Sjögren's syndrome

Sjögren's syndrome is an autoimmune condition, which means the immune system mistakenly targets the body's own tissues. Here it focuses on the glands that make tears and saliva, causing inflammation that reduces moisture and, over time, can affect the glands' function. Why this happens is not fully understood, and there is no single cause. A combination of genetic susceptibility, hormonal factors and possibly earlier infections is thought to play a part.

It is far more common in women, and often appears in middle age, though it can occur at any age. It may arise on its own, or alongside another autoimmune condition such as lupus, systemic sclerosis or rheumatoid arthritis. Having a relative with an autoimmune disease can slightly increase the likelihood.

The hallmark of Sjögren's is dryness, but it can affect more than the glands. Features may include:

• Persistently dry, gritty or uncomfortable eyes
• A dry mouth, difficulty swallowing dry foods, or dental problems
• Joint pain and stiffness
• Fatigue, which can be significant
• Sometimes dryness of other areas, or other autoimmune features

Diagnosis brings together your symptoms, an examination, blood tests for particular antibodies and markers of inflammation, and tests of eye and gland function. Because dryness has many causes, assessment helps confirm whether Sjögren's is responsible and whether it is occurring alongside another condition.

Where the joints are involved, ultrasound can help assess inflammation. Dr Borukhson uses point-of-care ultrasound during the consultation, so this can often be done in the same visit. You can read more on the ultrasound clinic page.

Treatment focuses on relieving dryness, protecting the eyes and teeth, managing joint symptoms and fatigue, and monitoring for any wider involvement. Prescription options can help where simple measures are not enough: longer-lasting lubricating eye drops or gels for dry eyes, saliva substitutes for a dry mouth and, in some cases, a medicine such as pilocarpine, which encourages the glands to produce more moisture. For joint pain and fatigue, hydroxychloroquine is sometimes used under specialist supervision, although the evidence for its benefit in Sjögren's is mixed, and immune-suppressing treatment is generally reserved for the less common situations where organs beyond the glands are involved. The approach is individual and is discussed with you, and because Sjögren's is long-term, regular review is helpful.

Sjögren's syndrome can affect the eyes, mouth, joints and, less commonly, other organs, so care sometimes draws on more than one specialty. Dr Borukhson practises within a world-renowned tertiary centre, with ready access to consultant colleagues across the other specialties that may be involved in caring for this condition. Where appropriate, she can involve those specialists directly, and bring particularly complex cases to a multidisciplinary team meeting (MDT) with minimal delay. This means that, when more than one area of expertise is needed, your care can be joined up and decisions reached promptly.

Day-to-day measures make a real difference to comfort. For dry eyes, lubricating drops used regularly, blinking breaks during screen work and protecting the eyes from wind and air conditioning all help. For a dry mouth, sip water through the day, chew sugar-free gum to stimulate saliva, and keep up careful dental care, as reduced saliva raises the risk of decay.

• Stay well hydrated and limit caffeine and alcohol, which worsen dryness
• Use a humidifier in heated or air-conditioned rooms
• Pace activity to manage fatigue, balancing rest with gentle regular exercise
• Stop smoking, which aggravates dryness and inflammation

Most people manage well over time with the right routine and review. Symptoms can fluctuate, and keeping appointments allows treatment to be adjusted and any wider changes picked up early.

Most symptoms can be managed at a routine review, but some changes warrant prompt attention. Seek same-day eye care if you develop sudden eye pain, marked redness or any change in vision, as these need assessing urgently in their own right and severe dryness can occasionally damage the eye surface.

Contact your specialist team without waiting for a scheduled appointment if you notice:

• A persistent new lump or swelling, especially in the glands near the jaw or in the neck
• Unexplained fever, weight loss or drenching night sweats
• New numbness, tingling or weakness in the limbs
• Breathlessness, a persistent cough or new joint swelling

These features are uncommon but are worth checking promptly. Steadily worsening dryness, fatigue or joint pain is best raised at a routine review so your plan can be reviewed.

Persistent dryness combined with joint pain and fatigue is worth assessing properly, both to confirm the diagnosis and to check whether any other autoimmune condition is present. A specialist review can bring clarity and a clear plan.

What tests are used to diagnose Sjögren's syndrome?

There is no single diagnostic test. The picture is built up from your symptoms and an examination, blood tests looking for specific antibodies and measures of inflammation, and assessments of how the eyes and glands are working. Because dryness has many possible causes, this combination helps confirm whether Sjögren's is responsible.

What happens at the first appointment?

Dr Borukhson takes a careful history of the dryness, joint symptoms and fatigue, examines you, and reviews or arranges the relevant blood tests. Where the joints are affected, point-of-care ultrasound can be used during the consultation itself to look for inflammation. You should leave with a clear explanation of what is suspected and what will happen next.

Will Sjögren's syndrome affect other parts of my body?

For most people the main effects are dryness of the eyes and mouth, joint symptoms and fatigue. Involvement of other organs is less common, and one purpose of regular review is to pick up any wider features early so they can be addressed promptly.

How often will I need follow-up?

Sjögren's is a long-term condition, so ongoing review is more useful than a one-off assessment. The right interval depends on your symptoms and whether there is any wider involvement, and it is agreed with you as part of the plan. Where more than one specialty is needed, care can be coordinated so that reviews stay joined up.

Can Sjögren's occur alongside other autoimmune conditions?

Yes. It can appear on its own or together with another autoimmune condition, such as lupus or systemic sclerosis, and checking for this is part of the assessment. Identifying any associated condition matters because it can shape both treatment and monitoring.