Sjögren’s disease is often more complicated than it appears on the surface. It goes beyond dry eyes and dry mouth because immune system dysfunction, inflammation, and other factors can affect your overall health and contribute to related conditions. Previously called Sjögren’s syndrome, Sjögren’s disease is an autoimmune disease, meaning the immune system mistakenly attacks healthy tissue. It mainly affects glands that produce moisture, which can lead to symptoms like dry eyes and dry mouth.

This article will teach you about conditions commonly associated with Sjögren’s disease and how they’re connected.

Autoimmune Diseases and Sjögren’s Disease

Having another autoimmune disease alongside Sjögren’s disease isn’t uncommon. It's estimated that around 25 percent of people with one autoimmune disease will develop another. Having two autoimmune diseases is called polyautoimmunity, while having three or more is called multiple autoimmune syndrome (MAS).

Many people with Sjögren’s disease have polyautoimmunity or MAS, especially with the following autoimmune diseases.

1. Rheumatoid Arthritis

In people with rheumatoid arthritis (RA), the immune system attacks the linings of the joints and eventually damages the bones within. Joints become swollen and painful, often occurring with stiffness after periods of rest. Some people also experience infection-like symptoms like fatigue and fever during RA flares.

Roughly half of people with Sjögren’s disease also have rheumatoid arthritis or another connective tissue disease, such as systemic lupus erythematosus (SLE). RA is common in people with Sjögren’s disease because both conditions are systemic autoimmune rheumatic diseases (SARDs). This means they can cause widespread issues in multiple areas of your body stemming from uncontrolled immune system activity.

2. Lupus

Systemic lupus erythematosus (SLE), the most common form of lupus, is another systemic autoimmune condition that commonly appears alongside Sjögren’s disease. In SLE, the immune system can attack many parts of the body. Many people with lupus have skin symptoms, such as a butterfly-shaped rash across the nose and cheeks, along with joint pain or fatigue. Lupus symptoms can differ greatly from person to person. There is overlap between the antibodies seen in lupus and Sjögren’s disease. It is best to speak with your rheumatologist to identify whether Sjögren’s symptoms are present or if all the symptoms are due to lupus.

Like RA and Sjögren’s, lupus is an SARD that often clusters with other SARDs. These conditions aren’t curable, so you’ll need to manage them long term. In treating these conditions, doctors aim to reduce the abnormal immune system activity to lessen symptoms.

3. Hashimoto’s Thyroiditis

Hashimoto’s thyroiditis is an autoimmune disease affecting the thyroid gland. Your thyroid is a hormone-producing gland at the base of your neck. If you have Hashimoto’s thyroiditis, your immune system attacks the hormone-producing cells of the thyroid, which can lead to hypothyroidism (too few thyroid hormones).

Hypothyroidism can cause many symptoms, including some that overlap with common symptoms of Sjögren’s disease. Hypothyroidism from Hashimoto’s thyroiditis can occur with:

• Skin dryness
• Sensitivity to cold temperatures
• Muscle pain
• Brain fog
• Hair loss
• Joint pain
• Weight gain
• Fatigue

Like the other conditions in this section, Hashimoto’s disease is an autoimmune disease that commonly occurs with others.

Sjögren’s disease is connected with autoimmune thyroid diseases. One study concluded that Sjögren’s disease and autoimmune thyroid diseases are the most frequent coexisting autoimmune disorders. Researchers aren’t certain of the exact connections between Sjögren’s disease and autoimmune thyroid diseases, but they believe both conditions may share similar genetic causes.

Other Conditions Associated With Sjögren’s Disease

Sjögren’s disease isn’t only associated with other autoimmune diseases. People with Sjögren’s disease are also more likely to have several other diseases and conditions that don’t stem from immune system dysfunction.

4. Fibromyalgia

Fibromyalgia is a chronic (long-term) condition with causes that aren’t well understood. It tends to occur with widespread pain, sleep issues, and fatigue. Several common fibromyalgia symptoms are also prevalent in Sjögren’s disease, including fatigue, dry eyes, and dry mouth.

While fibromyalgia isn’t an autoimmune condition itself, people with autoimmune diseases are at a higher risk of having it than people without autoimmune diseases. Fibromyalgia can also increase the severity of co-occurring autoimmune diseases.

Specialists believe fibromyalgia and Sjögren’s disease have a bidirectional relationship, which means each condition can contribute to the other. The two conditions have potential connections in the immune system, as fibromyalgia and Sjögren’s disease both involve imbalances in proinflammatory cytokines (protein messengers) in the immune system.

Fibromyalgia and Sjögren’s disease also share some risk factors like insomnia. Still, the connections between fibromyalgia and Sjögren’s aren’t fully understood, and specialists continue to research their similarities and shared underlying causes.

5. Lymphoma

Complications of Sjögren’s disease can affect the lymph nodes, which causes a small percentage of people living with Sjögren’s to develop lymphoma (cancer of the lymphatic system, which is responsible for balancing fluids in your body).

People with Sjögren’s disease are six to nine times more likely to develop a specific type of lymphoma called non-Hodgkin lymphoma than people who don’t have Sjögren’s. Non-Hodgkin lymphoma affects lymphocytes (white blood cells), which are part of the immune system. This cancer is typically slow-growing and can cause early symptoms like enlarged lymph nodes and unintentional weight loss.

Lymphocytes are the main connection between non-Hodgkin lymphoma and Sjögren’s disease. Non-Hodgkin lymphoma causes you to produce too many lymphocytes, while Sjögren’s disease causes your lymphocytes to be overactive. These overactive lymphocytes cause inflammation that damages the lymph nodes, which increases the likelihood of developing lymphoma.

6. Hypertension

Hypertension (high blood pressure) affects people with Sjögren’s disease at higher rates. People with Sjögren’s disease are at an increased risk for cardiovascular diseases in general, which include conditions that make it harder for your heart to pump oxygenated blood through your body. Cardiovascular diseases and their complications are the leading causes of death in people with Sjögren’s disease.

Hypertension doesn’t usually cause symptoms of its own, but it can put people with Sjögren’s disease at a significantly higher risk of life-threatening events such as stroke. Managing hypertension can reduce the risk of heart-related complications like stroke and heart failure.

Researchers believe the connection between Sjögren’s and hypertension boils down to high levels of serum uric acid, or uric acid in the blood. High levels of uric acid form crystals in the urinary system, which triggers inflammation in the blood vessels and makes them narrower. This increases the pressure of blood against the inner walls of your blood vessels.

7. Yeast Infections

People with Sjögren’s disease tend to get more infections than other people, including thrush. Also called oral candidiasis, oral thrush is a fungal infection affecting the mouth. In people with Sjögren’s disease, thrush stems from dry mouth and causes unusual symptoms like redness, irritation, and deeper grooves in the tongue. People without Sjögren’s disease are more likely to experience a white cottage cheese-like thrush infection.

People with autoimmune diseases like Sjögren’s disease are often at an increased risk of infections (including bacterial, fungal, and viral infections) in general because they take immunosuppressants, or medications that reduce immune system activity. Your immune system normally works to prevent infections, but when it’s suppressed by medication, it’s less able to fight infection-causing germs.

Less Common Conditions Associated With Sjögren’s Disease

The conditions listed above aren’t the only conditions you may have with Sjögren’s disease. Other, less common comorbidities (conditions you have alongside Sjögren’s) can include:

• Lung infections and conditions (including pneumonia, bronchitis, and interstitial lung disease)
• Liver conditions (including hepatitis and cirrhosis)
• Kidney diseases (including tubulointerstitial nephritis)
• Irritable bowel syndrome (IBS)
• Other autoimmune diseases

Talk to Your Doctor

Your doctor or rheumatologist can help you manage Sjögren’s disease and any conditions you have with it to reduce the impact on your quality of life.

If you think you might have an overlapping condition with Sjögren’s that hasn’t been diagnosed yet, be sure to keep a record of your symptoms to bring to your healthcare provider. Your rheumatologist might choose to monitor you for other conditions with routine blood tests, including rheumatoid factor (RF) blood tests and complement levels (C3 and C4).

Early detection of Sjögren’s comorbidities can help guide your Sjögren’s disease treatment, as some conditions can affect treatment decisions for others you have.

Join the Conversation

On MySjögrensTeam, people share their experiences with Sjögren’s disease, get advice, and find support from others who understand.

Do you have any co-occurring conditions associated with your Sjögren’s disease? Let others know in the comments below.