Sjögren's Syndrome is a chronic autoimmune disease characterized primarily by the immune system's abnormal attack on the lacrimal and salivary glands, leading to decreased secretion of tears and saliva. This condition may be accompanied by systemic symptoms and, in severe cases, can affect organ function, impacting the patient's quality of life. Currently, there is no cure, but proper treatment and daily management can effectively alleviate symptoms and prevent complications.
This disease is more common in middle-aged women, with a male-to-female ratio of about 1:9, and is often misdiagnosed as age-related changes or dry eye syndrome. Recent studies have shown that Sjögren's Syndrome may be related to specific genotypes and environmental triggers. Early diagnosis is key to slowing disease progression, and patients need regular monitoring of liver and kidney function as well as blood markers to avoid organ damage.
The pathogenesis of Sjögren's Syndrome involves complex autoimmune abnormalities. Normal immune cells should recognize foreign pathogens, but T cells and B cells in patients mistakenly attack the tissues of the lacrimal and salivary glands, leading to inflammation and atrophy of these glands. This process may be related to genetic susceptibility, with research indicating that specific human leukocyte antigens (HLA-DR3 and HLA-DQ) increase the risk of developing the disease.
Environmental triggers are considered significant inducements for disease onset. Viral infections (such as Epstein-Barr virus), hormonal changes (such as menopausal hormone fluctuations), or prolonged exposure to chemicals may activate genetic immune system defects. Studies show that individuals with a history of rheumatoid arthritis or systemic lupus erythematosus have a 3-5 times higher incidence of Sjögren's Syndrome compared to the general population.
The symptoms of Sjögren's Syndrome can be divided into "exocrine gland symptoms" and "systemic manifestations." The three classic main symptoms are: persistent dry mouth leading to difficulty swallowing, dry eye symptoms requiring frequent use of artificial tears, and insufficient saliva secretion leading to an increase in dental caries. Some patients may experience skin cracking, nasal bleeding, and other mucosal damage phenomena.
About 30% of patients may experience systemic symptoms such as joint pain and fatigue, with severe cases potentially accompanied by pulmonary fibrosis and renal tubular acidosis. In terms of the nervous system, some patients may develop peripheral neuropathy leading to limb numbness. It is noteworthy that the severity of symptoms is not always directly correlated with the extent of gland damage, and objective examinations are necessary to confirm the diagnosis.
Diagnosing Sjögren's Syndrome requires integrating clinical symptoms with objective examination results. Diagnostic criteria include the 2016 EULAR/ACR classification system, which must meet symptom indicators and objective biomarkers. Common examination items include: the Schirmer test to measure tear secretion, sialography to examine salivary gland structure, and blood tests for anti-SSA/Ro and SSB/La antibodies.
Physicians must rule out drug side effects (such as antihistamines) and diseases with similar symptoms, such as primary dry eye syndrome or drug-induced dry mouth. For suspected cases, further lip gland biopsy may be performed to observe the degree of lymphocytic infiltration. About 15% of patients may have concurrent lymphoma, requiring regular monitoring of serum monoclonal protein to exclude malignant transformation.
The treatment goal is to alleviate symptoms, delay organ damage, and manage systemic complications. For dry mouth symptoms, salivary gland stimulants such as cevimeline can be used, while severe dry eye syndrome may require the use of autologous plasma eye drops or punctal occlusion surgery. In terms of immunomodulatory treatment, the first-line drug is the antimalarial drug hydroxychloroquine, which can reduce inflammation indices and has a better safety profile.
Although Sjögren's Syndrome cannot be completely prevented, the risk of complications can be reduced through the following methods: regular dental check-ups to prevent cavities, using artificial tears and saliva substitutes to alleviate symptoms. Patients are advised to quit smoking to reduce salivary gland damage and avoid antihistamines that exacerbate dry mouth.
It is recommended to monitor antinuclear antibodies and complement levels every six months to assess disease activity. For patients with concurrent autoimmune diseases, special attention should be paid to cardiovascular risks, with regular checks of blood lipids and blood pressure. Nutritionists recommend a high-fiber diet and avoiding dry foods to alleviate swallowing difficulties.
If you experience persistent dry mouth and dry eye symptoms for more than three months, and are accompanied by the following conditions, you should seek medical attention immediately: unexplained weight loss, joint swelling or skin purpura, or signs of kidney dysfunction such as decreased urination. If symptoms are severe enough to affect daily eating or sleeping, prompt autoimmune-related examinations should be conducted.
Dry mouth is a typical symptom of Sjögren's Syndrome and can be alleviated by increasing fluid intake, using artificial saliva gels or sprays. It is advisable to avoid caffeine and alcoholic beverages, and to use humidifiers to maintain environmental humidity. Regularly chewing sugar-free gum can also stimulate saliva secretion, improving swallowing or speech difficulties.
Do Sjögren's Syndrome patients need to regularly undergo salivary gland biopsy?Salivary gland biopsy (lip biopsy) is an important traditional diagnostic indicator for Sjögren's Syndrome, but most diagnoses now rely on serological indicators and symptom assessment. Unless symptoms are unclear or initial results are uncertain, follow-up periods typically do not require repeated invasive examinations.
What are the applications of biologics in the treatment of Sjögren's Syndrome?Biologics such as anti-CD20 monoclonal antibodies (like rituximab) may be effective for patients with severe autoimmune activity, potentially reducing gland inflammation. However, treatment needs to be objectively assessed for disease severity, as it may increase the risk of infection, and should be evaluated by a physician based on individual circumstances.
How can I prevent oral infections or cavities caused by Sjögren's Syndrome?A dry mouth environment can easily lead to plaque accumulation and fungal infections, so it is recommended to use fluoride mouthwash daily and have dental check-ups every six months. If cracks appear on the tongue or oral ulcers develop, timely use of antifungal ointments or medications is necessary to avoid serious infections.
How is the fatigue symptom in Sjögren's Syndrome different from general fatigue? How can it be improved?Fatigue in Sjögren's Syndrome is often accompanied by chronic inflammation and differs from general fatigue, as it may persist for weeks and not improve significantly with rest. It is recommended to adopt a rhythmic activity schedule, combining light aerobic exercises like walking, and incorporating cognitive behavioral therapy to adjust the pace of life, which can effectively alleviate symptoms.
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