More Information on Sjögrens Syndrome


Author   -   Prof. Dr. med. Klaus Kruger (Munich).  Translation into English Language by SjögrensCambs



Sjögrens Syndrome - more information and practical advice for patients and medical professionals


What is the Sjögrens Syndrome?
In Sjögren's syndrome, there is an inflammatory attack of the tear and salivary glands, which leads to the most common and usually premature symptoms of dry mouth and eyes.


Sjögrens Syndrome comes as a separate disease ("primary SS") or as an adjunct in other diseases of the immune system such. rheumatoid arthritis or lupus erythematosus ("secondary SS"). Within the group of rheumatic immune diseases, Sjögren's Syndrome is the second most common after rheumatoid arthritis.


Tips for coping with Sjögren syndrome
For intensive oral care (use mild toothpaste) and careful caries prophylaxis (avoid too much sugar, fluoride), as well as frequent dental checks is to be observed!

Use of chewing aids (e.g., sugarless chewing gum) stimulates the salivary glands

The increased risk of infection - in case of doubt, immediate consultation with a specialist (and if necessary antibiotic use) makes sense. Also, sudden painful swelling of the salivary gland indicates an infectious complications.

Ensure adequate humidification and avoid unfavorable ambient conditions (air conditioning, smoking),


Use glasses with side protection in strong winds.

Nightly use of eye gel or ointment instead of artificial tears is associated with significantly prolonged action (and thus undisturbed sleep).

If the nasal mucosa is involved, use sufficient nasal gel to counteract the otherwise threatening formation of bark

A "leaden" severe fatigue is typical for the SS - treat yourself to as many breaks as possible (afternoon sleep)

Sharing experiences with fellow sufferers.


Prof. Dr. med. Klaus Kruger



Symptoms of Sjögren's syndrome


Clinically, Sjögren syndrome is mainly characterized by an inflammatory attack of the tear and salivary glands, which leads to the most common and usually premature symptoms of dry mouth and eyes, in the further course, however, a "dehydration" of other mucosal areas (eg genital organs, respiratory tract ) and the skin can cause. 


Often, however, it is not a pure disease of the glands, but also of the entire organism, which leads to general symptoms such as tiredness, fatigue or fever and with varying frequency swelling of the salivary glands, involvement of the joints and muscles (usually in the form of pain), but Also various internal organs and inflammation of the blood vessels (vasculitis) can exist.


The chronic disorder of the glandular function leads to massive impairments and unpleasant sequelae, especially in the area of ​​the mouth and eyes. These include e.g. Chronic inflammation and frequent infections in the area of ​​the oral cavity and the conjunctiva, caries and periodontitis, bad breath, difficulty in swallowing solid and dry foods, taste and smell disturbance, hoarseness and later permanent respiratory infections.


In rarer cases (8%) a lymphatic gland tumor may develop as a complication during the course of Sjögren's syndrome. Since it is almost always noticeable in the area of ​​the salivary glands or cervical lymph nodes, attention should be paid to a permanent enlargement or even increase in the size of these organs. If in doubt, the appropriate caring specialist should be consulted - this complication can be quickly diagnosed or excluded by magnetic resonance imaging and examination of a tissue sample!


Diagnosis of Sjögrens Syndrome

Unfortunately, the diagnosis of a Sjögren's syndrome usually comes with a delay of several years, because the almost always early symptoms of eye and mouth dryness are often not reported to the doctor in the early stages or are not interpreted correctly by him.


In addition to the typical clinical findings, inadequate tear or saliva production is initially detectable with simple functional tests. Accurate examinations of the salivary glands by means of imaging techniques with contrast media (scintigraphy, sialography, magnetic resonance imaging) then lead to the suspected diagnosis, a sampling from the inside of the lips with microscopic examination of glandular tissue finally mostly proof (or exclusion). Also, laboratory tests provide assistance, but can not ensure the diagnosis alone.


Particularly useful here is the immunological detection of certain antibodies that are found in many - but not all - SS patients in the blood (SS-A and SS-B antibodies).


However, it is important to note that there are many other potential causes of dry mouth and eyes. Other diseases such as Diabetes mellitus or fibromyalgia syndrome, but also viral diseases (for example, the viral liver inflammation / jaundice) not infrequently lead to similar sequelae, also a number of drugs for conditions such as hypertension and mental health conditions).


It is also to be noted that with increasing age the gland production can also decrease in healthy ones. Salivary gland swelling can also have many other causes. All this must be excluded as part of the investigation as a cause, a thorough medical examination by the ophthalmologist and otolaryngologist for this is in addition to the above measures requires meaningful treatment in Sjögren's syndrome. Although the disease still is not curable, and no drugs There are a number of treatment options available that successfully combat all symptoms. In addition, there are further hopeful Research indicators. 


Two different treatment approaches in Sjögren's Syndrome are currently distinguished: dryness symptoms are also treated primarily by replacements such as artificial tears and saliva or nasal gel, in the case of dry mouth through proper hydration. Various tear and saliva substitutes are available. It must be tested individually, which is the optimal one for each patient. 


On the other hand, for the systemic, (Secondary Sjogrens Syndrome)   a range of medications are diagnosed, each with its own specific uses. However, these drugs have little impact on the dryness symptoms, so are not necessary if only these (Primary SS) symptoms are  present.


Recent testing in the United States successfully indicates substances such as pilocarpine and cevimeline that effect by stimulating the glands increasing fluid production. Of these substances, oral pilocarpine ( example trade name: Salagen®) has been approved and can be prescribed in a number of  European countries since 2000.



 Author: Prof. Dr. med. Klaus Kruger (Munich)