GLOSSARY

Oriental%20Lotus_edited.png

The terms listed here are defined in the context of Sjogren’s.

Antibody

A protein produced by a type of B cell lymphocyte, usually in response an infection. Antibodies are also referred to as immunoglobulins such as IgG, IgM, etc.  See also Autoantibodies.

ANA - See Antinuclear Antibody

AIRD - See Autoimmune Rheumatic Disease

Antigen

A substance that can be recognized by the immune system, usually a foreign invader such as a virus or bacterium. If the antigen is part of the body, it is called an autoantigen.

Asymptomatic

A disease or condition is present but there are no obvious symptoms.  

Antinuclear Antibodies (ANA)

Autoantibodies directed against components in the cell nucleus. Blood tests for ANA are almost always positive in SLE and Systemic Sclerosis. ANA is positive in 50-70 % of Sjogren’s patients. ANA is occasionally seen in healthy individuals, or triggered by certain infections or medications.

Autoantibodies

Antibodies that target the body’s own tissue.

Autoantigen

A part of the body that is targeted by an autoantibody (or certain types of T cells).

Autoimmune Rheumatic Disease (AIRD)

An autoimmune disease that is systemic and involves connective tissues, organs and other areas of the body. Sjogren’s is included in this group of diseases, along with rheumatoid arthritis and others. Some AIRDs may not be purely autoimmune. For details, see the blog post, So What is Sjogren’s, Really?

Autoimmune Disease

A type of immune-mediated disease where the body inappropriately produces antibodies against its own tissues. The role that autoantibodies play in Sjogren’s is unclear. Sjogren’s is considered to be an autoimmune disease, although it is probably more precise to call it "immune-mediated." For an explanation, see the blog post, So What is Sjogren’s, Really?

 

Organ-specific autoimmune diseases, such as autoimmune thyroid disease or type I diabetes, attack one specific organ. (The thyroid and the pancreas in these examples)


Systemic autoimmune diseases, such as Sjogren’s and rheumatoid arthritis attack multiple areas of the body.

Autoinflammatory Disease

An immune-mediated disease with no associated autoantibodies. Sjogren’s may have an autoinflammatory component. For details see the blog post, So What is Sjogren’s, Really?  

Biomarkers
A characteristic or indicator, that can be objectively measured. 

Brain Fog

A group of symptoms that describe difficulty thinking. There are many possible causes. The few studies on Sjogren’s patients document cognitive changes, mostly mild, with reduced concentration, memory, and/or executive function. More than 50% of Sjogren’s patients experience brain fog.

Comorbidities

Diseases associated with Sjogren’s but not caused directly by Sjogren’s. Comorbidities are also called "associated diseases" because they occur at higher rates in Sjogren’s patients than in the population as a whole. 

Central Nervous System

The brain and spinal cord

Complications

On Sjogren’s Advocate and in most academic articles, complications refer to direct systemic (non-sicca) disease manifestations of Sjogren’s, not including general systemic features.   

Connective Tissue Disease (CTD)

A broad term for disorders involving tissues that support the organs and other parts of the body. Examples of connective tissue include cartilage, synovium (the joint lining), tendons, ligaments, fat, bone and many of the structures that support the skin. Sjogren’s is considered to be a connective tissue disease, although it also impacts the exocrine glands and many organs and systems. Rheumatologists care for many, but not all, types of CTD.   

Dysautonomia- see this page

Features / Manifestations

Signs and symptoms caused directly by Sjogren’s. On Sjogren’s Advocate, features and manifestations mean the same thing. 

Functional Neurologic Disorder (FND) 

Nervous system (neurological) symptoms that can't be explained by a neurological disease or other medical condition. Many people with undiagnosed conditions, especially SFN, SFPN, and dysautonomia are labeled with FND.

Fibromyalgia

A disorder of chronic, widespread pain and tenderness, fatigue, unrefreshed sleep, and cognitive dysfunction. It is a diagnosis of exclusion; this means that patients should be thoroughly evaluated for other disorders, such as Sjogren’s. If you have Sjogren’s, the fibromyalgia label should be dropped.

To learn more, read this blog post.

General Systemic Features

Core Sjogren’s features such as severe physical fatigue, flu-like malaise, brain fog (difficulty with concentration and memory), widespread body aches, muscle pain and stiffness. General systemic features are often mislabeled fibromyalgia even though they are direct Sjogren’s manifestations. These core features are poorly researched and poorly understood, yet account for the greatest reduction in function and quality of life for most patients. Read more...

Health Related Quality of Life (HRQOL) 

An overall assessment of an individual's or a group's perceived physical and mental wellbeing over time. There are various formal tools that assess HRQOL in individuals and populations.

Immune-Mediated Disease 

This is actually the correct term to use for “the body attacking self” vs. the more commonly used term, “autoimmune”. Immune-mediated diseases include both autoimmune and autoinflammatory processes. Sjogren’s is an immune-mediated disease. For details see the blog post, So What is Sjogren’s, Really? 

Immune System

A complex network of cells, proteins and tissues that defends the body against infection.
The immune system is elaborate and complicated. There are still many unknowns about how the immune system works and why it sometimes turns against the body. 

Lymphoma

A cancer that begins in lymphocytes. Approximately 5-10% of Sjogren’s patients develop Non-Hodgkin B cell lymphoma, typically low grade and curable.

Manifestations / Features

Signs and/or symptoms caused directly by Sjogren’s. On Sjogren’s Advocate, manifestations and features mean the same thing.

ME/CFS

See this link for a description. Many Sjogren’s patients are misdiagnosed with ME/CFS because of symptom overlap. It is possible, although not likely, to have both. It is important to distinguish the two conditions because treatments and exercise recommendations differ.

Morbidity (not to be confused with mortality or comorbidity) 

Refers to illness, or more broadly, any condition that reduces health or wellbeing. It is commonly used to indicate the amount of disease (prevalence) within a population. Morbidities are not deaths.

Examples: 

  • Sjogren’s is associated with a high degree of functional morbidity.

  • Lung disease, arthritis, sicca, and peripheral neuropathies are common Sjogren’s morbidities.

Mortality

In medicine, mortality usually means mortality rate. This describes the number of deaths that occur in a population due to a specific illness or condition.

Multisystem disease

A disease involving more than one organ or system in the body. “System” includes any organ (the skin is also an organ) or body system (such as the nervous system, hematology system).

Nerve conduction studies

These tests evaluate the electrical conduction of the myelinated motor and sensory nerves. Because they do not test for small unmyelinated nerve function, they cannot rule out SFN, SFPN, or dysautonomia.  

Neurologic/neurological

Pertaining to the nervous system, either the central nervous system or the peripheral nervous system.

Peripheral nervous system

The part of the nervous system outside the brain and spinal cord. 

Neuropathy

Disease or dysfunction of the peripheral nervous system.

RF- See Rheumatoid Factor

Rheumatic disease 

Immune-mediated and inflammatory diseases that cause the immune system to attack normal tissues in body, including joints, muscles, bones and organs. Rheumatic diseases are often grouped under the term “arthritis” - which is used to describe over 100 diseases and conditions. Sometimes called rheumatologic disease.

Rheumatoid Factor (RF) 

 An autoantibody present in the blood of most patients with rheumatoid arthritis (RA) and Sjogren's. RF may be detected in some healthy people. A significant number (30-40%) of people with RA and Sjogren’s do not have rheumatoid factor.

Rheumatologist

Rheumatologists are the specialists who are supposed to take the lead in treating Sjogren’s and other rheumatic diseases.
 

"A rheumatologist is an internist or pediatrician who received further training in the diagnosis (detection) and treatment of musculoskeletal disease and systemic autoimmune conditions commonly referred to as rheumatic diseases. These diseases can affect the joints, muscles, and bones causing pain, swelling, stiffness, and deformity." ~ American College of Rheumatology

Seronegative Sjogren's 

In Sjogren’s, this technically refers to SS-A negative patients. Rheumatologists often use the term “seronegative” based their own preferences about which common autoantibodies count as seropositive. Common autoantibodies associated with Sjogren’s include SS-A, ANA, SS-B, and RF.

Many primary care providers use “seronegative” to mean any RF-negative rheumatology patient. This can be very confusing.

Seropositive Sjogren's 

This term is used by researchers and Sjogren's experts to refer to SS-A positive Sjogren’s patients. In the real world, “seropositive” is used much more loosely. Some rheumatologists will call SS-A or SS-B positive patients seropositive. Others will call patients seropositive if they have any of the following:  SS-A, SS-B, ANA, or RF.
 

Many primary care providers are not familiar with Sjogren’s-related autoantibodies, including SS-A. They might use “seropositive” to mean RF-positive Sjogren’s.

SFN - See small fiber neuropathy  

SFPN - See small fiber polyneuropathy  

Sicca Manifestations

Sicca is the part of Sjogren’s that causes dryness, inflammation, and other abnormalities of the exocrine (fluid-secreting) glands in the body, such as tear and saliva glands. While most Sjogren’s patients have sicca, not all of them do. Sjogren’s should never be called “sicca syndrome”.   

Sign(s)

Objective evidence of a disease or condition that is evident upon physical examination or as measured by various tests.   

Sjogren's antibodies: SS-A (anti-Ro) and SS-B (anti-La)

SS-A (anti-Ro) and SS-B (anti-La) have been traditionally called Sjogren’s antibodies. This can be confusing because they may also be seen in other autoimmune rheumatic diseases. SS-A and SS-B are members of the family of antibodies called anti-nuclear antibodies (ANAs)

“Antibodies” in this case actually means autoantibodies. For details, see the blog post So What is Sjogren’s, Really?  

SLE - See Systemic lupus erythematosus

Small fiber neuropathy

Small fibers are the unmyelinated nerves outside the brain and spinal cord that detect sensations and control autonomic functions such as heart rate, blood pressure, bowel motility, sweating, etc. Neuropathy means that these nerves are not working correctly. In SFN, the number of nerve fibers is often reduced on skin biopsy. Sensory neuropathy and autonomic neuropathies often occur together.

Small fiber polyneuropathy

Small fiber neuropathy that impacts widespread areas of the body and a large number of nerves. Because most SFNs impact widespread areas, the term small fiber neuropathy is often used to refer to small fiber polyneuropathy.   

SS-A and SS-B - See Sjogren's antibodies  

Symptom(s)

Subjective experience of the patient which may or may not be associated with signs.   

Systemic lupus erythematosus (SLE)

An autoimmune rheumatic disease closely related to Sjögren’s. Like Sjogren’s,SLE may damage any organ or body system. While these diseases carry similar features, SLE and Sjogren’s each has its own spectrum of clinical manifestations. When they occur together, each disease deserves separate attention and management. 
Read more about why Sjogren’s should never be called “secondary” to SLE or other diseases.

Systemic Manifestations / Features

Any non-sicca disease manifestation caused by Sjogren’s.

In Sjogren’s, the confusing convention is to divide the disease manifestations into two categories: sicca manifestations and systemic (non-sicca) manifestations. This may seem illogical and contradictory because the word “systemic” in medicine usually describes something that impacts multiple areas of the body and sicca impacts multiple exocrine glands in the body. Even so, in Sjogren’s, sicca is not considered systemic.

 

Many rheumatologists will tell their patients that they just have sicca disease. This is not correct because non-sicca (systemic) manifestations can be found in almost every Sjogren's patient.   Read more…  

Updated 06-22-21