Sjogren's Syndrome and Lupus Sjogren’s can sometimes be a multi-system illness involving the lungs, kidney, brain and nervous system, but much more commonly it just involves the tear glands and salivary glands. Sjögren’s syndrome frequently causes dry eyes and dry mouth when tear glands and salivary glands that supply the tears and saliva become inflamed. The patient’s own white blood cells attack the glands, disabling them. Dry eyes may also result from autoimmune attack on the tear glands as part of Sjogren’s syndrome. Sometimes in Sjögren’s syndrome the parotid gland at the base of the jaw becomes swollen, almost like the mumps, but the change is usually on one side only. Systemic lupus is commonly a multi-system illness that may affect the skin, joints and other organs. Though lupus may be mild, in general there is less potential threat to the organs in Sjögren’s syndrome than in lupus. To complicate things, some patients have both Sjögren’s and lupus. When Sjögren’s syndrome does become systemic and infect organs, it is treated similarly to lupus. Steroids and Plaquenil can be given and occasionally immune-suppressing agents such as Imuran or even Cytoxan are used to suppress disease activity. The finding of dry eyes can be documented by placing a piece of filter paper in the lower eyelid for five minutes. Less than 8mm of wetness is consistent with Sjögren’s. People with Sjögren’s experience a gritty or sandy sensation in the eye and there may be an accumulation of mucus in the inner portion of the eyelid on awakening. The eyes can sometimes be red and reading or watching television can occasionally be difficult. People with Sjögren’s ingest a lot of fluids because of dry mouth. They have a difficult time eating food like crackers without extra fluid. Dental cavities and loose fillings are common. People with Sjögren’s may experience dryness of skin, nose, vagina, larynx, and bronchial tubes. The treatment for Sjögren’s syndrome is related to reducing dryness. Artificial tears applied frequently or through a plastic reservoir called Lacriserts may help. Ointment applied to the eyes at night may increase lubrication. Saliva stimulants such as Salagen and Evoxac tablets may increase moisture. Artificial saliva preparations including Salvart, or sugar-free candy or gum may also help. A surgical treatment called punctal occlusion seals the tear drainage system. Then tears are retained and eventually lost by evaporation. It is wise to do a temporary punctal procedure before a permanent occlusion, because some people may have excessive tearing after the procedure. Artificial tear preparations vary in viscosity, preservatives and salt content. If they burn when they are installed in the eye or if there is blurring of vision, then a different preparation should be used. Sometimes the burning is from the preservative or the salt content. Several types of preservative-free artificial tears have been developed, and these are described in the ingredients section, or your pharmacist can help you select one. Sjögren’s syndrome is different from lupus in that it is not generally associated with sun sensitivityor, Raynaud’s phenomenon, chest pain with deep breathing or facial rash. Rather, these tend to be manifestations of lupus. The blood picture is also different. Lupus and Sjögren’s syndrome share antinuclear antibodies but lupus patients also tend to have anti-DNA antibodies. Sjögren’s syndrome patients will often, test positively for SS-A and SS-B antibodies. Complement, including the C3 and C4 proteins, may be low in lupus when it is active, but generally are normal with Sjögren’s syndrome. There are certain immunological similarities and sharing of symptoms between Sjögren’s syndrome and lupus. But Sjögren’s syndrome tends to be more limited and confined to the tear glands and salivary glands. Treatment to help the symptoms is available. An accurate diagnosis can be established by a rheumatologist or an ophthalmologist. Source: Robert S. Katz, M.D.