An important part of Sjogren's.
While Sjogren's is far more than a dryness (sicca) disease, sicca features are extremely important. While not every Sjogren's patient has sicca, the vast majority do,or eventually will. Ongoing clinical management can prevent serious outcomes such as severe dental caries, loss of teeth, visual impairment, or even blindness. Sicca is not limited to dry eyes and dry mouth. Fluid secreting (exocrine) glands in the nose, throat, sinuses, airways, GI tract, pancreas, vagina, or skin may also be part of sicca.
Sicca features are often referred to as Glandular features. This is why the term "Extraglandular Manifestatons" (EGMs) is often used to describe systemic features. It is important to know that rheumatologists define EGM differently. See the Sjogren's is Always Systemic page for the varied use of this term, and why this can be so confusing.
Sicca, or glandular features, should not be confused with the glandular domain of the ESSDAI, which is a category of systemic disease, and not caused by dryness. The glandular domain refers to enlargement of the major salivary gland tissue, typically the parotid glands.
Sjogren's Advocate focuses on systemic features because they tend to be neglected. This is not meant to downplay sicca, but to suggest that readers check out the excellent information and resources on the Sjogren's Foundation website.
Glandular Features (Sicca)
Sicca / dryness is present in the vast majority of diagnosed patients. However, 20%, and possibly more, do not have sicca when they first present (2). Even when sicca symptoms predominate, there is much more going on in the body.
The actual prevalence of clinically apparent sicca is unclear because Sjogren’s is rarely diagnosed in the early stages of disease.
Sicca is often, but not always, the first sign of Sjogren's. Because dryness tends to come on slowly, patients may not think that these symptoms are important. Sometimes they don't notice the dryness, especially early on. Changes on dental and eye exam occur long after damage to the exocrine glands has started. Even when dryness is clinically obvious, lack of awareness by eye and dental providers frequently results in missed opportunities for timely diagnosis. Ophthalmologists treating dry eye disease often fail to consider Sjogren’s as a possible cause (34, 35).
Sjogren’s is more than dryness, but even sicca symptoms are “more than dry.” Local inflammation, neuropathic pain, and changes in tear and saliva composition may all contribute to symptoms. Many good treatments are available for eye and oral sicca manifestations. All dentists and eye doctors should be familiar with the oral and ocular (eye) Clinical Practice Guidelines, available at the Sjogren's Foundation website.