Dry, gritty eyes and a parched mouth are common complaints. As smartphone and computer use has grown, so have the number of people reporting dry eyes. But in middle-aged women, when severe dryness of the eyes and mouth persists for more than three months, it should not be dismissed as simple dryness. It may be a sign of the autoimmune disease "Sjögren's disease."
Sjögren's disease was once called "Sjögren's syndrome," but its name was changed to "Sjögren's disease" through international consensus in 2023. The reasoning is that it is more appropriate to view it not merely as a "syndrome" of clustered symptoms, but as a single disease whose autoantibodies, diagnostic criteria, and pathogenesis have largely been identified.
Appearing on Seoul Economic Daily TV's "Now, the Master Physician" on the 13th, Kwak Seung-ki, a professor of rheumatology at Seoul St. Mary's Hospital, explained, "Autoimmune diseases arise when antibodies that should attack outside germs instead attack one's own body," adding, "Sjögren's disease is one of the representative autoimmune diseases, and it mainly invades the salivary and lacrimal glands." He said, "If extreme dry eyes — severe enough that it's hard to open your eyes — or dry mouth that makes it difficult to swallow food without water persists for more than three months, Sjögren's disease can be suspected."
◇ Dry Eyes and Mouth Are the Hallmark Symptoms of Sjögren's Disease
The hallmark symptoms of Sjögren's disease are dry eyes and dry mouth. The eyes feel rough as if sand has gotten into them, and the mouth becomes so dry it is hard to swallow food without water. However, about half of patients visit the hospital for symptoms other than dryness. Fatigue, muscle pain, joint pain, Raynaud's phenomenon, and salivary gland swelling can appear, and rarely it invades systemic organs such as the lungs, blood vessels, kidneys, and nervous system.
Sjögren's disease is far more common in women. About 90% of patients are women, and it appears especially often in those in their 50s and 60s. For this reason, it is easily confused with menopausal symptoms, since fatigue, muscle pain, and dryness are also common in women around menopause. Professor Kwak said, "Fatigue and muscle pain are very nonspecific symptoms, so they are not easy to distinguish from menopausal symptoms," adding, "If symptoms persist for at least three months and, in particular, dry mouth and dry eyes are both severe, testing should be considered."
◇ Risk of Lung Involvement and Lymphoma
Lung involvement, in particular, is one of the complications patients worry about most. This is because some Sjögren's patients can develop pulmonary fibrosis, in which the lungs harden. However, Professor Kwak stressed that excessive anxiety should be avoided. He said, "Based on domestic data, pulmonary fibrosis is visible on lung CT in about 6% of cases," adding, "Rapid progression is uncommon, and quite a few patients live for 5 or 10 years without major change."
The risk of lymphoma also warrants attention. In some Sjögren's patients, the salivary glands repeatedly swell and subside, and if salivary gland swelling persists for three weeks to over a month, medical attention is needed. Professor Kwak said, "Lymphoma occurring in Sjögren's patients arises most often in the salivary glands," adding, "If the salivary glands remain swollen for a long time, testing is necessary." He added, however, that "compared with ordinary lymphoma, it often progresses relatively slowly, so early detection and follow-up monitoring are important."
◇ Autoantibodies Confirmed by Blood Test; Treatment Eases Symptoms
The most important test in diagnosis is the blood test. It checks for the Sjögren's-specific autoantibodies anti-Ro (SSA) and anti-La (SSB), as well as rheumatoid factor and antinuclear antibodies. Tests measuring tear production, ophthalmic exams checking corneal and conjunctival damage, saliva production tests, and salivary gland function tests are also performed. In some patients with strong suspicion of Sjögren's disease despite normal blood tests, a small salivary gland from inside the lip is removed for a biopsy.
Professor Kwak said, "About 90% of cases show abnormalities on blood tests, and most are diagnosed with blood tests and tear and salivary gland tests," adding, "When a specialist suspects and evaluates it, the diagnosis itself is not a particularly difficult disease."
Sjögren's disease is closer to a chronic condition requiring lifelong management than something that can be cured. Current treatment focuses on controlling individual symptoms such as dry eyes, dry mouth, arthritis, and pulmonary fibrosis. For dry eyes, artificial tears, anti-inflammatory eye drops, autologous serum eye drops, and tear-duct occlusion may be used. For severe dry mouth, drugs that promote saliva secretion, such as pilocarpine (a saliva-secretion stimulant), can help.
Recently, the development of targeted therapies aimed at the cause of Sjögren's disease itself has been active. Professor Kwak said, "Drugs aimed at fundamental treatment, such as antibody therapies that suppress the proliferation of B cells that produce autoantibodies, are undergoing clinical trials," adding, "Some Phase 3 clinical trials have concluded, with approval data submitted to the U.S. FDA and the European EMA, and we expect treatments to emerge going forward."
◇ Dental Care and Regular Checkups Are Important
In daily management, dental care is more important than anything. When saliva decreases, the bacteria that cause cavities become more active, raising the risk of cavities and periodontal disease. Professor Kwak advised, "It is good to brush your teeth properly four times a day — morning, noon, evening, and before bed — and to use dental floss," adding, "Regular dental visits are also necessary."
It is better to drink water frequently in small amounts rather than a lot at once. Beverages that have a diuretic effect or can irritate the mouth, such as coffee, black tea, green tea, and carbonated drinks, are recommended to be reduced. However, Professor Kwak said, "Life needs its pleasures too, so if you really want to drink coffee, it's good to keep it to about one cup a day."
Because of its name, Sjögren's disease may feel like a rare and serious illness, but not all patients develop severe complications. Some patients with mild symptoms take no medication and only monitor their progress through blood tests every six months. However, since other autoimmune diseases such as lupus can rarely accompany it, regular follow-up monitoring is necessary.
Professor Kwak said, "Even without Sjögren's disease, dry eyes or dry mouth can occur as side effects of medication," adding, "Sleeping pills, antidepressants, and antihistamines can cause dry mouth, so the medications you take should also be checked."
He stressed, "Having only dry eyes does not necessarily mean you should worry about Sjögren's disease," while emphasizing, "But if dry mouth persists without a drug cause, and dry eyes also continue severely for more than three months, it's worth getting tested at least once."
The Identity of a Disease That Dries Out Both Eyes and Mouth [Kwak Seung-ki, Professor of Rheumatology, Seoul St. Mary's Hospital]
