Hidden Symptoms of Sjögren’s: The Autoimmune Signs Your Body Is Telling You

Sjögren’s is often misunderstood. This autoimmune condition is best known for causing dry eyes and dry mouth, but Sjögren’s can cause many other symptoms affecting different parts of the body.

This matters for several reasons, including because Sjögren’s often goes undiagnosed for years or even forever, leaving patients in the dark about what’s making them feel unwell.

The longer Sjögren’s goes unrecognized, the more autoimmunity and inflammation can continue to cause more and more problems throughout the body.

I frequently see patients in my functional medicine telehealth clinic who have spent years trying to figure out what’s wrong and either not been diagnosed or only recently been diagnosed.

I also see those whose healthcare providers have left them with more questions than answers about how all of their symptoms may be connected, beyond dry eyes and dry mouth to fatigue, oral cavities, digestive issues, and yeast infections.

In this article, I’ll cover some of the hidden symptoms and signs of Sjögren’s, what’s really going on in your body with this autoimmune disease, how to know if you might have it, and how to get started with a more holistic approach to treatment.

Overview of Sjögren’s and Autoimmunity

Sjögren’s syndrome is an autoimmune disease, meaning that the immune system is attacking the self. There are more than 100 different kinds of autoimmune diseases that have been identified, differentiated by the part of the body the immune system is attacking.

Beyond these recognized conditions, I see patients every day who have some level of autoimmunity going on that hasn’t yet advanced to a point where it meets the criteria for a diagnosis (but it’s still a problem).

In the case of Sjögren’s, the immune system attacks mucous membranes— most famously tear ducts and salivary glands, which is what leads to the hallmark symptoms of dry eyes and dry mouth.

There are also several other possible symptoms of Sjögren’s, and about 60% of patients with this condition also have at least one other diagnosed autoimmune disease, such as rheumatoid arthritis or systemic lupus erythematosus. (1)

Sjögren’s is sometimes referred to as the “silent autoimmune disease” because of its tendency to go undetected. Researchers estimate that Sjögren’s goes undiagnosed in at least half of those who have it. (1)

Hidden Sjögren’s Symptoms

While it’s important to recognize the most common symptoms of Sjögren’s like dry mouth and dry eyes, it’s also essential to remember that Sjögren’s is a systemic autoimmune disease which can affect the mucous membranes more broadly.

We have many other mucous membranes throughout the body besides the salivary and lacrimal (tear) glands, and the symptoms that correspond to these other mucous membranes are often the ones that go unrecognized, leaving patients without a diagnosis or symptom relief for way too long.

For example, Sjögren’s can affect the gut, the lungs, the sinuses, the skin, the joints, the thyroid, and the liver— to name a few.

Not everyone will experience all of the possible symptoms of Sjögren’s, and symptoms may come and go, or develop or worsen over time. In some cases symptoms progress slowly, making them more difficult to identify, while in other cases they come on more quickly.

Below, I’ll highlight some of the most common hidden symptoms of Sjögren’s I see in my telehealth functional medicine practice.

Dry Mouth and Dry Eyes

Dry mouth and dry eyes might be the most commonly understood symptoms of Sjögren’s, but they’re often “hidden” because they can be very subtle, especially at first.

With Sjögren’s disease, an autoimmune response affects the salivary glands, leading to a dry mouth which can make speaking or swallowing uncomfortable and may cause a sore throat or sores within the mouth.

Sjögren’s also tends to affect the tear ducts, leading to dry eyes. Some people may experience a burning sensation, a “gritty” feeling, or itchiness of the eyes.

Dry mouth and dry eyes are collectively referred to as sicca syndrome. These symptoms may be more mild or more disruptive depending on the individual and how far their condition has progressed.

Fatigue

Fatigue is one of the most common symptoms of Sjögren’s. Of course, fatigue is a symptom of many different conditions and doesn’t point to Sjögren’s on its own.

But when combined with dry mouth and dry eyes, and/or any of the other symptoms listed below, this suggests that Sjögren’s may be present.

Roughly half of Sjögren’s patients report extreme fatigue that interferes with their day-to-day life. (2) Extra sleep or rest often leaves them feeling unrefreshed. (3)

There are several possible causes of fatigue associated with Sjögren’s, which may relate to other effects of the disease such as subclinical hypothyroidism or gut imbalances.

Fatigue may also be directly linked to increased inflammation. (4) Sjögren’s also frequently overlaps with fibromyalgia, another condition that causes debilitating fatigue. (5)

Leaky Gut and Digestive Symptoms

Sjögren’s can affect the mucous membranes lining the digestive tract, which can lead to increased intestinal permeability (leaky gut) and various digestive symptoms, including abdominal pain, diarrhea, constipation, bloating, or acid reflux.

I wish more people were aware of this, because leaky gut is a contributing factor to so many other potential health issues affecting the gut, the brain, and the rest of the body. You can learn more about leaky gut and how to address it here.

Joint Pain or Muscle Pain

Many patients with Sjögren’s experience muscle or joint pain or discomfort. This is often related to a co-occurring autoimmune condition that impacts the joints, like rheumatoid arthritis or lupus. However, joint pain can also occur in Sjögren’s without another existing diagnosis.

Learn how to reverse autoimmune symptoms, dampen inflammation, and balance your immune system with my course, Mastering Autoimmune Conditions & Inflammation with Functional Medicine.

Dry Skin or Skin Rashes

Sjögren’s can affect the mucous membranes of the skin, leading to dryness, irritation, and/or a feeling of burning skin. (6)

Many patients will also experience sensitivity to the sun and sun-sensitive rashes on the chest, back, face, or arms. Another possible skin-related manifestation of Sjögren’s is a rash on the lower legs caused by the inflammation of small blood vessels (vasculitis).

Vaginal Dryness

For females, the mucous membrane of the vagina can also be affected by Sjögren’s, leading to vaginal dryness. This can lead to discomfort, soreness, or itching, as well as pain during intercourse.

Dental Problems

Dry mouth associated with Sjögren’s can lead to dental problems including tooth decay, cavities, infections, chipping of teeth, and/or inflammation of the gums. Dry mouth may also disrupt the balance of the oral microbiome.

Chronic Cough

Sjögren’s can impact the mucous membranes in the throat and respiratory tract, which can lead to a chronic dry cough. In many patients this cough is mild, so may go relatively unnoticed. However, some patients may also experience more serious pulmonary or lung symptoms or complications.

Other Possible Symptoms and Complications

Other potential symptoms or complications of Sjögren’s may include:

• Oral thrush (yeast infection in the mouth)
• Peripheral neuropathy (numbness or tingling in the hands or feet) or other nervous system symptoms
• Eye infections
• Sinus problems
• Headaches
• Pancreatitis (inflammation of the pancreas)
• Kidney disease
• Lymphomas (tumors in the lymph nodes)

Other symptoms are also possible with Sjögren’s. Every case looks a bit different. And although conventional medicine tends to view autoimmune diseases exclusively through the lens of the part of the body most affected, when autoimmunity and inflammation are present the entire body can be affected.

Do You Have Sjögren’s? How To Find Out

There isn’t one specific test that identifies Sjögren’s, but the American College of Rheumatology and the European League Against Rheumatism have developed a series of international classification criteria for diagnosis.

These criteria include a combination of eye and mouth symptoms as well as different kinds of testing, which may include:

• Imaging of the salivary glands
• Blood tests for specific antibodies (anti-SSA and anti-SSB)
• A lip biopsy
• Histopathology (looking at biopsied tissue under the microscope)

Tear production can be assessed with the Schirmer test, which involves gently inserting a small strip of specialized paper between the eye and lower eyelid.

A practitioner will take a look at your symptoms, do a physical exam, and run one or more of these tests in order to diagnose you with Sjögren’s.

In functional medicine, we also want to go beyond the diagnosis and get a better picture of what’s going on within your body that may have led to the development of this autoimmune disorder in the first place— and how it’s affecting you now.

Functional medicine testing may include: 

• Blood testing for different kinds of autoantibodies as well as inflammatory markers like C-reactive protein (CRP)
• Gut microbiome and/or zonulin testing to look for signs of leaky gut, dysbiosis (an imbalance between healthy and pathogenic gut bacteria), yeast overgrowth, and other potential gut issues
• Testing for hormonal imbalances

Risk Factors for Sjögren’s

As with other autoimmune conditions, there is no single cause of Sjögren’s. In most cases, it’s likely a combination of various genetic and environmental factors.

Here are some factors that may lead to an increased risk of Sjögren’s:

• Certain genetic variations
• The presence of another autoimmune connective tissue disorder such as lupus, rheumatoid arthritis, or scleroderma
• The presence of a different kind of autoimmune condition including celiac disease, sarcoidosis, or Hashimoto’s
• Hormonal imbalances
• Gut and/or oral microbiome imbalances (dysbiosis)
• A dysregulated immune system response to a virus such as Epstein-Barr virus (EBV) or hepatitis C

Treatment

Conventional treatment for Sjögren’s syndrome often involves a combination of eye drops or artificial tears for dry eyes, medications like pilocarpine for dry mouth, immunosuppressants like hydroxychloroquine to temper the overactive immune system response, or corticosteroids to reduce inflammation.

In functional medicine, rather than just managing the symptoms and effects of the disease, we also want to address the underlying causes of autoimmunity and inflammation.

Specialized testing, as I mentioned above, can help with identifying these causes and triggers so that we can address them directly.

It’s also important to work on restoring balance to the gut and supporting the health of the gut barrier, which is so often impacted by Sjögren’s. Prebiotics and probiotics (either in food or supplement form or both), combined with a personalized, anti-inflammatory diet, are a good starting point.

In addition to the gut microbiome, supporting the oral microbiome is essential given the effects Sjögren’s can have on the mouth. Tongue scraping, oil pulling, and using natural oral care products are a few things that can help. You can learn more about the oral microbiome in my article here.

Other holistic tools may include natural anti-inflammatory supplements like curcumin and vitamin C, reducing exposure to toxins, and implementing a stress management practice. Omega-3 supplements have also been shown to help reduce inflammation and improve dry eyes. (7)

READ NEXT: Healing Sjogren’s Naturally: Diet & Self Care 

A Whole Person Approach to Autoimmunity

When you’re experiencing nonspecific symptoms like fatigue, digestive issues, dry skin, or a persistent cough, it can be hard to get answers. Unfortunately, Sjögren’s is thought of as “rare” but is more common than you may think— it just goes undiagnosed more than half of the time.

Taking a more holistic, whole person approach to autoimmunity and health in general allows us to understand more clearly what’s going on and work to address the problem from its root.

Whether you’ve been diagnosed with Sjögren’s or are wondering if you might have it, we can help you get to the bottom of what’s going on with your health, and come up with a holistic, functional medicine treatment approach that works for you.

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.