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Medical Author:

Kanchan Pema, MD

Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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The defining symptoms of Sjögren's syndrome are dry eyes (xerophthalmia) and dry mouth (xerostomia). Other areas can be dry as well, such as the inside of the nose, the skin, the airways of the lungs, and the vagina. These symptoms often are referred to as the sicca (dryness) complex.

A dry mouth can cause

• difficulty chewing or swallowing;



• inability to eat dry foods, such as crackers, that stick on the roof the mouth;



• cracked or sore tongue, or tongue sticking to the roof of the mouth;



• dry, burning throat that leads to a dry cough;



• awakening at night with the need for a drink of water;



• difficulty speaking continuously;



• hoarseness;



• high incidence of dental decay and periodontal disease;



• change in the sense of taste;



• difficulty wearing dentures;



• cracks and redness in the corners of the mouth.

Dry eyes can cause

• red, itchy, or painful eyes;



• gritty, scratchy, burning, or sandy sensation in the eyes;



• eyes matted and stuck closed on awakening;



• blurry vision;



• sensitivity to bright light that makes reading or watching television difficult;



• damage to the cornea, the dome over the colored portion (iris) of the eye.

Almost every system of the body can be affected. Symptoms depend on which areas are affected and may include any of the following:

• Painful swelling of the parotid (salivary) glands: These glands are located between your ear and the angle of your jaw.



• Tiredness (fatigue) that can be severe enough to interfere with normal activities



• Joint pain (arthralgia) and occasionally joint swelling (arthritis)



• Dry and itchy skin



• Red-purple skin lesions (palpable purpura) that commonly occur on the legs: These occur when blood vessels in the skin become inflamed



• Episodic white, blue, and red discoloration of the fingers or toes (Raynaud's phenomena)



• Painful sexual intercourse (dyspareunia)



• Dry cough



• Difficulty swallowing



• Recurrent pneumonia and bronchitis



• Acid reflux and heartburn



• Severe abdominal pain that could be due to pancreatitis or kidney stones



• Inflammation of the bladder causing frequent urination, lower abdominal pain, and pain on urination



• Thyroid disease may also accompany Sjögren's syndrome

Symptoms are mild in most people but can be very severe in others. Symptoms can vary over time and may improve, worsen, or even go away completely for periods of time.

Dry eyes and mouth do not always mean Sjögren's syndrome. The symptoms are common and can be caused by other medical disorders, by some medications, and by anxiety. It is important to consider other diseases that produce similar symptoms. Dryness also may be a result of normal changes in glands and tissues that occur with aging, previous radiation to the head and neck, lymphoma, sarcoidosis, hepatitis C, human immune deficiency virus, human T-cell leukemia virus-1 infection, cancer, inflammatory disease, infections, and medications.

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