Your doctor will diagnose Sjögren’s syndrome using your
- Medical history. Because there are many causes of dry eyes and dry mouth (including many common medications, other diseases, or previous treatment such as radiation of the head or neck), your doctor needs a thorough history
- A physical exam. During the exam, your doctor will check for clinical signs of Sjögren’s syndrome, such as indications of mouth dryness or signs of other connective tissue diseases.
- Results from clinical or laboratory tests. Depending on what your doctor finds during the history and exam, he or she may want to perform some tests or refer you to a specialist to establish the diagnosis of Sjögren’s syndrome, including:
- Blood tests to determine the presence of antibodies common in Sjögren’s syndrome, including anti-SSA and anti-SSB antibodies or rheumatoid factor.
- Other tests can identify decreases in tear and saliva production.
- Biopsy of the saliva glands and other specialized tests can also help to confirm the diagnosis. additional tests to see whether other parts of the body are affected.
Treatment can vary from person to person, depending on what parts of your body are affected,
Treatments for Dry Eyes
There are many treatments you can try or your doctor can prescribe for dry eyes. Here are some that might help:
- Artificial tears keep your eyes moist by replacing the natural tears. These products are available by prescription or over the counter under many brand names. Artificial tears come in different thicknesses, so you may have to experiment to find the right one. Some drops contain preservatives that might irritate your eyes. Drops without preservatives usually don’t bother the eyes.
- Ointments are thicker than artificial tears. Because they moisturize and protect the eye for several hours, and may blur your vision, they are most effective during sleep.
- Other therapies, such as plugging or blocking the tear ducts, anti-inflammatory medication, or surgery may be needed in more severe cases.
Treatments for Dry Mouth
There are many remedies for dry mouth. You can try some of them on your own. Your doctor may prescribe others. Here are some many people find useful:
- Chewing gum and hard candy. If your salivary glands still produce some saliva, you can stimulate them to make more by chewing gum or sucking on hard candy. However, gum and candy must be sugar-free, because dry mouth makes you extremely prone to progressive dental decay (cavities).
- Taking sips of water or another sugar-free, noncarbonated drink throughout the day to wet your mouth, especially when you are eating or talking. Note that drinking large amounts of liquid throughout the day will not make your mouth any less dry and will make you urinate more often. You should only take small sips of liquid, but not too often. If you sip liquids every few minutes, it may reduce or remove the mucus coating inside your mouth, increasing the feeling of dryness.
- Using an oil or petroleum-based lip balm or lipstick can soothe dry, cracked lips. If your mouth hurts, your doctor may give you medicine in a mouth rinse, ointment, or gel to apply to the sore areas to control pain and inflammation.
- Using other therapies such as saliva substitutes or medications that stimulate the salivary glands to produce saliva are sometimes indicated.
Treatments for Symptoms in Other Parts of the Body
If you have extraglandular involvement, which means a problem that extends beyond the moisture-producing glands of your eyes and mouth, your doctor may treat those problems using nonsteroidal anti-inflammatory drugs (NSAIDs)1, or immune-modifying drugs.
Footnote
1Warning: Side effects of NSAIDs include stomach problems; skin rashes; high blood pressure; fluid retention; and liver, kidney, and heart problems. The longer a person uses NSAIDs, the more likely he or she is to have side effects, ranging from mild to serious. Many other drugs cannot be taken when a patient is being treated with NSAIDs, because NSAIDs alter the way the body uses or eliminates these other drugs. Check with your health care provider or pharmacist before you take NSAIDs. NSAIDs should only be used at the lowest dose possible for the shortest time needed.
The symptoms of Sjögren’s syndrome usually develop gradually and are similar to those of many other diseases. This means it can take time to get a diagnosis. You may see a number of doctors, any of whom could diagnose the disease and help with your treatment, including a
- A rheumatologist—a doctor who specializes in diseases of the joints, muscles, and bones.
- A primary care physician
- An internist
- An ophthalmologist—a doctor who specializes in caring for the eyes.
- An otolaryngologist—a doctor who specializes in caring for the ears, nose, and throat.
Usually a rheumatologist will coordinate your treatment among a number of specialists.
General Tips for Eye Care
- Don’t use artificial tears that irritate your eyes. If one brand or prescription bothers you, try another. Eye drops that do not contain preservatives are usually essential for long-term use.
- Practice blinking. You tend to blink less when reading or using the computer. Remember to blink 5 to 6 times a minute.
- Protect your eyes from drafts, breezes, and wind.
- Put humidifiers in the rooms where you spend the most time, including the bedroom, or install a humidifier in your heating and air conditioning unit.
- Don’t smoke, and stay out of smoky rooms.
- Apply mascara only to the tips of your lashes so it doesn’t get in your eyes. If you use eyeliner or eye shadow, put it only on the skin above your lashes, not on the sensitive skin under your lashes, close to your eyes. Avoid facial creams on the lower lid skin at bedtime if you are awakening with eye irritation.
- Ask your doctor whether any medications that you are taking contribute to dryness. If they do, ask how the dryness can be reduced.
The Importance of Oral Hygiene
Natural saliva contains substances that rid the mouth of the bacteria that cause dental decay (cavities) and mouth infections, so good oral hygiene is extremely important when you have dry mouth. Here’s what you can do to prevent cavities and infections:
- Visit a dentist regularly, at least twice a year, to have your teeth examined and cleaned.
- Rinse your mouth with water several times a day. Don’t use mouthwash that contains alcohol, because alcohol is drying.
- Use toothpaste that contains fluoride to gently brush your teeth, gums, and tongue after each meal and before bedtime. Non-foaming toothpaste is less drying.
- Floss your teeth every day.
- Avoid sugar between meals. That means choosing sugar-free gum, candy, and soda. If you do eat or drink sugary foods, brush your teeth immediately afterward.
- See a dentist right away if you notice anything unusual or have continuous burning or other oral symptoms.
- Ask your dentist whether you need to take fluoride supplements, use a fluoride gel at night, or have a varnish put on your teeth to protect the enamel.
Protect Your Voice
You can develop hoarseness if their vocal cords become inflamed or become irritated from throat dryness or coughing. To prevent further strain on your vocal cords, try not to clear your throat before speaking. Clearing your throat is hard on the vocal cords. To avoid irritating your vocal cords, try:
- Sipping water.
- Chewing sugar-free gum.
- Sucking on sugar-free candy.
- Making an “h” sound, hum, or laugh to gently bring the vocal cords together
Medicines and Dryness
Certain drugs can contribute to eye and mouth dryness. If you take any of the drugs listed below, ask your doctor whether they could be causing symptoms. Don’t stop taking any medicine without asking your doctor. Sometimes your doctor can make adjustments to the dose to help protect you against drying side effects or chose a drug that’s least likely to cause dryness. Drugs that can cause dryness include:
- Antihistamines.
- Decongestants.
- Diuretics.
- Some antidiarrhea drugs.
- Some antipsychotic drugs.
- Tranquilizers.
- Some blood pressure medicines.
- Antidepressants.
A small number of people with Sjögren’s syndrome may develop lymphoma. A form of cancer, lymphoma can affect the salivary glands, lymph nodes, the gastrointestinal tract, or the lungs. If you have enlargement of a salivary gland, you should contact your doctor. Other symptoms may include the following:
- Unexplained fever.
- Night sweats.
- Constant fatigue.
- Unexplained weight loss.
- Itchy skin.
- Reddened patches on the skin.
Many of these can be symptoms of other problems, including Sjögren’s syndrome itself. Nevertheless, it is important to see your doctor if you have any of these symptoms.