Sjögren's syndrome is a chronic autoimmune disease that primarily affects the salivary and lacrimal glands, causing dry mouth and eyes. The disease is often associated with other autoimmune diseases, such as rheumatoid arthritis or systemic lupus erythematosus. Timely diagnosis and treatment improve the quality of life and reduce the risk of complications.

What is Sjögren's syndrome?

Sjögren's syndrome is an autoimmune disease that causes the immune system to attack the moisture glands in the body, causing them to malfunction. This syndrome is divided into two main types:

• Primary Sjögren's syndrome: develops as an independent disease.
• Secondary Sjögren's syndrome: occurs in combination with other autoimmune diseases such as rheumatoid arthritis or lupus.

Sjögren's syndrome can affect not only the salivary and lacrimal glands, but also other body systems, including the joints, kidneys, lungs, nervous system, and blood vessels.

Sjögren's syndrome is named after the Swedish ophthalmologist Henrik Sjögren, who in 1933 first described this disease in a detailed study. He noted a combination of symptoms, including dry eyes and mouth, that were not fully understood at the time. Sjogren's research greatly contributed to the understanding of autoimmune diseases and diagnostic methods that allow doctors to more accurately identify and manage the condition.

The role of glands in the body

Salivary and lacrimal glands are essential for maintaining moisture in the body. Saliva helps in the digestion of food, protects the teeth from caries and reduces the formation of bacteria in the mouth. Tears, in turn, moisturize and protect the eyes, preventing them from drying out and damaging them. By destroying these glands, Sjögren's syndrome causes long-term health problems.

These glands play an important role in maintaining general health, and their damage can lead to a number of complications that significantly affect the patient's quality of life.

Causes of Sjögren's syndrome

The causes of the disease are not fully understood, however, research points to various factors that could contribute to the development of Sjögren's syndrome:

• Genetic predisposition: People with a family history of autoimmune diseases have a higher risk of developing Sjögren's syndrome. This predisposition may be due to mutations in certain genes that affect the functioning of the immune system.
• Hormonal changes: Sjögren's syndrome is more common in women, especially after menopause. This indicates a link between hormonal changes and the development of autoimmune diseases. Declining estrogen levels can affect the immune system, making the body more susceptible to inflammation and autoimmune reactions.
• Infections: Some viral and bacterial infections can be the causative agents or catalysts of the disease. For example, infections with Epstein-Barr virus, cytomegalovirus, or hepatitis viruses can stimulate the immune system in a way that causes autoimmune reactions against the body's own tissues.
• Environmental factors: researchers have identified several external factors that could influence the development of the disease. Stress, exposure to toxins (such as the presence of heavy metals or pollution), and poor nutrition are associated with an increased risk of Sjögren's syndrome. These factors can contribute to an imbalance of the immune system and increase the likelihood of autoimmune inflammation.
• Immune system dysfunction: Sjögren's syndrome occurs when the immune system mistakenly attacks the body. Research shows that certain cytokines and immune cell activity (such as T cells and B cells) can be overactive, contributing to glandular damage and inflammation.

In addition, theories related to microbiome imbalance are being explored. Changes in the gut microbiome can affect immune system responses, which in turn increases the risk of autoimmune diseases. This aspect is especially relevant because the health of the microbiome is closely related to a person's diet, lifestyle and environmental influences.

In summary, the causes of Sjögren's syndrome are complex and multifaceted. Both genetic and environmental factors, as well as the interaction of the immune system with external and internal influences, form the overall picture of the development of the disease. Therefore, it is essential to consider the combination of these factors in diagnostic and treatment approaches.

Symptoms of Sjögren's syndrome

Symptoms can develop gradually and their severity can vary greatly from patient to patient. The clinical manifestations of Sjögren's syndrome include both general and specific signs affecting the glands and other body systems.

Main features

• Dry mouth (xerostomia): Dry mouth is one of the most common symptoms of Sjögren's syndrome. This can make it difficult to speak, eat and swallow, and cause bad breath. Lack of saliva increases the risk of caries and gum disease.
• Burning or itching in the eyes: reduced tear production causes the eye to dry out, causing a burning sensation, itching, sensitivity to light, and often blurred vision. Prolonged, untreated dryness can cause eye damage.
• Dry skin and mucous membranes: patients often experience dryness on the skin, nasal and vaginal mucous membranes, which causes discomfort and increases the risk of infections.
• Joint pain and inflammation: Sjögren's syndrome can cause joint stiffness, swelling, and chronic pain that impairs mobility and quality of daily life.
• Chronic fatigue: lack of energy and fatigue is a common problem that significantly affects work and social activity.
• Enlarged lymph nodes: due to inflammation, the lymph nodes may become enlarged and tender, especially in the neck and jaw area.

Additional symptoms

In some patients, manifestations of Sjogren's syndrome extend beyond the glands and include:

• Gastrointestinal disorders: indigestion, abdominal pain and diarrhea may be associated with the systemic nature of the disease.
• Lung damage: Dryness and inflammation of the lungs can lead to chronic cough, shortness of breath and even pulmonary fibrosis.
• Involvement of the nervous system: Patients may experience neuritis, tingling or numbness in the extremities, and cognitive impairment such as difficulty concentrating or memory loss.
• Cardiovascular symptoms: In rare cases, the disease can affect the heart muscle or cause vasculitis, which damages blood vessels.
• Depression and emotional problems: Prolonged discomfort and deteriorating health can lead to depression, anxiety and emotional exhaustion.

Impact of symptoms on quality of life

Patients often experience a combination of symptoms that significantly affect their quality of life. Everyday activities such as eating, working and socializing become difficult, which can lead to feelings of isolation. The diverse symptoms of the disease require an individual approach to treatment and symptom control.

General deterioration of health

In addition to specific symptoms, many patients observe:

• Weight loss: Decreased appetite and digestive problems can lead to unplanned weight loss.
• Drowsiness and exhaustion: Chronic fatigue often accompanies Sjögren's syndrome, making it difficult to regain energy even after rest.
• Immune system overload: increased susceptibility to infections because the immune system is busy attacking the body's own tissues in the wrong way.

The variety and severity of these symptoms means that patients need personalized care and regular follow-up by their doctor to improve their quality of life and prevent complications.

How is Sjögren's syndrome diagnosed?

To diagnose Sjögren's syndrome, doctors use several diagnostic methods that help determine the severity and extent of the disease, as well as create an effective treatment plan. These methods include laboratory, clinical and imaging examinations:

• Blood tests: they are the main step in the diagnosis of the disease. Doctors look for specific antibodies, such as SSA/Ro and SSB/La, that are specific for Sjögren's syndrome. In addition, general inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are also tested, as well as immunoglobulin levels, which may be elevated in autoimmune diseases.
• Salivary gland biopsy: this method involves removing a small tissue sample from a salivary gland, usually inside the lower lip. A biopsy checks for the presence of inflammatory cells and glandular damage, which helps confirm the diagnosis. It is especially useful when blood test results are not clear enough.
• Schirmer test: this simple test measures the amount of tears the eyes produce over a period of time. Paper strips are placed under the lower eyelid and wetness is recorded after five minutes. The test results help determine the degree of dry eyes, which is a common symptom of Sjögren's syndrome.
• Imaging diagnostics: Ultrasound and magnetic resonance imaging are useful for identifying structural changes in the salivary and lacrimal glands. Ultrasound can detect glandular enlargement, while magnetic resonance imaging provides detailed information about the condition of the glandular tissue.

Additional diagnostic methods:

• Sialometry: This test measures the rate and amount of saliva produced to determine the severity of dryness. It is particularly useful for patients with oral symptoms.
• Ophthalmological examination: eye doctors may use fluorescein dyes and slit lamps (slit-lamp) tests to assess ocular surface damage and effects of dryness.
• Autonomic nervous system function tests: Nerve damage associated with Sjögren's syndrome can be identified using reflex and sweat production tests.
• Immunological tests: in addition to SSA/Ro and SSB/La antibodies, antinuclear antibodies (ANA) and rheumatoid factor (RF) are sometimes tested, which are often positive in patients with Sjögren's syndrome.

Accurate diagnostic approach:

Accurate diagnosis requires careful evaluation of the patient's medical history and analysis of symptoms. The doctor carefully evaluates patients' complaints, such as dry eyes and mouth, joint pain and chronic fatigue, as well as family history to identify possible risk factors. Also, differential diagnosis is essential to rule out other diseases with similar symptoms, such as lupus, rheumatoid arthritis or chronic infection.

In summary, the diagnosis of Sjögren's syndrome is based on a combination of different tests that provide a complete understanding of the course and severity of the disease. This multifaceted approach helps doctors develop a comprehensive and personalized treatment strategy.

Complications of Sjögren's syndrome

Untreated Sjögren's syndrome can have serious health consequences:

• Diseases of teeth and gums: dry mouth increases the risk of caries and periodontitis.
• Damage to the cornea: Dryness can cause damage to the cornea of ​​the eye.
• Kidney problems: the disease can affect the kidneys and cause kidney damage.
• Lymphoma: Patients with Sjögren's syndrome are at increased risk of lymphoma.
• Other systemic complications: including nervous system damage and vasculitis.

Complications of the disease can be of different degrees of severity, and timely treatment is essential for their prevention.

Treatment and control of Sjögren's syndrome

Although the disease cannot be completely cured, the symptoms can be effectively controlled. Treatment is tailored to the individual needs of each patient to reduce symptoms, improve quality of life and prevent potential complications. Treatment approaches include several important aspects:

• Moisturizers: Artificial tears and saliva substitutes are an important tool to reduce the feeling of dryness. In addition, nasal sprays and moisturizers are also available to help relieve discomfort in the mucous membranes.
• Lifestyle changes: Avoiding smoking, alcohol abuse, and dehydration are essential steps in controlling symptoms. Stress management techniques such as meditation and relaxation exercises can help improve your overall well-being.
• Physical therapy: For patients with joint stiffness or muscle pain, physical therapy and light exercise can help improve mobility and reduce discomfort.

Additional treatment approaches:

• Natural remedies and nutritional supplements: Some patients benefit from omega-3 fatty acids, turmeric, and other anti-inflammatory agents taken in dietary supplements. It is recommended to use these remedies only after consulting a doctor.
• Humidifiers and improving air quality: the use of humidifiers indoors helps to reduce the dryness of the air, which can worsen the symptoms of the disease.

Regular medical monitoring is crucial to prevent more serious complications, such as the development of lymphoma or progressive organ damage. Doctors recommend blood tests, imaging and other tests at least once a year to assess the progression of the disease and adjust the treatment plan according to the patients' changing needs.

The importance of nutrition and physical activity

Proper nutrition and regular physical activity can improve patients' quality of life:

• Nutrition: enrich the menu with omega-3 fatty acids and antioxidants that help reduce inflammation. Avoid foods that may make your symptoms worse, such as very salty or spicy foods.
• Physical activity: Light exercise and yoga practice help maintain joint mobility and improve general well-being.

Physical activity also helps fight chronic fatigue and maintain mental balance.

How to live with Sjögren's syndrome?

Living with Sjögren's syndrome requires adaptation and discipline:

• Education: Learn about the disease to better understand its management options.
• Support: Join support groups to share your experiences with other patients.
• Cooperation with the doctor: regularly consult with specialists to tailor treatment to your individual needs.

The quality of life can be significantly improved by introducing healthy habits and emotional support.

Latest research and technologies

Scientific research continues to develop new treatments, including genetic therapies and immunomodulatory approaches, which could improve disease control in the future. Research is also focused on more accurate diagnostic methods to detect the presence of the disease early and prevent complications more effectively.

Conclusion

Sjögren's syndrome is a complex autoimmune disease that can affect daily life, but with the right treatment and lifestyle changes, it is possible to improve quality of life. Timely diagnosis, symptom management and emotional support are essential elements to successfully living with this disease. If you suspect Sjögren's syndrome, consult a doctor and start the necessary treatment.

Additional resources

• Sjögren's syndrome (source: Latvian Society of Adult Rheumatology)
• Sjögren's syndrome. How to recognize in outpatient practice? (source: Doctus)
• Sjögren's syndrome. Exocrine manifestations (source: Doctus)