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Secondary Sjogren's Syndrome and Arthritis

What is secondary Sjogren’s syndrome?

Sjogren’s syndrome is an autoimmune disorder that damages moisture-producing glands, making it difficult to produce saliva and tears. A hallmark of the disease is infiltration of target organs by lymphocytes. When Sjogren’s syndrome occurs by itself, it’s called primary Sjogren’s syndrome.

If you already have another autoimmune disease, the condition is called secondary Sjogren’s syndrome. With secondary Sjogren’s, you might have a milder form of the condition. But you’ll still experience symptoms of the coexisting disease. The most common cause of secondary Sjogren’s is rheumatoid arthritis (RA), another type of autoimmune disease.

Learn more: What do you want to know about rheumatoid arthritis? »

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Symptoms

Symptoms

The symptoms of Sjogren’s can include dry eyes, mouth, throat, and upper airways. You may have difficulty tasting or swallowing your food. You may also develop a cough, hoarseness, dental issues, or have difficulty speaking. For women, vaginal dryness may occur.

Primary and secondary forms of Sjogren’s can have similar symptoms, which include:

Less often, Sjogren’s causes:

Secondary Sjogren’s can accompany the following conditions:

  • RA
  • primary biliary cholangitis
  • lupus
  • scleroderma

While symptoms of RA usually include inflammation, pain, and stiffness of the joints, it can also cause other symptoms similar to Sjogren’s. These include:

  • slight fever
  • fatigue
  • loss of appetite

Read more: Sjogren’s syndrome »

Risk factors

Risk factors

According to the Cleveland Clinic, more than a million people in the United States have primary Sjogren’s. More than 90 percent are women. You can develop Sjogren’s at any age, but it’s most often diagnosed after age 40, according to the Mayo Clinic. The exact cause of Sjogren’s is unknown. But like RA, it’s a disorder of the immune system.

The precise cause of RA is also unknown, but there’s a genetic component involved. If you have a family member with any autoimmune disease, like RA, you’re at risk for developing one, too.

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Diagnosis

Diagnosis

There’s no single test for Sjogren’s. Diagnosis can occur after you’ve been diagnosed with another autoimmune disease and develop dryness of the mouth and eyes. Or you may experience severe gastrointestinal problems or nerve pain (neuropathy).

To diagnose secondary Sjogren’s with RA, you’ll need to undergo a series of tests. Most often these include SSA/SSB antibodies and a lower lip biopsy to look for focal areas of lymphocytes. You may be referred to an eye doctor to test for dry eye. Your doctor will also rule out other potential causes of your symptoms.

Tests for Sjogren’s

Your doctor will first look at your complete medical history and conduct a physical exam. They will also likely order the following tests:

  • blood tests: These are used to see if you have certain antibodies characteristic of Sjogren’s. Your doctor will look for anti-Ro/SSA and anti-La/SSB antibodies, ANA, and rheumatoid factor (RF).
  • biopsy: During this procedure, your doctor will focus on your saliva glands.
  • Schirmer’s test: During this five-minute eye test, your doctor places filter paper over the corner of your eye to see how wet it gets.
  • Rose-Bengal or lissamine green staining test: This is another eye test that measures dryness of the cornea.

Conditions that mimic Sjogren’s

Be sure to tell your doctor about over-the-counter (OTC) and prescription medications you are taking. Some medications can cause symptoms associated with Sjogren’s. These medications include:

  • tricyclic antidepressants such as amitriptyline (Elavil) and nortriptyline (Pamelor)
  • antihistamines such as diphenhydramine (Benadryl) and cetirizine (Zyrtec)
  • oral contraceptives
  • blood pressure medications

Radiation treatments can also cause similar symptoms, especially if you receive these treatments around the head and neck area.

Other autoimmune disorders may also mimic Sjogren’s. It’s important that you take all the recommended tests and follow up with your doctor to determine the exact cause of your symptoms.

Treatments

Treatment options

There’s no cure for Sjogren’s or arthritis, so treatment is essential to alleviating symptoms and improving your overall quality of life. Your treatment plan depends on the severity of your symptoms. You’ll likely need to try a combination of treatments. Some options include:

Medications

If you have aches and pains in your joints and muscles, try OTC pain relievers or anti-inflammatory medications. Nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil, Motrin) may help.

If they don’t do the trick, ask your doctor about corticosteroids and antirheumatic or immunosuppressive medications. These work by decreasing inflammation and preventing your body from attacking its own healthy tissues.

With secondary Sjogren’s, you may also need medications to help increase secretions such as tears and saliva. Common prescription drugs include cevimeline (Evoxac) and pilocarpine (Salagen). You might need prescription eye drops to help dry eye. Cyclosporine (Restasis) and lifitegrast ophthalmic solution (Xiidra) are two options.

Lifestyle

Certain lifestyle choices can also help you combat secondary Sjogren’s and RA. First, you can fight fatigue by getting a good night’s sleep and taking breaks during the day. Also, ask your doctor about exercises that can help you increase flexibility and ease muscle and joint pain. Regular exercise can improve flexibility and lessen discomfort. It’ll also help maintain proper body weight and put less stress on joints and muscles.

Maintaining a diet rich in nutrients can improve your overall health. Stick with plant-based foods and anti-inflammatory fats found in fish and plant oils. Avoid sugar and processed foods. These can increase inflammation.

Read more: Foods that reduce inflammation »

If you have arthritis, you may also find relief with complementary treatments such as yoga, tai chi, or acupuncture. You can even temporarily soothe aches and pains by applying heat or cold compresses.

Oral hygiene

Chronic dry mouth causes oral and dental problems, so proper oral hygiene is important. Limit your sugar intake and get regular dental checkups. Choose dental products made for dry mouth and be sure to floss every day. Hard candy and chewing gum can help you produce saliva, but make sure they’re sugar-free.

For dry lips, use lip balm that has an oil or petroleum base. Your doctor can recommend mouth rinses or ointments to ease pain and inflammation. These may be used along with your prescription medications.

Eye treatments

There are several things you can do to help eye-related symptoms of Sjogren’s syndrome. Use a humidifier to keep the air moist at home. Avoid smoke, and protect your eyes from wind. You should also avoid eye makeup or skin creams that could irritate your eyes.

Your doctor might suggest you try OTC artificial tears. It they don’t help, ask your doctor to prescribe something stronger.

Thicker eye ointments can be used while you sleep. But talk with your doctor before applying ointments or gels to your eyes. Also, a surgical procedure called punctual occlusion can temporarily or permanently close off tear ducts that drain tears from your eyes. Placing warm compresses on the eyes before bedtime can open up eyelid oil glands. This helps protect the cornea and lessen dry eye symptoms.

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Doctors

What kind of doctor do I need?

Doctors who specialize in diseases like arthritis are called rheumatologists. If you’ve been diagnosed with arthritis, your rheumatologist will most likely also be able to treat Sjogren’s.

Depending on the severity of your symptoms, your rheumatologist or general physician may refer you to other specialists. They will include an ophthalmologist, dentist, or an otolaryngologist, also known as an ear, nose, and throat specialist.

Read more: 5 types of health professionals you should know about »

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Outlook

Long-term outlook

There’s no cure for Sjogren’s or RA. But there are many treatments and lifestyle choices that can improve your quality of life.

Symptoms of arthritis vary from very mild to debilitating, but arthritis in primary Sjogren’s is rarely damaging. The key is to work with your doctor to find the best treatments. In rare cases, people with Sjogren’s may develop lymphoma. Report signs of unusual swelling or neurologic problems to your doctor.

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