Sjögren's syndrome is an autoimmune disease characterized by the immune system abnormally attacking the tear glands and salivary glands, leading to dryness of mucous membranes and mucosa-associated tissues. Symptoms vary from person to person, but dry mouth and dry eyes are the most common initial signs. Patients may gradually experience multi-system involvement over weeks to years, which can severely affect their quality of daily life.
This symptom complex can be divided into primary symptoms and secondary symptoms. Primary symptoms directly result from the immune system attacking the glands, while secondary symptoms may arise from long-term dryness leading to infections or tissue damage. Early diagnosis is crucial for delaying disease progression, so being familiar with symptom change patterns can help patients seek professional medical assistance early.
Early symptoms typically manifest as a sensation of dryness in the mouth and eyes, which may be mistaken for general fatigue or environmental factors. Patients often describe difficulty swallowing, especially needing to drink frequently when eating dry or hard foods. Increased eye discharge or a foreign body sensation may be perceived as an allergic reaction, but decreased tear production gradually increases the risk of corneal damage.
Other early signs include:
Dry mouth symptoms (known as xerostomia) may lead to cracks on the surface of the tongue, taste abnormalities, and frequent thirst. Increased viscosity of saliva may form thick secretions, raising the risk of oral infections. Dry eyes (xerophthalmia) may lead to corneal staining or ulcers, and patients may need to use artificial tears long-term.
About 40% of patients will experience systemic symptoms, including muscle weakness, joint pain, and unexplained fatigue. These symptoms may be related to abnormal immune system activity and can intermittently worsen. Some patients may experience skin dryness or vaginal dryness, impacting daily activities and quality of life.
During the progression of the disease, the immune system may attack other exocrine glands, such as the trachea or gastrointestinal mucosa, leading to coughing or difficulty swallowing. Some patients may present with secondary symptoms, such as swelling of the salivary glands or lymphadenopathy, which may become important diagnostic clues.
Patients who remain untreated long-term may develop severe complications, such as tooth loss, retinal disease, or peripheral neuropathy. The severity of symptoms may be influenced by environmental factors, with dry climates or medications (such as antihistamines) potentially exacerbating symptom expression.
When dry mouth or dry eye symptoms persist for more than 3 months and affect daily life, immediate medical evaluation is recommended. If unexplained joint swelling, skin ulcers, or recurrent oral infections occur, it may indicate that the disease has progressed to the second stage. Severe symptoms such as worsening blurred vision or difficulty swallowing require urgent medical evaluation to prevent tissue damage.
Patients are advised to keep a symptom diary to track the frequency and severity of symptoms. If systemic symptoms (such as low-grade fever or unexplained weight loss) or organ-specific symptoms (such as liver function abnormality-related symptoms) arise, immediate immunological testing should be arranged to confirm the diagnosis.
Increasing environmental humidity, sucking on sugar-free lozenges to stimulate saliva production, using artificial tears to moisturize the eyes, and avoiding tobacco and alcohol irritants can help. Regular oral hygiene can prevent infections, and using fragrance-free lip balm can also relieve chapped lips. It is recommended to drink small amounts of water frequently and choose sugar-free gum to stimulate saliva production.
What side effects might there be from medications used to treat Sjögren's syndrome?Antimalarial medications such as hydroxychloroquine may cause gastrointestinal discomfort or retinal issues, requiring regular eye examinations. Immunosuppressants may suppress immunity, increasing the risk of infections, and blood cell counts need to be closely monitored during treatment. Local symptoms can be prioritized with artificial tears or saliva substitutes to reduce systemic medication side effects.
What should patients with Sjögren's syndrome pay attention to during dental check-ups?Due to decreased saliva production leading to cavities and periodontal disease, it is recommended to have dental check-ups every six months and use fluoride mouthwash for enhanced protection. Patients should inform their dentist of their Sjögren's syndrome history to avoid medications that may exacerbate dry mouth. In severe cases, consulting a physician about medications that stimulate saliva production or local administration methods may be advisable.
How can Sjögren's syndrome be distinguished from lupus in terms of symptoms?Although both are autoimmune diseases, Sjögren's syndrome primarily presents with dry mouth and dry eyes, while lupus is often accompanied by joint pain, skin rashes, and elevated systemic inflammatory markers. Sjögren's syndrome patients may experience organ involvement such as pulmonary fibrosis or peripheral neuropathy, but fever and positive antinuclear antibody rates are lower than in lupus.
Which foods in daily diet may worsen symptoms?Spicy, overly salty, or dry hard foods may irritate dry mouth discomfort, so it is recommended to choose moist foods like soups and fruit purees, avoiding sugary snacks to reduce the risk of cavities. Adequate vitamin C intake can maintain mucosal health, but excessive caffeine should be avoided as it can exacerbate dehydration.
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