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Secondary Sjögren’s Syndrome: How RA Can Affect the Eyes

Posted on June 02, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Imee Williams

Most people know rheumatoid arthritis (RA) as a joint condition, but it can affect other parts of the body, including the eyes. Sjögren’s syndrome is a rheumatic disease that causes dry eyes, which can increase the risk of eye infections and blurry vision. Secondary Sjögren’s syndrome is a common comorbidity of RA.

There are as many as 4 million people in the United States who have Sjögren’s syndrome. Studies have found that secondary Sjögren’s syndrome affects about 19.5 percent of people with RA. In this article, we will cover the causes, risk factors, and symptoms for secondary Sjögren’s syndrome with RA. We’ll also discuss ways to treat and manage both conditions so that you or your loved one can have a better quality of life.

What is Secondary Sjögren’s Syndrome?

Secondary Sjögren’s syndrome is a chronic autoimmune disease in which the immune system attacks mucous membranes and glands, particularly the salivary glands in the mouth and the lacrimal glands in the eyes. This can cause severe dry mouth, dry eyes, and dry skin.

Although the most common signs of Sjögren’s syndrome are eye complications, it can also affect other mucosal tissues in parts of the body. Sjögren’s syndrome can impact the:

  • Joints
  • Muscles
  • Nervous system
  • Gastrointestinal (GI or digestive) tract
  • Skin
  • Blood vessels
  • Lungs
  • Kidneys
  • Nose
  • Larynx
  • Vagina

When Sjögren’s only causes dry eyes or dry mouth, it’s considered a mild form of the disease.

Diagnosis of Sjögren’s

Sjögren’s is typically diagnosed through a combination of blood tests, eye tests, and a biopsy of a salivary gland from the lip. Imaging tests may include a sialogram (X-ray of salivary glands) and salivary scintigraphy, which tests the function of salivary glands.

Types of Sjögren’s

There are two types of Sjögren’s syndrome:

  • Primary Sjögren’s syndrome — When Sjögren’s syndrome appears by itself, without any other disease
  • Secondary Sjögren’s syndrome — When Sjögren’s syndrome occurs along with other autoimmune disorders

People with secondary Sjögren’s syndrome associated with RA tend to be older and female with a long history of RA.

Risk Factors

Sjögren’s syndrome is one of the most common autoimmune conditions in the United States. The prevalence of secondary Sjögren’s syndrome in people with RA increases the longer they’ve had RA. It’s typically diagnosed when people are in their late 40s. It affects women more often than men; in fact, women account for 90 percent of cases. However, it can also affect men and children. Men tend to be diagnosed later than women.

Symptoms

As with other autoimmune diseases, the severity of secondary Sjögren’s syndrome varies from person to person. Symptoms can range from mild to severe. The two most common symptoms of Sjögren’s syndrome are dry eyes (recurrent redness and burning or itching in the eyes, as if there is sand in them) and dry mouth (difficulty swallowing, talking, or chewing, as if your mouth is filled with cotton).

More severe Sjögren’s syndrome can affect the entire body. Symptoms may include:

  • Joint pain, swelling, or stiffness
  • Muscle aches and pain
  • Digestive issues, such as constipation
  • Vaginal dryness
  • Dry or peeling lips
  • Skin rashes
  • Persistent dry cough or sore throat
  • Dry nasal passages, throat, and lungs
  • Change in taste or smell
  • Prolonged fatigue
  • Difficulty sleeping

Eye Complications of Sjögren’s

Sjögren’s syndrome can also lead to eye complications, such as:

  • Decreased tearing
  • Light sensitivity
  • Blurred vision
  • Eye infections
  • Ulcers of the cornea
  • Uveitis (inflammation of the middle layer of the eye)
  • Scleritis (inflammation of the sclera, the white part of the eye)
  • Retinal vasculitis (inflammation in the blood vessels of the retina)
  • Optic neuritis (inflammation of the optic nerve)
  • In rare cases, blindness

One myRAteam member shared their experience with RA and secondary Sjögren’s syndrome. “I’ve had RA for over 30 years and recently was diagnosed with secondary Sjögren’s syndrome,” they said. “My main symptom is dry eyes, and I have to use eye drops all the time. I use different eye drops depending on the time of day.”

What Causes Secondary Sjögren’s Syndrome?

The cause of Sjögren’s syndrome remains unknown. However, researchers know that genetics, viral infections, and the immune system all play a role in the development of the disease.

In Sjögren’s syndrome, the immune system attacks itself, creating and releasing abnormal antibodies called autoantibodies in the blood. These autoantibodies then travel throughout the body, attacking various organs and tissues. When autoantibodies invade the eyes, they cause inflammation. This inflammation can lead to dysfunction and damage to the tear glands. Over time, this causes a decrease in fluid needed to produce tears and keep the eyes hydrated. Autoantibodies can even destroy the glands and cause them to stop producing moisture.

Treating Secondary Sjögren’s Syndrome and RA

There is currently no cure for secondary Sjögren’s syndrome. However, treatments can help to relieve and control symptoms.

Mild eye symptoms can often be treated with over-the-counter (OTC) moisturizing eye drops, also known as artificial tears. However, if OTC options don’t help, an ophthalmologist (eye doctor specializing in eye diseases) can prescribe stronger formulas.

Other treatments include:

Other prescription medications that can help reduce inflammation include:

  • Nonsteroidal anti-inflammatory drugs
  • Corticosteroids
  • Disease-modifying antirheumatic drugs, including methotrexate

It is important to manage chronic dry eyes to prevent eye irritation, discomfort, infections, and scarring. In severe cases, punctal occlusion may be needed to treat dry eyes. Punctal occlusion is a procedure that blocks the tear duct and keeps the eye hydrated.

Living With Secondary Sjögren’s Syndrome

People with secondary Sjögren’s syndrome can live full lives with proper self-care and treatment from a knowledgeable team of health care professionals. In addition to a rheumatologist, it is important for people with RA and secondary Sjögren’s syndrome to see an ophthalmologist regularly to prevent complications like eye damage. Any pain or redness in the eyes should be evaluated promptly, as this may signal an eye infection or corneal damage.

Regular Monitoring

Because Sjögren’s syndrome also increases the risk of developing lymphoma, people with the condition should be monitored regularly via blood tests for the development of lymphoma. They should also be checked regularly for other complications like vasculitis (inflammation of the blood vessels) and pulmonary, kidney, and liver disease.

Diet Changes

Changing your diet can help reduce inflammation and ease secondary Sjögren’s syndrome symptoms, especially if you experience dry mouth symptoms. Helpful guidelines include:

  • Avoiding alcohol and caffeine
  • Avoiding sugar and processed foods
  • Avoiding spicy, acidic, hard, or crunchy foods
  • Eating smooth, soft, and creamy foods like soups, casseroles, and pasta dishes
  • Eating omega-3 fatty acids found in fish and plant oils

Tips From myRAteam Members

Members from myRAteam also shared their tips on managing secondary Sjögren’s syndrome:

  • “If your mouth is dry, use mouthwash without alcohol.”
  • “I use a saline nasal spray in my nostrils each evening for dry nostrils.”
  • “I take sugar-free cough drops and mints to keep moisture in my mouth.”
  • “Avoid sitting next to air conditioning or heating vents.”
  • “Use eye lubricants daily.”
  • “Place a warm compress on your eyelids to help soothe irritation.”
  • “I stopped drinking fizzy or acidic drinks.”
  • “I bought a humidifier, and it has been a game-changer!”

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis, more than 189,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA.

Have you also been diagnosed with secondary Sjögren’s syndrome? What symptoms do you have, and how do you manage them? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Imee Williams is a freelance writer and Fulbright scholar, with a B.S. in neuroscience from Washington State University. Learn more about her here.

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