💦 Sjögren’s Syndrome
An autoimmune attack on the glands that make moisture. Dry eyes, dry mouth, and the damage that follows.
🧬 What it is
An autoimmune disease in which lymphocytes infiltrate and destroy the exocrine glands — the glands that make moisture. Chiefly the lacrimal glands that make tears and the salivary glands that make saliva.
One idea explains the whole disease: the body has attacked its own moisture supply. Every sign follows from something drying out.
Who gets it. Overwhelmingly women — around nine in ten — usually diagnosed after 40. Like other autoimmune diseases it is more common in people who already have one.
| Primary Sjögren’s | Secondary Sjögren’s | |
|---|---|---|
| Occurs | On its own | Alongside another autoimmune disease |
| Commonly with | — | Rheumatoid arthritis, lupus, scleroderma |
| Why it matters | A patient with RA or lupus who now complains of gritty eyes and a dry mouth is describing secondary Sjögren’s, not a new unrelated problem. | |
👀 How it shows up
The two hallmark symptoms have proper names, and both get asked.
- Keratoconjunctivitis sicca — dry eyes. Described as gritty, sandy, or like something is in the eye. Burning, redness, light sensitivity, sometimes stringy discharge.
- Xerostomia — dry mouth. Trouble swallowing dry food, trouble speaking for long, altered taste, a sticky feeling.
What dryness leads to — this is the part that causes real harm
- Rampant dental decay. Saliva buffers acid and washes away bacteria; without it, caries accelerate dramatically. Dental disease is often the most damaging consequence.
- Oral candidiasis — thrush, and angular cheilitis at the corners of the mouth.
- Corneal ulceration and scarring if dry eyes go untreated.
- Parotid gland swelling — recurrent, often bilateral, in front of and below the ear.
Beyond the glands. Sjögren’s is systemic, and the extra features are easy to miss: profound fatigue, joint pain, dry skin, vaginal dryness, dry cough, Raynaud phenomenon, and sometimes kidney, lung or nerve involvement.
There is also a raised lifetime risk of lymphoma — persistent, firm, one-sided gland swelling or new lymphadenopathy should be reported rather than watched.
🧪 How it is confirmed
- Anti-SSA (Ro) and anti-SSB (La) antibodies — the characteristic blood tests.
- ANA and rheumatoid factor are frequently positive too.
- Schirmer test — a paper strip in the lower lid measures tear production over 5 minutes.
- Minor salivary gland biopsy from the inner lip, showing lymphocytic infiltration — the most definitive test.
- Raised ESR; sometimes anemia or a low white count.
🩺 What you do — replace, protect, stimulate
There is no cure. Nursing is symptom control and, above all, preventing the damage that dryness causes.
Eyes
- Preservative-free artificial tears, used regularly rather than only when uncomfortable
- Thicker ointment or gel at night
- Humidifier; avoid fans, forced air, smoke and wind
- Wraparound sunglasses outdoors
- Punctal plugs to keep what tears there are on the eye
- Deliberate blinking during screen work
- Report eye pain or vision change — possible corneal ulcer
Mouth
- Sip water constantly; carry a bottle
- Sugar-free gum or candy to stimulate flow — sugar-free is not optional with no saliva to protect the teeth
- Saliva substitutes and moisturising gels
- Dental visits every 3–6 months, daily fluoride
- Moisten food with sauces; avoid dry, crumbly foods
- Avoid alcohol, caffeine, tobacco and alcohol-containing mouthwash — all drying
- Inspect the mouth for thrush
💊 Medications
| Purpose | Agent | Nursing point |
|---|---|---|
| Stimulate secretions | Pilocarpine, cevimeline | Cholinergic — expect sweating, flushing, urinary frequency. Caution in asthma and narrow-angle glaucoma. |
| Reduce eye inflammation | Cyclosporine eye drops | Takes weeks to work — tell the patient, or they will stop it. |
| Joint and systemic disease | Hydroxychloroquine | Needs baseline and periodic eye exams — retinal toxicity. |
| Severe organ involvement | Corticosteroids, immunosuppressants | Infection risk; teach fever reporting. |
Review the medication list for driers. Antihistamines, anticholinergics, tricyclic antidepressants, diuretics and some antihypertensives all reduce secretions and can make Sjögren’s markedly worse. Spotting one of these on the list is often the single most useful thing a nurse does for these patients.