Signs and Symptoms
Sjogren’s is much more than dry eyes and dry mouth. Most patients experience a number of systemic features. Flu-like fatigue, “brain fog,” joint pain, muscle pain and stiffness are very common. Some researchers label these features “benign manifestations.” This inappropriate term downplays the huge impact that these systemic symptoms have on daily function and quality of life.
Serious complications such as organ involvement and lymphoma occur in a significant number of patients.
Sjogren’s also frequently impacts the nervous system. Peripheral neuropathies and autonomic neuropathies are common and often overlooked until they become severe.
There is a wide range of overall disease severity among patients. Even if symptoms are fairly mild, it is still important to reduce the risk of complications and progression. This will be discussed in the Treatment and Monitoring section.
The purpose of this section will be to dive deeper into how the many features of Sjogren's need attention in the clinical setting. There are still huge gaps in basic knowledge. One of the most important gaps is the poor understanding of fatigue and brain fog. Little research attention has been given to these life-changing symptoms. Other features, such as sicca manifestations, are better researched and have many treatment options.
The most common presentation is thought to be some version of the “Sjogren’s Triad”- fatigue, pain and dryness. Understanding other common early presentations could lead to more timely diagnosis. Long delays after first symptom onset are the norm. Common presenting complaints and Red flags are described in the PCPs-Steps to Diagnosis section.
Some Sjogren’s manifestations are detected by routine tests rather than by symptoms. A few examples include:
Abnormalities of kidney function occur in up to 50 % of Sjogren's patients. This often occurs without any signs or symptoms. (10) Abnormal electrolytes, especially low blood potassium, may signal changes in kidney function. The typical milder versions of kidney involvement usually don’t require treatment, but need to be monitored. Progressive kidney disease occurs in about 5 % of patients.
Immunological changes such as hypergammaglobulinemia (high IgG) may be found on blood tests. This is often first noticed because it causes a very high ESR.
Hematological changes may include low white blood count, low platelet count or anemia. A rare but serious hematologic complication is autoimmune hemolytic anemia.
Autonomic neuropathy. When this impacts the cardiovascular system, fatigue and dizziness are common. Patients may have rapid heart rates, especially with prolonged standing. Some have low blood pressure. These signs are often misattributed to anxiety, autoimmune fatigue or de-conditioning. This is unfortunate, because helpful treatments are available for POTS and other cardiovascular dysautonomias.
These four features are just a few examples of the many systemic manifestations that can occur in Sjogren’s.
Comorbidities will also be discussed. These are not direct Sjogren’s manifestations, but diseases and conditions that occur at higher rates in Sjogren’s patients. It is important for PCPs and non-rheumatology specialists to be aware of comorbidities. They call for increased monitoring to allow for early intervention. When possible, preventive measures should be taken.