Sjögren's syndrome is a systemic autoimmune disorder characterized by focal lymphocytic infiltration of the exocrine glands, which causes hallmark symptoms like dry eyes and dry mouth [1]. This condition can occur on its own as primary Sjögren's syndrome, or as a secondary complication alongside other rheumatic disorders such as rheumatoid arthritis, systemic lupus erythematosus, and scleroderma [1]. Because the immune system targets moisture-producing glands, managing the resulting dryness is a primary focus of patient care.
The disruption of epithelial cells and subsequent lymphoplasmocytic infiltration lead to a significant reduction in saliva production, resulting in xerostomia, or clinical dry mouth [2], [4]. This lack of adequate saliva not only causes persistent oral discomfort and subjective mouth dryness [5], but it also elevates the risk of dental complications, such as dental caries, due to the loss of saliva's natural protective and buffering functions [5].
Beyond the oral cavity, Sjögren's syndrome is a complex systemic disease that can involve other organ systems. Research indicates a notable link between Sjögren's syndrome and endocrine conditions, particularly autoimmune thyroid diseases like Hashimoto's thyroiditis and Graves' disease [2], [4]. Individuals with the syndrome face a substantially higher risk of developing thyroid dysfunction compared to the general population [2]. In rarer instances, the autoimmune process can manifest beyond the upper gastrointestinal tract, causing atypical symptoms like small intestine involvement, recurrent nausea, and abdominal complications [3].
Clinical evaluation of patients experiencing xerostomia often involves specialized diagnostic tools. Salivary gland scintigraphy (SGS) is frequently utilized to assess the function and ejection fractions of the parotid and submandibular glands, helping clinicians evaluate salivary output and identify underlying autoimmune or thyroid abnormalities [4]. Genetic studies continue to explore the dysregulation of innate and adaptive immune responses to better understand the root causes of the disease and refine future clinical management [6].
While systemic medications such as glucocorticoids are sometimes used off-label to manage severe glandular, joint, or systemic manifestations of Sjögren's syndrome, robust clinical trial evidence specifically guiding their use remains limited [8]. Consequently, current management largely centers on alleviating symptoms of dry mouth, protecting oral health, and monitoring for associated systemic conditions like thyroid disease under the guidance of a healthcare professional.
Sources
- [1] Primary Sjögren's syndrome. PubMed
- [2] Increased risk of thyroid disease in patients with Sjogren's syndrome: a systematic review and meta-analysis. PubMed
- [3] An Unusual Gastrointestinal Presentation of Sjogren's Syndrome: A Case Report. PubMed
- [4] High Prevalence of Thyroid Disease and Role of Salivary Gland Scintigraphy in Patients with Xerostomia. PubMed
- [5] Association between dental caries experience and salivary profile among autoimmune thyroid disease subjects - a cross-sectional comparative study. PubMed
- [6] Genetics in Sjögren's syndrome: where we are and where we go. PubMed
- [7] Scleromyxoedema and Thyroid Disease: A Case Report. PubMed
- [8] What about glucocorticoids in primary Sjögren's syndrome? PubMed