Symptoms

What are the Signs and Symptoms of Sjögren’s Disease?

Signs of Sjögren’s disease can be measured, observed, or detected by a doctor or another healthcare professional and indicate that a person has Sjögren’s. They include things like:

• Reduced production of tears
• Reduced saliva production
• Swollen salivary glands
• Lab test results
• Enlarged lymph nodes

Symptoms are what patients experience and report to their doctors that indicate Sjögren’s disease. They include things like fatigue, pain, or headaches.

Two of the most common and well-known symptoms of Sjögren’s are dry eye and dry mouth — but Sjögren’s disease is much more than just these two symptoms. And in fact, some research suggests that for some people, other symptoms of Sjögren’s may appear years before any dryness.

What’s more, every person with Sjögren’s experiences it differently — one person with the disease may have a completely different set of symptoms than another person. Plus, Sjögren’s disease can overlap with other autoimmune conditions, such as rheumatoid arthritis or systemic lupus erythematosus (SLE, also called lupus). Overlap can mean both:

• Having symptoms that are associated with more than one autoimmune condition
• Being diagnosed by multiple autoimmune conditions

It’s important to keep in mind that having a symptom that’s associated with another autoimmune disease don’t necessarily mean that you have that disease. For example, fatigue is a symptom associated with both Sjögren’s and lupus. You can have fatigue and have just lupus, just Sjögren’s, or both conditions.

Likewise, being diagnosed with one autoimmune disease doesn’t always rule out having another autoimmune condition. It’s possible to have just one autoimmune disease, but keep in mind that many people have multiple. That’s why it’s important to ask your doctor to consider all of your symptoms and check for other autoimmune conditions if you’ve been diagnosed with an autoimmune disease.

Signs and Symptoms of Sjögren’s Disease

Sjögren’s disease causes a wide range of symptoms that can impact any body part or system.

Dryness

Sjögren’s affects your body’s ability to produce moisture, which leads to dryness. People with Sjögren’s might experience symptoms like:

• Dry eyes that may feel itchy or gritty
• Dry mouth that can also include trouble chewing, swallowing, or speaking
• Dry nose or throat, which may lead to frequent nosebleeds or coughing
• Dry skin
• Genital dryness

Joint and Muscle Signs and Symptoms

Many people with Sjögren’s experience problems with their joints or muscles. These symptoms may include:

• Joint pain or stiffness
• Muscle pain or weakness
• Inflammation (like redness or swelling) around a joint

Nervous System Signs and Symptoms

Sjögren’s can cause a wide range of nervous system signs and symptoms in both the peripheral nervous system (PNS) and central nervous system (CNS). Some people may experience nervous system symptoms years before they experience other symptoms, like dryness. Nervous system symptoms can include:

• Brain fog
• Fatigue (feeling very tired most of the time)
• Headaches or migraines
• Trouble concentrating or remembering things
• Numbness, tingling, pain, or weakness in the hands and feet

When Sjögren’s affects a part of the nervous system called the autonomic nervous system (ANS), which is part of the PNS, it can cause a problem called autonomic dysfunction (often called dysautonomia). Autonomic dysfunction is when the ANS isn’t working as it should. It can cause a wide range of signs and symptoms that include:

• Trouble balancing
• Shortness of breath
• Sleep problems
• Orthostatic hypotension (when blood pressure drops suddenly after a person stands up from sitting or lying down)
• Postural orthostatic tachycardia syndrome (POTS) (a condition that includes a range of symptoms that happen when a person stands up from lying down, including the heart rate rising much more than normal, dizziness, or extreme tiredness)
• Gastrointestinal (GI) issues, such as slow motility (when food moves slowly through the digestive tract)

Sexual or Urinary Signs and Symptoms

Sjögren’s patients may experience a number of sexual or urinary symptoms. 

Signs and symptoms related to sex and the genitals can include:

• Genital dryness (when the tissues inside and outside the vagina are thin and dry)
• Genital yeast infections
• Pain, burning, or stinging around the genitals
• Discomfort or pain during sex
• Low libido (desire to have sex)
• Difficulty or inability to orgasm
• Erectile dysfunction
• Prostatitis (inflammation of the prostate gland)

Urinary symptoms can include:

• Urinary tract infections, which can make you feel like you need to urinate more frequently or urgently
• Pain or difficulty urinating (in people with prostates)

Skin, Hair, and Nails Signs and Symptoms

Many people with Sjögren’s notice problems with their skin, hair, or nails. These may include:

• Skin that’s dry, itchy, red, scaly, or cracked
• Rashes such as hives (raised, itchy, red bumps)
• Hair that’s dry or brittle
• Hair loss or thinning
• Excessive hair shedding
• Nails that are dry, brittle, flaky, or cracked or have ridges that run along the length of the nail
• Nails that look yellow or greenish

Many people with Sjögren’s are also more likely to be sensitive to the sun and other types of ultraviolet (UV) light. For example, they may experience rashes caused by sun or heat.

Some Sjögren’s patients also experience a condition called vasculitis — this is when the blood vessels beneath the skin become inflamed and can appear as a purple rash, spots, or patches on the skin. If you have signs of vasculitis, you should talk to a doctor right away.

Oral and Dental Signs and Symptoms

Sjögren’s can lead to problems with the mouth and teeth. Symptoms can include:

• Dry mouth
• Mouth sores or blisters
• Candidiasis (yeast infection)
• Sore, red tongue
• Sores at the corners of the lips (called perleche or angular cheilitis)
• Cavities and tooth decay
• Trouble tasting
• Swollen or painful salivary glands (the glands that produce saliva)

Because of tooth decay, people with Sjögren’s are more likely to need dental work, such as crowns, implants, or dentures.

Eye and Vision Signs and Symptoms

Sjögren’s can cause a number of eye or vision problems that may include:

• Dry eye
• Damage to the cornea (the clear layer that covers the entire eye)
• Eye infections
• Vision problems, including blurry vision or problems with the pupil opening or closing in response to changes in light

Digestive Signs and Symptoms

Sjögren’s can affect your digestive system — also called the gastrointestinal system. Digestive signs and symptoms can include:

• Difficulty swallowing
• Heartburn or acid reflux
• Pain in your throat
• Upset stomach, diarrhea, or vomiting

People with Sjögren’s may have other digestive system conditions or problems, too — they include:

• Gastroparesis (when the stomach isn’t able to empty itself properly)
• Autoimmune pancreatitis (when the body’s immune system attacks the pancreas, an organ that helps the body digest food)
• Autoimmune gastrointestinal dysmotility (when the body’s immune system attacks the nerves of the muscles in the digestive system and makes it difficult to move food and waste through the body)

Liver problems associated with Sjögren’s include:

• Having abnormal liver function test results
• Chronic active autoimmune hepatitis (a condition where the immune system attacks the liver)
• Primary biliary cholangitis (a condition where the bile ducts in the liver are damaged and destroyed)

When mild, liver problems do not cause any symptoms. When severe, they may cause itchy skin (pruritis) or jaundice (yellowing of the skin).

Pancreas problems associated with Sjögren’s include:

• Pancreatic exocrine inefficiency (when the pancreas doesn’t produce enough of the enzymes that help digest food)
• Pancreatitis (inflammation of the pancreas)

Pancreas problems may cause symptoms like vomiting or nausea, loss of appetite, abdominal pain (that may radiate to the back), or fatigue.

Cardiovascular System Signs and Symptoms

The cardiovascular system is made up of the heart and blood vessels. These organs move blood around your body. Sjögren’s can impact both the heart and the blood vessels. 

Cardiovascular signs and symptoms associated with Sjögren’s include:

• Hypertension (high blood pressure) or hypotension (low blood pressure)
• Issues with the heartbeat, including an irregular heart beat (arrhythmia) or beating too fast (tachycardia) or too slow (bradycardia)
• Low counts of certain types of blood cells, including red blood cells (anemia) and white blood cells (leucopenia)
• Problems with blood clotting
• Vasculitis (inflammation of and damage to the blood vessels)
• Myocardial ischemia (when parts of the heart muscle don’t get enough oxygen)
• Pericarditis (inflammation of the membrane that surrounds the heart)

Kidney Signs and Symptoms

Sjögren’s can affect your kidneys.

Kidney problems that are associated with Sjögren’s include:

• Interstitial nephritis (when microscopic spaces between part of your kidneys called tubules become inflamed)
• Renal tubular acidosis (when your kidneys have trouble properly adjusting the acidity and electrolyte composition of the blood and urine)
• Glomerulonephritis (inflammation of the parts of your kidneys called glomeruli that filter your blood)

These problems usually do not cause noticeable symptoms, or symptoms may be very subtle. But they may include things like foamy urine, urine color changes, or kidney stones.

Respiratory Signs and Symptoms

Sjögren’s can affect the respiratory system in many patients — including your sinuses, trachea (windpipe), and lungs. Symptoms can include:

• Dry nose and sinuses
• Dry throat
• Coughing
• Shortness of breath

Sjögren’s can also be associated with other respiratory problems — including sinusitis (infection in the sinuses), bronchitis (inflammation of the tubes that carry air in and out of the lungs), pneumonia (a type of lung infection), or interstitial lung disease (a broad range of lung disorders that cause inflammation and scarring of the lung tissues). Up to 20% of Sjögren’s patients develop lung involvement. 

Lymphoma Signs and Symptoms

People with Sjögren’s disease are 44 times more likely to have a type of cancer called lymphoma. After 20 years of having Sjögren’s, close to one out of five patients will develop lymphoma. Lymphomas affect the body’s lymphatic system, which helps to keep fluids balanced in the body. 

It’s important to talk to your doctor about any new or unusual symptoms that could be early signs of lymphoma. These include:

• Swelling of the glands (lymph nodes) in the neck, armpits, and groin
• Unexplained weight loss
• Unexplained fevers
• Night sweats

Other Signs of Sjögren’s Disease

Some of the effects of Sjögren’s disease are hard for patients to feel or see because they’re happening inside of the body. These signs may need to be measured or diagnosed using lab or imaging tests. Examples of signs of Sjögren’s include:

• Having certain antibodies (Antinuclear antibodies, rheumatoid factor, anti-SS-A and SS-B, or centromere antibodies) in your blood
• Other blood test abnormalities (like an elevated sedimentation rate, elevated globulins, or positive cryoglobulins)
• Reduced tear or saliva production
• Dry spots on the surface of the eye
• Having lymphocytes (a type of white blood cell) in your salivary glands (seen on minor salivary gland lip biopsies)