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.
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:
When Sjögren’s only causes dry eyes or dry mouth, it’s considered a mild form of the disease.
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.
There are two types of Sjögren’s syndrome:
People with secondary Sjögren’s syndrome associated with RA tend to be older and female with a long history of RA.
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.
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:
Sjögren’s syndrome can also lead to eye complications, such as:
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.”
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.
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:
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.
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.
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.
Changing your diet can help reduce inflammation and ease secondary Sjögren’s syndrome symptoms, especially if you experience dry mouth symptoms. Helpful guidelines include:
Members from myRAteam also shared their tips on managing secondary Sjögren’s syndrome:
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.
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