Sjögren’s Syndrome and Your Body
This autoimmune condition, which primarily affects the eyes and mouth, can involve other organs and systems.
Most people, if they’re familiar with Sjögren’s syndrome at all, think of it as a disease that makes the mouth dry and the eyes gritty. That is true, but it can affect the skin, mucous membranes, circulatory and nervous systems, as well as the heart, liver and kidneys. Here is a look at what Sjögren’s can do to you – and what you can do to fight back.
Dry mouth can be more than uncomfortable. Without the protection saliva offers, you may experience tooth decay, mouth pain, oral infections and difficulty swallowing.
Many people get the relief they need from artificial saliva products, says Robert I. Fox, MD, a leading Sjögren’s expert and practicing rheumatologist at Scripps Memorial Hospital in La Jolla, Calif. Also helpful are toothpastes and mouth rinses developed specially for dry mouth. (Read “Treatment Options for Sjögren’s Syndrome” to learn about medications that treat Sjogren’s symptoms affecting the mouth and other parts of the body.)
Tips for relieving a dry mouth:
- Keep a water bottle with you and sip throughout the day.
- Suck on sugar-free candy or lozenges or chew sugar-free gum.
- If possible, avoid using drugs such as antihistamines and antidepressants that cause dryness.
- Avoid mouthwashes with alcohol, which can worsen dryness.
- For an inexpensive option to oral lubricants that is available in almost any pharmacy or discount store, Dr. Fox recommends vaginal lubricants. Although they aren't marketed for oral use, the FDA requires safety testing for vaginal lubricants and the risk of side effects is small, he says.
Untreated dry eyes can damage the eye’s surface, increase the risk of infection and even impair vision.
If you suffer from dry eyes, artificial tears may help restore moisture. If dryness is still a problem, your doctor may offer prescription treatments or outpatient procedures to ease symptoms.
Tips for easing dry eyes:
- Avoid sitting next to air conditioners or heaters. Adjust the fans in your car so that air does not blow directly on your face.
- Use a humidifier in your bedroom at night.
- Make a conscious effort to blink throughout the day, especially if you work at computer.
- Take a break during the day to close your eyes and relax. Cover your eyes with a warm washcloth.
- Eat more fish. Research shows that omega-3 fatty acids found in cold water fish eases dry eyes.
Saliva helps neutralize the acidity of gastric acids. When it is lacking, you may experience heartburn. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve other Sjögren’s symptoms can worsen the problem.
Tips for relieving heartburn:
- Eat smaller, more frequent meals.
- Note which foods tend to worsen heartburn and avoid those when possible. Common culprits include fatty foods, citrus fruits and juices, chocolate and caffeine.
- Avoid eating for at least two hours before going to bed at night so the stomach has a chance to empty and acid levels decrease before you lie down.
- Elevate the head of your bed on two-inch blocks to keep gastric acid from washing back into your esophagus while you sleep.
Upper Respiratory System
If your nasal passages are dry, as they can be with Sjögren’s, you may feel you’re constantly battling sinusitis and post-nasal drip. Dr. Fox says his Sjögren’s patients have longer-lasting infections than those without the syndrome, and that they have a higher chance of persisting with post-nasal drip and cough or of these developing into bronchitis or pneumonia.
Tips for moisturizing and protecting dry nasal passages:
- Use a humidifier or vaporizer.
- Make and use your own saltwater spray by mixing one teaspoon salt to one quart of deionized water and boiling to fully dissolve the salt.
- Drink plenty of fluids to thin your mucus.
- Avoid drinking alcohol, which can dry out your nasal passages.
- Avoid chlorinated swimming pools, because chlorine can irritate nasal passages.
- Apply warm, wet towels to your face.
Dry skin that cracks and itches is common with Sjögren’s syndrome. The lips are also frequently affected. In some people, Sjögren’s is associated with skin rashes. These most commonly first appear as areas of dark blotches on the legs and feet that grow together.
Tips for moisturizing skin:
- Limit showers to five minutes, because water removes the skin’s natural oils.
- When drying the skin with a towel, pat, do not rub.
- Apply creams and lotions after a shower or bath when your skin is still moist.
- For between-shower application, dampen your skin with a wet towel before applying lotion.
- Use a humidifier in your bedroom at night to help moisten your skin.
Vaginal dryness can make intercourse painful and interfere with sexual relationships.
Tips for moisturizing the vagina:
- Use vaginal moisturizers and lubricants.
- Avoid scented body washes or bubble baths that can irritate the inside of the vagina.
- Prolong foreplay so that your vagina has more time for natural lubrication.
Sjögren’s syndrome may be associated with joint pain and inflammation itself, or it may accompany an inflammatory form of arthritis, such as rheumatoid arthritis or lupus.
Tips for treating painful joints:
- Apply heat or cold (or alternate the two) to painful joints with warm washcloths or a bag of ice or frozen vegetables wrapped in a towel.
- Speak to your doctor or physical therapist about exercises to keep joints mobile, relieve stiffness and improve range of motion.
- Rest painful or swollen joints – use assistive devices to spare joints that are inflamed.
In some people with Sjögren’s syndrome, a bout with the flu or a sinus infection can leave dried mucus that obstructs the upper airways, causing a dry cough and potentially leading to pneumonia.
Sometimes the inflammatory process of Sjögren’s affects the walls of tiny balloon-like airs sacs (alveoli) in the lungs, where oxygen is added to your blood and the waste product carbon dioxide is removed.
This inflammation can cause the interstitium, the tissue that lines and supports the sacs, to thicken and scar – a problem known as interstitial pneumonitis or interstitial lung disease. This thickening makes it more difficult for oxygen to enter the bloodstream, causing shortness of breath. Interstitial pneumonitis may not show up on a routine chest X-ray. If your doctor suspects this problem, she may order a high-resolution CT scan to look for inflammation.
Tips for managing an upper respiratory infection:
- If you are sick with an upper respiratory infection, drink plenty of fluids to stay well hydrated, which may help prevent the development of pneumonia.
- Use a humidifier or vaporizer in your room.
- Try sinus lavage, an at-home procedure that uses salt water to remove mucus and debris from the nasal passages and sinuses.
The inflammation that accompanies Sjögren’s syndrome can affect the nervous system, resulting in problems such as peripheral neuropathy --damage to the nerves in the arms in legs causing pain, numbness and weakness; carpal tunnel syndrome -- a condition in which inflamed tissue in the wrist area compresses the median nerve that runs from the arm to the hand causing pain, numbness and tingling on the thumb side of the hand; and cranial neuropathy -- a condition that causes pain or loss of feeling in the face, and loss of taste and smell.
In some cases, the brain itself is affected, leading to blood clots and lesions similar to those seen in multiple sclerosis.
Two problems with the kidneys, interstitial nephritis or glomerulonephritis, can occur with Sjögren’s syndrome. Interstitial nephritis is inflammation of the tissue around the kidney’s filters (tubules). Glomerulonephritis, inflammation of the tubules themselves, is a condition in which kidneys leak protein into the urine.
In some people with Sjögren’s kidney problems exist in a latent form, perhaps even before they experience dry eyes and mouth. They don't experience symptoms until exposure to certain toxins or medications (including NSAIDs) causes kidney function to deteriorate.
While it is important to be aware that Sjögren’s can affect your entire body, Dr. Fox stresses that just because you experience a symptom, you cannot assume Sjögren’s is the cause. The best course of action is to see a doctor who can help determine the cause of troublesome symptoms and the best treatment for them.