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Do I Have Sjögrens?

If your eyes feel gritty and you need to blink more than you used to, if you need more drinks of water through the day because your mouth feels like a desert, and/or your skin feels dry itchy, burning, cracked; if you feel a profound fatigue most of the time, it’s a possibility. You needn’t have all, or even most of these symptoms; One or more can lead your doctor to a diagnosis. The trouble is that in the early stages, the symptoms come and go and are often non-specific, until later when the disorder becomes acute. Some symptoms of Sjögrens are:

  • Dizziness
  • Tiredness
  • Generally ill with low-grade fever
  • Itching, gritty eyes
  • Difficulty swallowing
  • Loss of sense of taste
  • Severe dental cavities
  • Hoarseness
  • Joint pain or swelling
  • Swollen glands

In spite of the fact that Sjögrens (Sjs) is the cause of suffering for 4 to 5 million Americans, it is not on the tip of all Doctor’s tongues, If your doctor evades your questions and you think that Sjs could be the cause of your troubles, keep looking for a Doctor who has others like you in their practice. Then, the necessary tests to make an objective diagnosis can be performed.  Check out our Resources Page for a list of institutions where you can get more information.  And remember, the earlier you have this checked out by your Doctor, the better.

Below, you can find some of the most recent questions answered by Dr. Carteron, you can find more by searching the menu on the far right. Questions and Answers are organized by topic, or you can ask Dr. Carteron a question by visiting this page.


Sneezing

Q:  I just have gotten a diagnosis of Sjogrens, I can not stop sneezing! I have MCTD, also.The Sjogrens has been in a flare. had the sneezing before the Medication, so do not think it is related to that. I sometimes sneeze for hours at a time. My nose is very stuffy also. I hope this is not a stupid question! thank you. A:  Sneezing is primarily associated with allergic reactions to some environmental antigen, or part of the early stages of a viral upper respiratory infection. The dry nasal passages than can occur in some Sjs patient's can cause crusting and affect air flow. In my experience, sneezing is not a common complaint of Sjs pts. However, Allergies/Allergic responses seem to be more common in Sjogren's than in other autoimmune diseases, like SLE. An ENT/Allergist could help you understand what is happening if it persists. Antihistamine allergy medications can be drying and thus make Sjogren's dryness worse. dr c  Read More →


All those Symptoms...Again

Q:  I have an unspecified autoimmune sero-negative disease. I have been to 3 rheumatologists(had to change because of insurance) and several orthopedic specialists for individual joint issues.. I started Restasis in December and found nodules in what I remember as being my submandibular glands a few years back. I asked my dentist and Endocrinologist (I have thyroid nodules and parathyroid level of 104 with no parathyroid growth) about them but neither seemed concerned.With all of these issues plus dry mouth, dry skin, recent hair loss, constant joint pain, documented joint damage, and fatigue plus Meniere's, could I assume that Sjogren's is the primary issue or could it be a group of unrelated ones? I am taking amtriptyline for sleep and triamterine for the Meniere's. The opthalmalogist who prescribed restasis reviewed my medication list, in fact all the doctors are aware of the varying symptoms.I take plaquinil for the arthritis. As you can see I am dealing with a bunch of symptoms, none... Read More →


"Flitting" Joint Pain or Arthralgias

Q:  Hi Dr. Carteron, I have been struggling for some years to obtain a diagnosis for the collection of symptoms I have. Eventually finding details of Sjogren's I find the closest match so far. As one of my symptoms is "flitting" joint pain, my doctor has in the past ordered tests for rheumatoid arthritis but these have returned negative. My question is, does that negative result rule out Sjogren's too? Would you expect to see anything on such a test if I have Sjogren's? Kind regards A:  "Flitting" joint pain could be joint pain without obvious inflammation or synovitis. Arthralgia (joint pain) could involve the same joints with each episode or the joint pain could move around (migratory arthralgia). Joint pain can be a part of Sjogren's.  Series often report about 50% of Sjs pts having Arthralgias. One report below from Denmark, found 70% of pts had Arthralgias, with only 17% having Arthritis (itis=inflammation). So a negative RF (rheumatoid factor), negative CCPAb, and normal inflammatory... Read More →


Tearing Muscles in Sjs??? Enthesitis?

Q:  Hi Dr Carteron My doctors still haven't made a definitive diagnosis but believe all my symptoms point to Sjogrens and/or RA. I use to play a lot of tennis but over the last 2 years started to constantly tear muscles keeping me out of the game. About 6 months ago the my hand joints started swelling and aching, my eyes became so dry, painful and very sensitive to light. Followed by more joints being affected and constant fatigue. My question is could the muscle tears be caused by Sjogren's. Thanks for your time A:  If some of the same inflammation you are describing elsewhere was occurring at the site of muscle/ligament/tendon insertion on bone, it is plausible there is a relationship. Generally, muscle involvement with Sjogren's is a myalgia (muscle pain), and MUCH less commonly a low-grade myositis (muscle inflammation). However, since Sjs can overlap with alot of other autoimmune processes, the possibilities are larger, rather than smaller. Seems to be a small subset of Sjs patients... Read More →


CCPAbs and Sjogren's

Hi Dr. Carteron, Q:  In early 2011 I had a positive ANA test and subsequently tested positive for SSB, after two years of increasingly severe fatigue and joint pain (bilateral with morning stiffness), mild dry eye and mouth, dizzy spells and brain fog, and occasional parotid pain with mild swelling. I was referred to a rheumatologist, whom I saw in July. After running her own tests on me, I was negative for ANA and positive CCP. She told me that I had RA with probable secondary Sjogren's. She prescribed hydroxychloroquinine 400 mg. Around the same time I also stopped eating gluten, as I discovered an intolerance through an elimination diet. I spent most of the following year abroad. While there, I went to se another rheumatologist who said that I did not have RA - maybe Sjogren's. Almost exactly six months after starting Plaquenil, I suddenly felt much better in terms of fatique and general wellbeing. My joint pain subsided more gradually but seem to have mostly resolved at this point.... Read More →


Patient Concern Sjs Diagnosis is Not Correct

Q:  I was diagnosed with Sjogrens on March 1, 2013.  My most distressing symptoms are fatigue and joint and muscle pain.  I do not have dry eye, though I do have blepharitis.  My nose runs a lot, and then my eyes run also, leaving a burning sensation, and I have to wipe the wetness away.  My mouth is only dry in the morning because I am a mouth breather when I sleep.  My diagnosis was based on blood work.  My rheumatologist told me the results showed I definitely have Sjogrens and connective tissue disease.  How common is Sjogrens in people who do not really have sicca symptoms?  I am concerned that my diagnosis isn't correct. Thank you. A: We have a recent diagnosis of Sjs in 3.2013. Symptoms include: Fatigue, Joint pain, Muscle pain, Blepharitis, runny nose, eye "irritation" symptoms, morning dry mouth (but notes mouth breathing). Pt does NOT feel she has Dry Eye or Dry Mouth. Dx'd w/ Sjogren's and Connective Tissue Disease (CTD). But we don't know any labs or if any objective... Read More →


Challenges of Diagnosis that Fits

Q:  I am a 58 year old women that was diagnose with sjogrens at the University of Chicago in 2009 thru a lip biopsy and a high titer which was 320 but the SSA/SSB was negative.  I do have dry eyes, dry mouth, dry skin cracks easily and lightheadedness.  I do not have fatigue.  I did go to the John Hopkins Sjogrens Center and the Rheum. Doctor looked at my lip biopsy and told me that my lip biopsy did not look like the average lip biopsy and my eye examine did not look bad.  I did have blood work done at the John Hopkins Sjogrens Center and the test reveal that my titer was only 140 with a negative SSA/SSB, normal pooling of saliva under the tongue, no enlargement of the salivary glands, eye exam showed deficient tear production the schirmer test of tear production showed 13 mm wetting in the right eye and 10 mm in the left eye, there was mild ocular surface staining.  My total protein was elevated (8.6) my eosinophil absolute was 0.04 and my antinuclear antibody scr. was positive.... Read More →


Sjogren's Clinics in North Carolina

Q:  diagnosed March 2013 - after many yrs of symptons - can sjogrens cause pressure headaches, fogginess and of course I have fatigue - pain in my left side of neck, behind ear and in jaw line = no fun have had 3 back surgeries so neuropathy I have already but now so many other symptons showing up do you know of any dr at Duke or UNC Medical @ Chapel Hill that specializes in Sjogrens?  Thank you A:  Sjogren's Clinics in North Carolina: Duke Medical Center. www.dukehealth.org  888.275.3853  Sjogren's Clinic    Durham, NC William St Clair MD Carolinas Medical Center.  www.carolinashealthcare.org    704.355.2000. Oral and Maxillofacial Surgery Clinic, Oral Medicine Division     Charlotte, NC Michael Brennan DDS  MHS dr c  Read More →


Diagnosed with Sjs in Your 20's

Q:  Hi! I was diagnosed with Sjogren's in April, from checking ANA because I've been struggling with joint pain. I've had dry eyes and mouth, extreme fatigue, dry skin, flu like symptoms, etc for about 2 years. I am ony 21 years old, and have many concerns. The symptom that really takes a toll on me is dry eyes, which I plan on seeing an ophthalmologist next week, since Salagen and artificial tears have done nothing for me. Also, fatigue is the symptom that bothers me most and for being 21, it's really taking a toll on my everyday life. Do you have any recommendations to help with fatigue? Also, I am kind of scared as what the future may hold, having Shogren's at such a young age. I'd really appreciate any insight. A:  Find a good healthcare team to assist you in your journey, educate yourself through ways that best work for you (www.sjogrens.org, support groups in person/online, blogs, books etc). Design a master plan for you. Work the plan...keep what works, and what does not put on... Read More →


Fatigue - # 1 Complaint of Many Sjs'ers

Hello Dr. Carteron, I have SS and was diagnosed about 7 years ago. He also diagnosed me with Fibromyalgia. (I also have Celiac and have had hyperthyroid and adrenal insufficiency in the past.) I am in a much better state of health than I was 7 years ago and I am still figuring things out. It's a constant adjustment as I age, my stressors change, etc. But I am contacting you in response to seeing you speak in a video about SS and wondered if you might be a good person to help me at my current stage. Basically where I am stumped is being able to tell the difference between my SS and FMS fatigue and other symptoms. The faitigue is most prominent at this point. I like the doctors I have now and have a good healer, nutritionist and chiropractor. They all understand  and support me, but not one person can really put all my issues together very well. Do you think you could address my desire to find a doctor to help sort out my multiple auto-immune issues? Q: Sorting through the components of... Read More →




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