Sjögren's Disease (Sjögren's Syndrome)
Sjögren's disease is a chronic autoimmune condition in which the immune system mistakenly attacks the glands responsible for producing tears and saliva. Although persistent dry eyes and dry mouth are its best-known features, Sjögren's is a systemic disease that can also affect the joints, nerves, lungs, kidneys and many other parts of the body.
The condition is more common than many people realise and often develops gradually over several years. Because dryness is frequently attributed to ageing, menopause or medication, many people experience a long delay before receiving the correct diagnosis. Early recognition allows symptoms to be managed more effectively and helps identify people at risk of wider autoimmune complications.
This information is intended for educational purposes and should not replace professional medical advice. If you have new, severe or worsening symptoms, always seek advice from your GP or specialist healthcare team.
KEY FACTS
✔ Medical name
Sjögren's Disease
✔ Also known as
Primary Sjögren's Syndrome (older terminology)
Secondary Sjögren's Syndrome (when associated with another autoimmune disease)
✔ What it affects
The immune system primarily targets the body's moisture-producing (exocrine) glands, particularly the tear (lacrimal) and salivary glands, but may also affect multiple organs throughout the body.
✔ Common symptoms
Dry, gritty or burning eyes
Persistent dry mouth
Fatigue
Joint pain
Dry skin
Dry nose or throat
Salivary gland swelling
Vaginal dryness
Peripheral neuropathy in some people
✔ Who can be affected?
Sjögren's disease can affect anyone but occurs most commonly in women between 40 and 60 years of age. It may occur on its own (primary Sjögren's disease) or alongside another autoimmune disease such as rheumatoid arthritis or systemic lupus erythematosus.
✔ How is it diagnosed?
Diagnosis combines your symptoms with blood tests, tear and saliva production tests, and sometimes a minor salivary gland biopsy. No single test confirms the condition on its own.
✔ Can it be treated?
Although there is currently no cure, treatments can effectively relieve dryness, manage fatigue and joint pain, and control systemic disease when present. Regular monitoring also helps identify potential complications early.
✔ Associated conditions
Rheumatoid arthritis
Systemic lupus erythematosus (SLE)
Systemic sclerosis
Small Fibre Neuropathy
Peripheral neuropathy
Raynaud's phenomenon
Autoimmune thyroid disease
Coeliac disease
Primary biliary cholangitis
✔ When should I seek urgent medical advice?
New persistent salivary gland swelling, enlarged lymph nodes, unexplained weight loss, night sweats or a new purplish rash require prompt medical assessment because they may indicate a serious complication.
UNDERSTANDING THE CONDITION
Sjögren’s disease is a long-term autoimmune condition in which the immune system mistakenly targets the body’s moisture-producing glands, particularly the tear glands and salivary glands.
Immune cells collect around the small ducts within these glands and disrupt their normal function. As a result, the eyes may produce fewer tears and the mouth may produce less saliva, causing persistent dryness, irritation and difficulty swallowing dry foods.
Sjögren’s disease is not limited to the eyes and mouth. It is a systemic autoimmune disease, meaning the same immune process may also affect other parts of the body, including the joints, skin, nerves, lungs, kidneys and blood vessels. This helps explain why some people experience fatigue, pain, Raynaud’s phenomenon, peripheral neuropathy or other symptoms alongside dryness.
The condition may occur on its own, known as primary Sjögren’s disease, or alongside another autoimmune condition such as rheumatoid arthritis, systemic lupus erythematosus or systemic sclerosis, when it is often described as secondary Sjögren’s disease.
Symptoms often develop gradually, and dryness may initially be attributed to ageing, menopause or medication. This can delay diagnosis, particularly when fatigue, pain or neurological symptoms are more prominent than dry eyes or dry mouth.
Although there is currently no cure, many symptoms can be managed effectively with appropriate treatment, regular eye and dental care, monitoring for systemic complications and specialist support where needed.
COMMON SYMPTOMS
The symptoms of Sjögren's disease vary considerably from one person to another.
For some people, the condition mainly causes dry eyes and a dry mouth. Others experience widespread fatigue, joint pain or symptoms affecting the nervous system, lungs, kidneys or other organs.
Symptoms often develop gradually over several years, which is one reason why the diagnosis is frequently delayed.
Dry Eyes
Reduced tear production is one of the hallmark features of Sjögren's disease.
People commonly describe:
Dry or gritty eyes
Burning or stinging sensations
A feeling of sand in the eyes
Redness
Sensitivity to light (photophobia)
Blurred vision that improves with blinking
Eye discomfort that worsens during reading or screen use
Without appropriate treatment, persistent dryness can damage the surface of the eye and increase the risk of infection or corneal injury.
Dry Mouth
Reduced saliva production can make everyday activities surprisingly difficult.
Common symptoms include:
Persistent dry mouth
Difficulty swallowing dry foods
Frequent need to sip water
Difficulty speaking for prolonged periods
Altered taste
Bad breath
Increased dental decay
Recurrent oral thrush (candidiasis)
Because saliva plays an important role in protecting the teeth and oral tissues, maintaining good dental care is an essential part of long-term management.
Fatigue
Fatigue is one of the most common and disabling symptoms of Sjögren's disease.
Unlike ordinary tiredness, this fatigue is often:
Persistent
Disproportionate to activity
Not fully relieved by rest
Difficult to predict
Research has shown that fatigue often bears little relationship to blood test results or disease activity, meaning it should be assessed and managed as an important symptom in its own right.
Joint and Muscle Pain
Many people experience:
Aching joints
Morning stiffness
Muscle pain
Intermittent joint swelling
These symptoms may resemble other inflammatory conditions and sometimes occur alongside rheumatoid arthritis or other autoimmune diseases.
Dryness in Other Parts of the Body
Sjögren's disease may affect many moisture-producing tissues beyond the eyes and mouth.
Possible symptoms include:
Dry nose
Dry throat
Persistent dry cough
Dry skin
Vaginal dryness
These symptoms can significantly affect comfort and quality of life but are often overlooked during routine consultations.
Symptoms Affecting Other Organs
Although many people experience mainly glandular symptoms, Sjögren's disease is a systemic autoimmune disease and may affect other organs.
Possible manifestations include:
Peripheral neuropathy
Small Fibre Neuropathy
Raynaud's phenomenon
Lung disease
Kidney involvement
Skin vasculitis
Swollen lymph nodes
Persistent salivary gland enlargement
Not everyone develops these complications, but recognising them early is important because they may require specialist assessment and treatment.
Symptoms Can Fluctuate
Many people notice that their symptoms vary from day to day.
Dryness may worsen:
In air-conditioned or centrally heated environments
During prolonged screen use
With dehydration
During periods of illness or stress
After taking certain medications that reduce saliva or tear production
Understanding these triggers can help reduce flare-ups and improve day-to-day symptom control.
CAUSES, MECHANISMS AND DIAGNOSIS
Why Does It Happen?
Why Does Sjögren's Disease Affect So Many Different Parts of the Body?
Although Sjögren's disease is often thought of as a condition that causes dry eyes and a dry mouth, it is actually a systemic autoimmune disease.
The immune system mistakenly attacks the body's moisture-producing glands, particularly the tear and salivary glands. Over time, immune cells gather around the small ducts within these glands, disrupting their normal function and reducing the production of tears and saliva.
However, the same immune processes can also affect tissues throughout the body.
This is why some people develop symptoms involving the:
Joints
Muscles
Skin
Peripheral nerves
Kidneys
Lungs
Blood vessels
Lymphatic system
Rather than being separate problems, these symptoms all reflect the same underlying autoimmune condition.
The Role of the Immune System
In Sjögren's disease, the immune system becomes overactive.
White blood cells known as T cells and B cells accumulate within the glands and surrounding tissues, producing inflammation and disrupting normal gland function.
Certain autoantibodies, particularly Anti-Ro (SSA) and Anti-La (SSB), are commonly associated with the disease and help support the diagnosis.
More Than a Dryness Condition
Understanding Sjögren's disease as a systemic autoimmune condition helps explain why many people experience fatigue, pain and neurological symptoms that cannot be explained by dryness alone.
Current international recommendations encourage clinicians to assess not only glandular symptoms but also the broader impact of fatigue, pain and systemic involvement on daily life and quality of life.
Why Early Diagnosis Matters
Recognising Sjögren's disease early allows treatment to focus on:
Protecting the eyes and mouth.
Reducing symptoms.
Identifying associated autoimmune diseases.
Monitoring for complications.
Supporting long-term health and quality of life.
Regular follow-up also helps identify the small number of people who develop more significant organ involvement or other complications requiring specialist care.
How It Is Diagnosed
There is no single test that confirms Sjögren's disease.
Instead, diagnosis combines your symptoms, a clinical examination, blood tests, measurements of tear and saliva production, and sometimes a minor salivary gland biopsy. Because several other conditions can also cause dryness, a careful assessment is needed to determine whether an autoimmune disease is responsible.
Medical History
Your clinician will begin by understanding your symptoms and how they affect your daily life.
This may include discussing:
Dry eye symptoms
Dry mouth and swallowing difficulties
Fatigue
Joint or muscle pain
Dry skin or other mucosal dryness
Salivary gland swelling
Previous autoimmune conditions
Family history of autoimmune disease
Current medications that may contribute to dryness
Understanding the pattern of symptoms helps distinguish Sjögren's disease from more common causes of dryness, such as ageing, menopause or medication side effects.
Physical Examination
Your clinician may assess:
Moisture of the eyes and mouth
Salivary gland enlargement
Joint swelling
Skin changes
Signs of peripheral neuropathy
Lymph node enlargement
The examination also looks for evidence of systemic disease that may require referral to a specialist.
Blood Tests
Blood tests help identify autoimmune activity and exclude other conditions.
Depending on your symptoms, investigations may include:
Anti-Ro (SSA) antibodies
Anti-La (SSB) antibodies
Antinuclear antibodies (ANA)
Rheumatoid factor (RF)
Full blood count
Inflammatory markers (ESR and CRP)
Immunoglobulins
Complement levels (C3 and C4)
Anti-Ro antibodies are one of the most important laboratory markers and form part of the current international classification criteria. Low complement levels or raised immunoglobulins may indicate more active disease and can also help identify people who require closer monitoring.
Assessing Tear and Saliva Production
Because Sjögren's disease affects the body's moisture-producing glands, several simple tests can assess how well these glands are functioning.
These may include:
Schirmer's test, which measures tear production.
Ocular surface staining, which looks for damage caused by dry eyes.
Unstimulated salivary flow testing, which measures saliva production.
These investigations provide objective evidence of gland dysfunction and contribute to the overall diagnostic assessment.
Minor Salivary Gland Biopsy
In some people, a minor salivary gland (lip) biopsy may be recommended.
This involves removing a small sample of tissue from the inside of the lower lip under local anaesthetic.
The sample is examined under the microscope for characteristic clusters of immune cells surrounding the salivary ducts.
Although not everyone requires a biopsy, it is an important investigation when the diagnosis remains uncertain or blood tests are inconclusive.
Classification Criteria and Clinical Diagnosis
Doctors may use the 2016 American College of Rheumatology (ACR) / European Alliance of Associations for Rheumatology (EULAR) classification criteria to support the diagnosis.
These criteria assign weighted scores to investigations such as:
Anti-Ro (SSA) antibodies
Minor salivary gland biopsy
Schirmer's test
Ocular staining
Salivary flow measurement
Although these criteria are valuable, they were developed primarily for research and should not replace clinical judgement.
A person may still have Sjögren's disease even if they do not fully meet the classification score, particularly during the early stages of the condition. Persistent clinical suspicion should therefore prompt specialist assessment rather than reassurance based solely on the classification criteria.
Looking Beyond the Diagnosis
Once Sjögren's disease has been diagnosed, the assessment does not stop there.
Your healthcare team will also evaluate whether the disease is affecting other organs, including the:
Nervous system
Lungs
Kidneys
Blood vessels
Skin
They may also screen for associated autoimmune conditions such as rheumatoid arthritis, systemic lupus erythematosus or autoimmune thyroid disease, as these can influence treatment and long-term monitoring.
HOW IS IT USUALLY MANAGED?
Management depends on the diagnosis, symptom severity, underlying mechanisms and each person's individual circumstances.
Although there is currently no cure for Sjögren's disease, effective treatment can significantly improve symptoms, protect the eyes and mouth, and manage systemic complications where they occur.
Treatment is tailored to the individual's symptoms and disease severity. Most people are managed with a combination of local treatments, lifestyle measures and regular monitoring, while those with more significant organ involvement may require specialist immunomodulatory therapy.
Managing Dry Eyes
Protecting the eyes is one of the main priorities of treatment.
Depending on symptom severity, management may include:
Preservative-free artificial tears
Lubricating eye gels or ointments
Topical anti-inflammatory eye drops under specialist supervision
Punctal plugs or other specialist treatments for severe dryness
Regular ophthalmology reviews help prevent complications such as corneal damage and infection.
Managing Dry Mouth
Treatment aims to improve comfort, protect the teeth and reduce the risk of oral infections.
Management may include:
Frequent hydration
Sugar-free chewing gum or lozenges
Saliva substitutes
Prescription medications to stimulate saliva production where appropriate
Regular dental reviews
Fluoride treatment to reduce tooth decay
Maintaining good oral hygiene is an important part of long-term care.
Managing Fatigue and Pain
Fatigue and pain are among the symptoms that have the greatest impact on quality of life.
Because they often do not correlate with blood test results or disease activity, they should be assessed and managed individually rather than assuming they will improve simply by treating the autoimmune disease.
Management may include:
Activity pacing
Sleep optimisation
Physical rehabilitation
Pain management strategies
Education and self-management support
This approach reflects current international recommendations, which recognise fatigue, pain and dryness as the three core symptom domains affecting people with Sjögren's disease.
Managing Systemic Disease
While many people experience symptoms limited to dryness, others develop inflammation affecting different organs of the body.
When systemic disease is present, treatment may include medications prescribed and monitored by a rheumatology specialist.
Depending on the severity and organs involved, these may include:
Hydroxychloroquine
Short courses of corticosteroids
Conventional immunosuppressive medications
Biologic therapies in selected cases
Unlike treatments for dry eyes and dry mouth, these medicines aim to control the underlying autoimmune inflammation rather than simply relieve symptoms. They are generally reserved for people with significant joint, lung, kidney, neurological or other systemic involvement.
Lifestyle Measures
Simple everyday measures can often make a significant difference to symptom control.
These include:
Drinking water regularly throughout the day.
Using a humidifier, particularly during winter.
Avoiding smoking.
Limiting alcohol where appropriate.
Avoiding medications that worsen dryness where suitable alternatives exist.
Maintaining regular dental and eye examinations.
Using lip balm and skin moisturisers when needed.
These measures do not treat the underlying autoimmune disease but can improve comfort and reduce complications associated with dryness.
Complementary Approaches
Some complementary approaches have been investigated as supportive treatments alongside conventional medical care.
Current evidence suggests:
Omega-3 fatty acid supplementation provides modest benefit for some people with dry eye symptoms, although the evidence remains limited.
Acupuncture has shown short-term improvement in dry mouth symptoms in small studies.
Current evidence does not support restrictive "autoimmune diets", unvalidated detoxification programmes or proprietary supplement protocols marketed as cures for Sjögren's disease.
Monitoring Your Health
Because Sjögren's disease is a long-term condition, regular follow-up is an important part of care.
Monitoring may include:
Review of dryness symptoms
Assessment of fatigue and pain
Blood tests
Eye examinations
Dental reviews
Monitoring for systemic complications
Assessment for lymphoma risk where appropriate
Regular review allows treatment to be adjusted over time and helps identify complications at an early stage.
LIVING WELL WITH THE CONDITION
Impact on Daily Life
Living with Sjögren's disease involves more than managing dry eyes and dry mouth.
For many people, fatigue, pain and fluctuating symptoms have a greater impact on everyday life than dryness itself. Symptoms often vary from day to day, making it difficult to predict energy levels or plan activities.
Although there is currently no cure, many people are able to live full and active lives with appropriate treatment, self-management strategies and regular follow-up.
Simple measures such as protecting the eyes, maintaining good oral health, pacing activities and recognising symptom triggers can make a significant difference to long-term wellbeing. Regular reviews also help identify changes in disease activity and reduce the risk of long-term complications.
HOW ROWAN HEALTH SUPPORTS YOU
At Rowan Health, we recognise that Sjögren's disease is more than a condition causing dry eyes and dry mouth. Our assessment considers how the condition affects your fatigue, pain, gland function, daily activities and overall wellbeing, while also identifying any signs of systemic involvement or associated autoimmune conditions.
Following a comprehensive assessment, we develop an individualised care plan tailored to your symptoms, priorities and medical history. Depending on your presentation, support may combine education, symptom management strategies and selected evidence-informed integrative approaches alongside your conventional medical care.
Our aim is to improve symptom control, support your long-term health and help you maintain the best possible quality of life.
When to Seek Medical Advice
Although most people with Sjögren's disease experience stable symptoms, certain changes require prompt medical assessment.
Seek medical advice promptly if you develop:
New or persistent swelling of the salivary glands.
Enlarged lymph nodes.
Unexplained weight loss.
Night sweats.
A new purplish rash (purpura).
New numbness or weakness.
Persistent cough or increasing breathlessness.
Blood in the urine or significant swelling of the legs.
These symptoms may indicate systemic disease or, more rarely, lymphoma, which occurs more frequently in people with Sjögren's disease than in the general population and should be assessed without delay.
Call 999 if symptoms are severe or suggest a medical emergency.
If your symptoms are severe, rapidly worsening or causing immediate concern, contact NHS 24 on 111. In a medical emergency, call 999 or attend your nearest Accident & Emergency department.
FAQs
Is Sjögren's disease the same as Sjögren's syndrome?
Yes.
The condition has traditionally been known as Sjögren's syndrome, and many people still use this name. More recently, organisations such as the British Society for Rheumatology have adopted the term Sjögren's disease to reflect that it is a systemic autoimmune disease rather than simply a collection of symptoms. Both terms refer to the same condition.
Is dry mouth always caused by Sjögren's disease?
No.
Dry mouth is common and may result from ageing, menopause, dehydration or certain medications, including antihistamines, antidepressants and some blood pressure medicines.
Sjögren's disease is only one possible cause, which is why a proper medical assessment is important before making the diagnosis.
Can I have Sjögren's disease if my blood tests are normal?Can I have Sjögren's disease if my blood tests are normal?
Yes.
Although Anti-Ro (SSA) antibodies are an important marker, not everyone with Sjögren's disease has positive blood tests.
When symptoms strongly suggest the diagnosis, further investigations such as tear testing, salivary flow assessment or a minor salivary gland biopsy may still be appropriate following specialist assessment.
Why am I so tired?
Fatigue is one of the most common symptoms of Sjögren's disease and affects up to 70% of people with the condition.
Importantly, fatigue often does not correlate with blood test results or the degree of dryness. This is why it should be assessed and managed as an important symptom in its own right rather than assuming it reflects uncontrolled autoimmune disease.
Can Sjögren's disease affect my nerves?
Yes.
Some people develop peripheral neuropathy or Small Fibre Neuropathy, which may cause burning pain, tingling, numbness or altered sensation.
Recognising these symptoms early is important because they may require further neurological assessment.
Does Sjögren's disease increase the risk of lymphoma?
Yes, although the overall risk remains low.
People with Sjögren's disease have a higher risk of developing certain B-cell lymphomas than the general population. For this reason, regular follow-up and prompt assessment of new salivary gland swelling, enlarged lymph nodes or unexplained weight loss are important parts of long-term care.
Can I still live a normal life?
Many people with Sjögren's disease lead full and active lives.
Although symptoms often fluctuate, appropriate treatment, regular monitoring and practical self-management strategies can significantly improve quality of life.
How can Rowan Health help?
Our assessment considers not only dryness but also fatigue, pain, neurological symptoms and the broader impact of Sjögren's disease on your daily life.
Following a comprehensive evaluation, we develop a personalised support plan that complements your conventional medical care while helping you manage symptoms and maintain your long-term wellbeing.
Sources & references
Shiboski CH, Shiboski SC, Seror R, et al. 2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren's Syndrome. Arthritis & Rheumatology. 2017.
Ramos-Casals M, Brito-Zerón P, Bombardieri S, et al. EULAR Recommendations for the Management of Sjögren's Syndrome with Topical and Systemic Therapies. Annals of the Rheumatic Diseases. 2020.
British Society for Rheumatology. Guideline on the Management of Adult and Juvenile-Onset Sjögren Disease. Rheumatology. 2025.
Price E, Allen A, Rauz S, et al. The Management of Sjögren's Syndrome: British Society for Rheumatology Guideline Scope. Rheumatology. 2021.
Qin B, Wang J, Yang Z, et al. Epidemiology of Primary Sjögren's Syndrome: A Systematic Review and Meta-analysis.
Retamozo S, Brito-Zerón P, Ramos-Casals M. Prognostic Markers of Lymphoma Development in Primary Sjögren Syndrome. Lupus. 2019.
Clinical Review
Clinical content reviewed by
Rowan Health
Last reviewed:
4 August 2026
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