Causes
The cause is not fully understood. As in other autoimmune diseases, inherited susceptibility genes appear to combine with environmental triggers, possibly including viral infections, to set off an immune attack — in this case on the lacrimal (tear) and salivary glands. White blood cells infiltrate the glands and gradually reduce their output, and the same process can involve organs beyond the glands.Symptoms
Dryness is the core problem, but Sjögren's is a systemic disease:- Dry, gritty eyes: Burning, itching, a foreign-body sensation, and sensitivity to light; severe dryness can damage the cornea.
- Dry mouth: Difficulty chewing and swallowing dry food, altered taste, a burning tongue, and needing water constantly.
- Dental problems: Saliva protects teeth, so cavities, gum disease, and oral yeast infections become much more common.
- Salivary gland swelling: The parotid glands in front of the ears may swell, sometimes repeatedly.
- Joint and muscle pain: Aching and stiffness resembling mild inflammatory arthritis are common, as is significant fatigue.
- Other involvement: Dry skin, vaginal dryness, chronic cough, nerve symptoms such as numbness or tingling, and, less commonly, kidney, lung, or liver inflammation.
Diagnosis
Diagnosis combines symptoms with objective testing. Because dryness has many everyday causes — medications such as antihistamines and decongestants are among the most common — the evaluation also focuses on excluding these. Blood tests look for anti-SSA (Ro) and anti-SSB (La) antibodies, antinuclear antibodies, and rheumatoid factor. Eye tests measure tear production and check the eye surface for dryness damage, and dental or imaging studies can assess salivary flow. When the picture remains unclear, a small biopsy of minor salivary glands from the inner lip can confirm the characteristic immune infiltration.Treatment
There is no cure, but treatment relieves symptoms and protects the eyes, teeth, and organs:- Eye care: Preservative-free artificial tears through the day, lubricating gels at night, prescription anti-inflammatory eye drops, and tiny plugs that slow tear drainage.
- Mouth care: Frequent sips of water, sugar-free gum or lozenges to stimulate saliva, prescription medicines that boost saliva production, and meticulous dental hygiene with regular dental visits and fluoride.
- Systemic treatment: Hydroxychloroquine is often used for joint pain, rashes, and fatigue; stronger immunosuppressants are reserved for significant organ involvement.
- Practical measures: A bedroom humidifier, avoiding drying medications when possible, and not smoking all reduce daily symptoms.
Living With Sjögren's Syndrome Day to Day
Sjögren's is managed by routine rather than by any single prescription. The people who do well protect the eye surface several times a day, treat their teeth as a medical problem, and get systemic features looked at rather than filed under fatigue.
Eye care that actually works
Use preservative-free artificial tears on a schedule — four or more times a day, before symptoms start — and switch to a thicker gel or ointment at bedtime. Avoid redness-relief drops, which constrict vessels and rebound. Prescription anti-inflammatory drops, punctal plugs, and warm compresses for the eyelid glands are added when tears alone are not enough. Point car vents and ceiling fans away from your face, and take a blink break every twenty minutes at a screen; see our dry eye and air conditioning and computer vision syndrome articles, and the dry eye syndrome page.
Teeth are a medical problem now
Saliva neutralizes acid and remineralizes enamel, so its loss produces rapid cavities, often at the gum line where they are hardest to repair. Dental cleanings every three to four months, prescription high-fluoride toothpaste, fluoride varnish, and xylitol gum to stimulate what flow remains all pay off. Sipping sweetened or acidic drinks all day is the most damaging habit. Oral thrush and cracking at the mouth corners are common and treated with fluconazole or a clotrimazole troche. The prescription saliva stimulants pilocarpine and cevimeline genuinely increase flow; sweating, flushing, and stomach upset are the usual reasons people stop them.
The drying medications worth reviewing
Many people with Sjögren's take something that adds to the dryness. Older sedating antihistamines and promethazine are the worst offenders; loratadine, cetirizine, and fexofenadine are less drying. Bladder medications such as oxybutynin for overactive bladder, decongestants, older antidepressants, and paroxetine all reduce secretions. Our polypharmacy article covers how the list is pruned safely.
What hydroxychloroquine does and does not do
Hydroxychloroquine is the usual systemic medication, prescribed for joint pain, rash, and fatigue rather than for dryness; it does not restore tear or saliva flow. It takes two to three months to show benefit, so judging it at four weeks is premature. A baseline eye examination and annual retinal screening after five years of use are standard. Stronger immune-suppressing drugs are reserved for lung, kidney, or nerve involvement.
The features that need prompt evaluation
Parotid swelling that persists rather than coming and going deserves imaging, because lymphoma of the glands is the most important long-term risk. New numbness or burning in the feet suggests peripheral neuropathy, and a persistent dry cough can reflect airway dryness or lung involvement. Thyroid testing for hypothyroidism is routine, and overlap with rheumatoid arthritis or lupus is common. Sun sensitivity is real with anti-Ro antibodies, and Florida heat worsens dryness and fatigue; see our chronic conditions in Florida heat guide. Our immunology team coordinates rheumatology, eye, and dental care. The National Institute of Dental and Craniofacial Research and NIAMS publish patient guidance on Sjögren's syndrome.
If dryness has started costing you fillings or sleep, schedule a visit and bring your full medication list.