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Sjögren Syndrome

What is Sjögren Syndrome?

Sjögren syndrome is an autoimmune disease that affects the salivary and tear glands, reducing production of tears and saliva. While this syndrome mostly only affects these aspects of health, it can have other systemic manifestations including nerve damage, lung disease, and a significant increase in the risk of developing lymphoma.

Sjögren syndrome may occur alone (primary) or in association with another autoimmune disease (secondary), such as systemic lupus erythematosus (SLE), rheumatoid arthritis, or scleroderma. Patients diagnosed with Sjögren syndrome should be vigilant about screening for related conditions.

Natural interventions such as omega-3 fatty acids and lactoferrin may help reduce inflammation and improve symptoms.

What are the Risk Factors for Sjögren Syndrome?

  • Family history
  • Viral infections such as cytomegalovirus, Epstein-Barr virus, or others
  • Gender – women are nine times more likely than men
  • Age – onset is most common in those aged 55 to 65

What are the Signs and Symptoms of Sjögren Syndrome?

  • Dry eyes and/or dry mouth
  • Dryness in other areas, including the nose, throat, skin, and vagina
  • Additional symptoms may include fatigue, fever, joint pain, among others

What are Conventional Medical Treatments for Sjögren Syndrome?

Note: There is no cure for Sjögren syndrome; treatments generally aim to minimize symptoms and prevent complications.

  • Artificial tears and ophthalmic ointments
  • Cyclosporine eye drops
  • Tear duct plugs
  • Topical steroids
  • Salivary substitutes and stimulants
  • Acetylcholine activators to stimulate saliva production
  • Acetaminophen or non-steroidal anti-inflammatory drugs
  • Corticosteroids
  • Immunosuppressive drugs (eg, cyclophosphamide or hydroxychloroquine)
  • Antirheumatic drugs
  • The monoclonal antibody rituximab

What are Emerging Therapies for Sjögren Syndrome?

  • Autologous serum eye drops made from the patient’s blood may be more effective than traditional artificial tears at treating dry eyes.
  • Lacrimal (tear) gland repair with progenitor cells was effective in animals.
  • Monoclonal antibodies used to treat autoimmune diseases, such as belimumab for SLE, may be effective in Sjögren syndrome as well.
  • Mesenchymal stem cell therapy may suppress autoimmunity and improve symptoms.
  • Topical nerve growth factor may relieve dry eye caused by a variety of conditions.
  • Many Sjögren syndrome patients do not receive a formal diagnosis for many years. The discovery of novel diagnostic biomarkers such as cathepsin S, B-cell-activating factor, and myxovirus resistance protein A can help patients receive earlier diagnoses and prompt treatment.

What Dietary and Lifestyle Changes Can Be Beneficial for Sjögren Syndrome?

  • Eat a well-balanced diet
  • Moisten food with broth or sauce if it is difficult to swallow
  • Drink plenty of liquids
  • Avoid irritants (eg, alcohol and spicy or salty foods)
  • Avoid medications that cause dryness (eg, antihistamines)
  • Quit smoking
  • Get regular dental cleanings and exams every few months
  • Engage in a regular form of exercise
  • Consider acupuncture for relieving dry eyes

What Natural Interventions May Be Beneficial for Sjögren Syndrome?

  • Omega-3 fatty acids. Omega-3 fatty acids reduce inflammation associated with Sjögren syndrome. The Sjögren Syndrome Foundation recommends oral supplementation in their clinical practice guidelines.
  • Gamma linolenic acid. This omega-6 fatty acid has anti-inflammatory properties and was shown to improve dry eye symptoms.
  • White peony extract. Peony glucosides have anti-inflammatory and immune-regulating properties. Peony has been used to treat a range of autoimmune diseases. When supplemented with white peony extract, Sjögren syndrome patients experienced improved salivary gland and tear duct function.
  • Lactoferrin. Low levels of lactoferrin in tears have been associated with increased severity of eye surface damage due to dry eye in patients with Sjögren syndrome. Oral supplementation is an effective treatment option for dry eye conditions.
  • Vitamin D. Vitamin D has been shown to modulate the immune system and suppress autoimmunity. Deficiency is strongly linked to dry eyes.
  • Probiotics. Sjögren syndrome patients with dry mouth have less diverse oral microbiomes and an increased risk of dental problem. Probiotic lozenges may improve oral health.
  • Other natural interventions that may benefit patients with Sjögren syndrome include N-acetylcysteine, maqui berry extract, green tea extract, resveratrol, vitamin B12, and folate.