What Is The Connection Between Lupus and Sjogren’s Syndrome?

Sjogren’s syndrome is a rare autoimmune condition that often accompanies other autoimmune conditions. Some of these include lupus or rheumatoid arthritis. It is estimated that up to 15 to 18 percent of people living with lupus also have Sjogren’s syndrome.¹ It is considered primary Sjogren’s syndrome when it occurs on its own, with no other autoimmune conditions present. If a person has it and another autoimmune issue, it is considered secondary Sjogren’s syndrome.^2,3 While we do not know the exact reason, there are some theories as to why Sjogren’s syndrome and lupus may run together.

What is Sjogren’s syndrome?

Sjogren’s syndrome is an autoimmune condition that causes a person’s immune system to mistakenly attack certain healthy parts of their body. Most commonly, Sjogren’s syndrome affects the tear and saliva glands. Other fluid-producing areas, like the nose, throat, skin, or vagina can also be impacted. Rarely, Sjogren’s syndrome can affect the liver, kidneys, or lungs. Women are the most commonly affected by Sjogren’s syndrome. The average age of onset is around 45 to 55 years old.^2-4

A “syndrome” refers to a group of symptoms that commonly occur together. Because it affects the tear and saliva glands, common symptoms of Sjögren’s syndrome include:^2-4

• Dry mouth
• Dry or burning eyes
• A sensation of grittiness in the eyes
• Swelling of the glands around the neck or the head
• Trouble swallowing, especially dry foods
• Irritation of the esophagus and acid reflux (GERD)
• Fatigue

Some people with Sjogren’s syndrome may experience joint pain or swelling, even if they do not have another joint-related autoimmune condition. If the skin or other organs are affected, a person may experience rashes, inflammation of their lungs, or issues with their liver or kidney functioning.²

Sjogren’s syndrome treatments

There is currently no cure for Sjögren’s syndrome, however, its symptoms can be manageable. The amount of treatment needed depends on the symptoms experienced. Some people may have very mild Sjogren’s syndrome, with minimal symptoms. Others may have many symptoms that require several different treatment options. Our body’s fluids help protect us from infection. When our eyes or mouth are dry, we are more susceptible to foreign invaders. A dry mouth can also lead to tooth decay. These reasons are why treating Sjogren’s syndrome and maintaining regular check-ups with your doctor and dentist can be quite important.

Common symptom-related treatment options for Sjogren’s syndrome include:^2-4

• Eye drops to keep the eyes moist or help the eye produce more tears
• Gum, lozenges, saliva substitutes, or drugs that help the mouth produce more saliva
• Antibiotics or antifungal drugs for any infections that arise
• Irrigation for dry noses
• Acid reflux (GERD) drugs, such as proton-pump inhibitors or H2 blockers

If a person’s Sjogren’s syndrome impacts their skin or other organs, they may need treatment with systemic (whole-body) drugs. These include steroids, drugs that suppress the immune system, or a medication called hydroxychloroquine that is also used for the treatment of RA and lupus.^2-4

Sjogren’s syndrome causes

The symptoms of Sjogren’s syndrome come from the dysfunction of the immune system. The body starts making faulty proteins and immune system cells that attack normal, healthy tissues. The exact reason why the immune system gets confused is not known. Experts believe that the development of Sjogren’s syndrome (along with many other autoimmune conditions) may be related to genetic factors, environmental exposures, and past infections.¹

To make a diagnosis, doctors will consider a person’s symptoms and possibly do tests on tear and saliva production. A biopsy (a small sampling of tissue) may also be taken from a gland. Blood tests looking for specific antibodies can also help make a diagnosis. Antibodies called anti-ANA, anti-SSA, and anti-SSB (also called anti-Ro and anti-La antibodies), and rheumatoid factor are commonly found in the blood of a person living with Sjogren’s syndrome.^2-4

Sjogren’s syndrome and lupus

As mentioned, although Sjogren’s syndrome and lupus often occur together, the exact reason why is not known. However, experts have some theories on how different factors may interact and lead to both conditions:

Genetics

Although it is not clear what specific genes may lead to the development of Sjogren’s syndrome or lupus, some of the same genes may lead to both (and the development of other autoimmune conditions, too). Especially genes that impact the immune system and how well it functions.

Similar antibodies

Some of the antibodies commonly found in Sjogren’s syndrome are also found in lupus. Especially the anti-ANA antibody. As many as 80 percent of people with Sjogren’s syndrome may also have anti-ANA. Rheumatoid factor, which plays a role in RA, can be found in over 75 percent of people with Sjogren’s syndrome. These antibodies may play a role in attacking different parts of the body, leading to different symptoms.

Changes in hormones and other factors

Sex hormone imbalances, changes in prolactin (a hormone produced in the brain), different bacteria in the gut, and vitamin D levels have been thought to potentially play a role in both lupus and Sjogren’s syndrome.

Environmental factors

Similar exposures or past infections may contribute to the development of multiple autoimmune issues, including lupus and Sjogren’s syndrome.

Overlapping symptoms

The symptoms of Sjogren’s syndrome and lupus can be very similar. In some cases, it can be hard to tell the two apart. This may lead to the diagnosis of both conditions in a person who only has one or the misdiagnosis of someone who actually has both.¹

Overall, there is still a lot to be learned about both Sjogren’s syndrome and lupus, including why they may occur together. But, with the right treatment options and regular health check-ins, managing Sjogren’s syndrome alongside lupus can be doable.