When your doctor asks how you’re doing, there may be certain things you don’t think are important enough to mention. Take dry eyes or dry mouth. These symptoms might seem minor compared to other issues. But don’t overlook them.
“You should feel empowered to bring all symptoms to your doctor’s attention,” says UNC Health rheumatologist and immunologist Saira Z. Sheikh, MD. “Don’t minimize dry eyes or dry mouth, because these symptoms can have a real impact on quality of life.”
Dry eyes and dry mouth can be signs of Sjogren’s disease, an autoimmune disease that affects 4 million people in the United States.
“Sjogren’s disease has significant impacts on the tear and salivary glands, and 85 percent of people can experience symptoms of dry eyes and dry mouth,” Dr. Sheikh says. “What’s less commonly known is that this is a multisystem disease that can involve other organs, resulting in symptoms such as joint pain, fatigue, a range of gastrointestinal tract concerns, nerve involvement and lung inflammation.”
Sjogren’s disease, which causes the body’s white blood cells to attack moisture-producing glands, is most often diagnosed in women in their late 40s, but the cause is unknown. Like other autoimmune conditions, in which the immune system overreacts and attacks the body, there are likely genetic and environmental factors that play a role.
We talked to Dr. Sheikh to learn more about diagnosis and treatment.
Sjogren’s Disease Symptoms and Diagnosis
Getting a diagnosis of Sjogren’s can be challenging, because potential other causes for symptoms have to be ruled out; dry eyes and mouth can be caused by a variety of health conditions, including environmental allergies, dehydration, and certain medications. Symptoms can range from mild to severe, so every individual’s experience with the disease is unique.
“There’s no real pattern,” Dr. Sheikh says. “Dry eyes might present slowly over years. One distinctive feature is a gritty or sandy feeling in the eyes, but there can also be irritation, itching, photophobia or blurred vision.”
Your dentist may be the one to notice the symptoms or effects of dry mouth and help to make the diagnosis.
“You might go to the dentist and have a lot of caries, or tooth decay, despite having great oral hygiene,” Dr. Sheikh says. “You can also have difficulty swallowing or feel like you have to drink water constantly just to wash down food. You might notice changes in taste.”
If Sjogren’s disease is affecting other systems of the body, you may notice other symptoms, including muscular or joint pain, skin rashes or dryness, a persistent cough or shortness of breath, heartburn, difficulty swallowing or nerve pain. Of course, many conditions can cause these symptoms, so it may take a while to identify the true cause.
About half of the time, Sjogren’s happens with another autoimmune disease, such as lupus, rheumatoid arthritis or scleroderma, so it may be identified in the process of diagnosing one of those conditions.
To diagnose Sjogren’s disease, your doctor will order blood tests to check for the presence of certain autoantibodies, or proteins made by your immune system, but these autoantibodies aren’t always present in all patients with the disease. You will likely need eye exams to check for dryness of the eyes and tear production and a test for salivary gland function that measures saliva production. Some patients may require a lower lip salivary gland biopsy, also known as a minor salivary gland biopsy, in which a tiny amount of tissue is removed and examined under a microscope, to confirm the diagnosis.
Living with Sjogren’s Disease
There is currently no cure for Sjogren’s disease, and the goal of treatment is to find relief from symptoms and improve day-to-day quality of life. That may involve care from multiple doctors, depending on the symptoms and systems of the body involved.
“The disease evolves over time, so you may present with a certain constellation of symptoms, but they may change,” Dr. Sheikh says. “We emphasize a lot of patient education so you can learn what to expect and what symptoms to bring to your doctor’s attention.”
Lifestyle changes are useful, Dr. Sheikh says.
For dry mouth, you should quit smoking and avoid oral irritants like alcohol or coffee. You’ll want to drink more water, and you might consider sugar-free gum, lozenges and candies or artificial saliva to help reduce the feeling of dry mouth. Your saliva helps protect your teeth, so if you have less of it you may need more regular dental cleanings and to try to reduce sugar from your diet.
“You’re at an increased risk for dental decay and cavities, so it’s important to see a dentist regularly,” Dr. Sheikh says. “There can also be an increased risk for fungal infection or burning in the mouth.”
Your doctor will evaluate the medications you take, because many drugs cause dry mouth.
“If there’s an option to change the medication that is likely causing dry mouth or stop it entirely, we’d recommend that,” Dr. Sheikh says. “There are some medications that you just can’t stop, but it’s important to recognize that they could be the culprit.”
For dry eye, you might start by using over-the-counter artificial tears, or your ophthalmologist may prescribe special eye drops. Changing your diet to include more flaxseed oil and omega-3 fatty acids can help with dry eyes; the Mediterranean diet emphasizes these ingredients, or your doctor may recommend a supplement. Sometimes, a minor procedure on the tear ducts can help relieve dry eyes.
Dr. Sheikh says there are prescription medications, including pilocarpine (Salagen) and cevimeline (Evoxac), that can help increase the production of saliva, and sometimes tears. However, they can cause side effects such as increased sweating, abdominal pain or excessive urination. Other medications that are used to modulate or suppress the immune system can be used depending on which symptoms are being treated.
It’s important to see your doctor regularly for monitoring, as people with Sjogren’s disease have an increased risk of lymphoma, which is cancer of the lymphatic system, part of the immune system.
Dr. Sheikh says research for new treatment options is ongoing and promising.
“Most people with Sjogren’s disease can live healthy lives with normal life expectancy, but I don’t want to undermine how impactful these symptoms are on daily life,” she says. “It can be debilitating, so it’s important to be a strong advocate for yourself and work in partnership with your healthcare provider.”
Concerned about dry eye or dry mouth? Talk to a doctor, or find one near you.