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Health Protocols

Sjögren Syndrome

Chronic dry eyes and dry mouth can be more than minor annoyances—they may be symptoms of Sjögren syndrome, a systemic autoimmune disease (Patel 2014). Sjögren syndrome affects the salivary and tear glands, reducing saliva and tear production (Nguyen 2009). Women are much more likely to be affected than men (Patel 2014).

Along with dry eyes and mouth, up to 30% of people with Sjögren syndrome also experience a wide range of systemic manifestations including fatigue, joint discomfort, nerve damage, lung disease, and blood vessel inflammation. Importantly, Sjögren syndrome markedly increases risk of lymphoma (a type of blood cancer), so people diagnosed with Sjögren syndrome should be monitored for signs of lymphoma (Mariette 2016; Barone 2016; Rischmueller 2016).

Sjögren syndrome is classified as primary when it occurs alone and secondary when it develops alongside another autoimmune disease such as systemic lupus erythematosus, rheumatoid arthritis, or systemic sclerosis (Kurien 2017; Mariette 2016).

Although many factors likely contribute to the development of Sjögren syndrome, studies have found strong links between Sjögren syndrome and cytomegalovirus (CMV)—a common virus to which about half of Americans have been exposed (Kurien 2017; Rischmueller 2016; Mariette 2016; Halenius 2014; Schuster 2014; Bate 2010).

Treatment of Sjögren syndrome ranges from artificial tears and saliva substitutes for symptom relief to immunosuppressive drugs such as methotrexate (Trexall), hydroxychloroquine (Plaquenil), and rituximab (Rituxan). Unfortunately, these more aggressive immunosuppressive treatments are associated with troublesome side effects, and none have been shown to reverse the impaired glandular function characteristic of Sjögren syndrome (Vivino 2016; Mariette 2016; Holdgate 2016; Martinez 2011).

The good news is that scientific research is uncovering promising new treatment approaches for Sjögren syndrome. For instance, chronic B-cell activation is a key feature of the disease, and emerging drugs that deplete B cells, such as belimumab (Benlysta), are undergoing clinical trials (Mavragani 2014; Quartuccio 2016). In a preliminary trial, 60% of participants with primary Sjögren syndrome responded positively to belimumab treatment (De Vita 2015; Ferro 2016; Barone 2016). Using stem cells and nerve growth factor to bring about anti-inflammatory and immune-modulating effects is another approach under investigation. Intravenously administered adult stem cells have been shown to increase the salivary flow rate in Sjögren patients, and topical nerve growth factor has been found to increase tear production in animal models of dry eye (Gromova 2016; Ullah 2015; Lin 2014; Lambiase 2011; Xu 2012).

A variety of interventions using natural products may provide therapeutic benefits in Sjögren syndrome. These integrative treatment options, such as omega-3 fatty acids, lactoferrin, maqui berry extract, and white peony extract, have been shown to improve symptoms and reduce inflammation and autoimmunity. In addition, vitamin D may prevent some complications of Sjögren syndrome (Liu 2014; Zhou 2016; Devendra 2015; Bae 2016; Hitoe 2014; Tincani 2013).

This protocol describes the development, diagnosis, and treatment of Sjögren syndrome, including novel and emerging treatments for the disease, as well as dietary and lifestyle considerations that may reduce symptoms. In addition, several evidence-based natural interventions that have shown promise against Sjögren syndrome in scientific studies are discussed.