s Syndrome?
Sjogren’s syndrome (pronounced SHOW-grins) is a disease that mainly affects a person’s ability to produce enough saliva and tears. With Sjogren’s, the body’s immune system mistakingly attacks the healthy cells of the lacrimal (tear-producing) and salivary glands. Occasionally, this disease can begin to affect other parts of the body including the liver, kidneys, blood vessels, pancreas, nervous system, digestive system, and urinary tract. In rare cases, a person can develop lymphoma (x).
Affecting about 0.5%-1.0% of the overall population, Sjogren’s is considered a relatively common condition. About half of the people who develop Sjogren’s already have another autoimmune condition like lupus or rheumatoid arthritis. Women between the ages of 45 and 55 represent the vast majority of those diagnosed with Sjogren’s but it can affect people of any age, gender, or ethnic background (x).
Mild cases are generally manageable. More severe cases, however, can significantly impact quality of life and become debilitating. There’s no cure for Sjogren’s so treatment involves keeping symptoms under control and preventing complications. Medication, lifestyle habits, and dietary supplements can all be aspects of an overall treatment plan (x).
Sjogren’s Syndrome Symptoms
Most people with Sjogren’s experience dry eyes and mouth to some degree. However, the severity of dry eyes and mouth and the presence of other symptoms vary (x). Dry eyes and mouth can be caused by many things other than Sjogren’s. Because of this, as well as the fact that symptoms can be mild and overlooked, getting a proper diagnosis takes about 3 years on average (x).
Sjogren’s syndrome affects the lacrimal glands which produce tears. Tears lubricate the eyes, protect them from germs and foreign objects, and deliver nutrients to the cornea. An underproduction of tears often causes people to feel like their eyes are burning, itchy, tired, or like there’s grit stuck in them. (x) Dry eyes are not only uncomfortable, they can affect vision by causing blurriness or sensitivity to light (x).
Reduced production of saliva, also known as “xerostomia”, imparts a dry, cottony, or chalky feeling in the mouth. But besides providing lubrication for the mouth and throat, the compounds in saliva help keep the teeth and gums healthy. They also fight germs, contribute to our sense of taste, and aid in swallowing and digestion. Therefore, having too little saliva can cause quite a few problems including tooth and gum decay, fungal infections like thrush, and trouble swallowing food (x). In addition, lack of moisture in the throat can cause a persistent, dry cough (x, x).
In about half of cases, the parotid gland (one of the three salivary glands located in the neck) becomes swollen and tender (x).
People with Sjogren’s might also experience dry sinuses and nasal passages that occur from a lack of moisture in the mucous membranes. This can lead to discomfort, nosebleeds, burning sensation, and increased risk of infection. When the sinuses become too dry, the tissues can get irritated and inflamed which in turn causes headaches, sinus pressure, and pain felt in the cheeks (x, x).
Body Aches, Pain and Fatigue
As is common with many autoimmune diseases, symptoms of Sjogren’s includes physical and mental fatigue that can interfere with daily activities. Aches and pains may also flare up in multiple joints and muscles (x, x).
In some people, Sjogren’s affects areas beyond the lacrimal and salivary glands. When this happens, it can lead to (x):
- Digestive symptoms similar to IBS (abdominal pain, diarrhea, and/or constipation)
- Bladder irritation
- Vaginal dryness
- Skin rashes and/or sensitivity
- Irritation in the lungs
- Liver or kidney problems
- Lymphoma, though rarely
Sjogren’s Syndrome Causes
Primary Sjogren’s refers to the symptoms listed above that aren’t associated with another condition. Secondary Sjogren, also known as Sjogren-overlap, occurs in the presence of other autoimmune diseases like lupus or rheumatoid arthritis (x).
With autoimmune disease, inflammatory cells erroneously attack the body’s healthy cells. Researchers aren’t quite sure what causes the body to do this.
One possible contributing factor may be when a person’s immune system doesn’t fully “shut off” after fighting a legitimate virus or pathogen like the Epstein-Barr virus (x).
Another factor involves genes. Since the tendency to develop autoimmune disease (though not necessarily the same one) tends to run in families, genetics appear to play a role in a person’s immune system behavior (x).
Additionally, because a majority of those with Sjogren’s are women, the hormone estrogen may play a role in the disease’s development (x).
Sjogren’s Syndrome Treatment
Treatment for Sjogren’s focuses on managing the symptoms and preventing complications. Taking medications – as well as avoiding others that can cause dryness — can also be part of the treatment plan. Finally, some lifestyle habits and dietary supplements may be appropriate to support overall health.
Treating Dry Mouth
Toothpastes and mouthwashes containing the compound betaine anhydrous help reduce mouth dryness that can occur with standard oral health products (x). Similarly, a study showed that an oral spray containing malic acid improved the feeling of dry mouth in study participants (x). Your doctor may be able to recommend or prescribe specific products to use.
In addition to carefully chosen toothpastes and mouthwashes, part of living with Sjogren’s requires diligence about oral health. The following habits are recommended (x):
- Brush and floss after each meal
- Sip water during the day
- See a dentist regularly
- Use products with fluoride or get professional fluoride treatments to prevent cavities
- Suck on sugarless candy or lozenges
Finally, research shows that acupuncture can stimulate production of saliva in those with dry mouth (x).
Treating Dry Eyes
Prescription or OTC eye drops or gels, preferably that don’t contain irritating preservatives, can combat dry eyes. Wearing wraparound glasses when outside might also help (x). In severe cases, a surgical procedure allows the eyes to produce more tears (x).
Use a Humidifier
Sleeping with a humidifier helps reduce dryness in the eyes, mouth, and nasal passages.
Research shows that an elimination-based diet called the autoimmune protocol (AIP) can reduce inflammation and improve symptoms in people with autoimmune diseases (x, x, x). This spin-off of the Paleo Diet restricts many foods while, in theory, allowing the body to heal from the constant inflammatory triggers found in food and beverages. The diet focuses on meat and non-starchy vegetables and prohibits grains, legumes, nuts, seeds, many kinds of fruit, coffee and tea, alcohol, processed oils, and sugar.
Non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen or acetaminophen can reduce joint pain. Corticosteroids may also relieve painful inflammation, though long-term use can cause other unwanted side effects (x).
A group of medications called “disease modifying anti-rheumatic drugs” are often used for conditions like rheumatoid arthritis and lupus. They’ve also been shown to help manage Sjogren’s syndrome. Examples include the drugs methotrexate and azathioprine. In addition, biological therapies such as one called Rituximab are also options for treating severe cases (x).
Supplements for Sjogren’s Syndrome
Dietary supplements may support overall health and minimize symptoms of inflammation that go along with autoimmune conditions like Sjogren’s. However, it’s always important to speak to your doctor before taking supplements because they could interact with medication or not be right for your specific situation.
Studies show that taking a combination of DHA and EPA (the omega-3 fatty acids found in fish oil) can reduce the symptoms of dry eyes about as well as eye drops (x). However, DHA/EPA provides the additional benefit of lowering inflammation. In other words, it can be part of the overall plan to keep inflammation and symptoms of autoimmune diseases under control (x, x). Suggested serving size for fish oil softgels is 2 capsules, which should be taken anywhere from two to three times per day.
Curcumin, the active compound in turmeric, has well-known anti-inflammatory effects. Research shows curcumin can help keep eyes healthy (important with Sjogren’s) and reduce painful inflammation throughout the whole body (x). In fact, one animal study even specifically suggests that it can be an effective intervention for Sjogren-like disorders (x). Curcumin is to be taken in one dose of 1000mg or less per day, depending on intended effect. It should be taken along with water or a meal.
Oxidative stress by molecules called reactive oxygen species (or ROS) causes damage to cells and occurs with rheumatic conditions like Sjogren’s (x). Glutathione is an antioxidant that scavenges these ROS. People produce glutathione naturally but sometimes what’s made in the body can’t keep up. Supplementing with glutathione can help support overall health, especially in the presence of an autoimmune condition (x). Suggested serving size can range from as little as 50mg per day to as much as 500mg (regular serving size) per day, depending on intended effect. In order to maximize effectiveness, it should be taken with food.
The Bottom Line
Sjogren’s syndrome can occur on its own or secondary to other rheumatic autoimmune conditions like lupus or arthritis. The immune system attacks the glands that make saliva and tears, so the main symptoms include dry eyes and dry mouth. While this may not seem very dire, tears do a lot to protect vision. Similarly, saliva plays a big role in oral health and digestion. Dryness can also be very uncomfortable which impacts quality of life. In addition to dry eyes and mouth, people may experience fatigue and joint pain, problems in other areas of their body, or in rare cases, lymphoma. Unfortunately, there is no cure for this condition but treatments such as eye drops, special oral health products, pain relievers, and medication can help. Diet and supplements can also improve symptoms and protect cells from further damage.
By: Charlie Gray