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Health condition · Clinically reviewed

Sjögren’s syndrome, autoimmune dry eyes and mouth — with systemic features.

A chronic autoimmune disease of the exocrine glands. Dryness is what patients notice first; extra-glandular disease and lymphoma risk are what matters long-term.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Every claim is checked against NICE, EULAR or peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects current UK guidance on Sjögren’s diagnosis, symptomatic care and systemic treatment.

Key facts

Sjögren’s syndrome at a glance.

The essentials, in plain English — what Sjögren’s is, how it is diagnosed, and how it is managed in the UK today.

  • Definition

    Chronic autoimmune sialadenitis — lymphocytic infiltration of the salivary and lacrimal glands causing progressive dryness.

  • Primary vs secondary

    Primary Sjögren’s occurs on its own; secondary Sjögren’s coexists with another autoimmune disease such as RA or SLE.

  • Autoantibodies

    Anti-Ro/SS-A and anti-La/SS-B are the classic serological markers, alongside a positive ANA and rheumatoid factor.

  • Objective testing

    The Schirmer test and unstimulated whole salivary flow measure gland function objectively — not just symptoms.

  • Extra-glandular disease

    Sjögren’s can involve the lungs, kidneys and peripheral nerves — it is not only a dry-eye and dry-mouth condition.

  • Lymphoma risk

    Sjögren’s carries an increased lifetime risk of B-cell lymphoma, most commonly parotid MALT lymphoma — persistent gland swelling needs review.

Why this guide matters

More than just dryness.

Sjögren’s is often dismissed as a nuisance condition of dry eyes and mouth — but extra-glandular disease and lymphoma risk make specialist monitoring essential.

  • Symptoms are only half the picture

    Objective tests and autoantibodies distinguish Sjögren’s from age-related dryness or medication side effects.

  • Systemic disease drives risk

    Lung, kidney and nerve involvement change management — every patient needs a systems review.

  • Lymphoma surveillance matters

    Persistent gland swelling or lymphadenopathy needs urgent work-up — early detection changes outcomes.

How the diagnosis is made

From persistent dryness to a clear diagnosis.

The steps a UK GP and rheumatology team will normally follow, in order — so you know what to expect and why.

  1. 01

    Recognising

    Symptom and medication history

    Dry eyes and dry mouth over months, with a careful review of medicines that can cause dryness (antihistamines, antidepressants, diuretics).

  2. 02

    Recognising

    Schirmer test

    A calibrated strip measures tear production over five minutes — an objective test for reduced lacrimal flow.

  3. 03

    Recognising

    Salivary flow (unstimulated whole saliva)

    Measuring saliva production over a timed period quantifies xerostomia beyond patient report.

  4. 04

    Confirming

    Bloods (anti-Ro, anti-La, ANA, RF)

    Autoantibody panel — anti-Ro/SS-A and anti-La/SS-B are highly suggestive when positive.

  5. 05

    Confirming

    Salivary gland ultrasound

    Ultrasound of the parotid and submandibular glands looks for the characteristic hypoechoic changes.

  6. 06

    Confirming

    Minor salivary gland biopsy (if uncertain)

    A small lip-gland biopsy showing focal lymphocytic sialadenitis confirms the diagnosis when serology is negative.

  7. 07

    Specialist

    Rheumatology consultation

    Specialist review coordinates monitoring for extra-glandular disease and lymphoma surveillance.

Typical timeline: 6–12 weeks from first appointment to a confirmed diagnosis and management plan.

Symptoms

What Sjögren’s syndrome actually feels like.

Dry eyes and dry mouth are the calling cards — but joint pain, fatigue and systemic features often matter more day-to-day.

  • Dry gritty eyes

    Persistent burning, sandy or foreign-body sensation — worse in wind, air-conditioning or after screen use.

  • Dry mouth (xerostomia)

    Difficulty swallowing dry food, needing sips of water to speak, and accelerated dental decay.

  • Joint pain

    Symmetrical small-joint arthralgia, often without frank swelling — commonly hands and wrists.

  • Fatigue

    A profound systemic tiredness that is one of the most disabling features of the disease.

  • Peripheral neuropathy

    Numbness, tingling or burning in the hands and feet — small-fibre and sensory neuropathies are common.

  • Interstitial lung disease

    Dry cough or breathlessness on exertion — needs pulmonary function tests and high-resolution CT.

  • Cutaneous vasculitis

    Palpable purpura on the lower legs — a marker of systemic vasculitic disease that needs urgent review.

  • Red flag

    Persistent parotid swelling or lymphadenopathy — needs urgent work-up for MALT lymphoma.

Treatment

How Sjögren’s syndrome is treated in the UK.

A layered approach: symptomatic care for dryness first, then immunomodulation and biologics reserved for systemic disease.

  • Artificial tears (preservative-free)

    The mainstay of ocular symptom control — preservative-free drops used frequently through the day.

  • Punctal plugs

    Small silicone plugs occlude the tear-drainage ducts, conserving natural and artificial tears on the ocular surface.

  • Saliva substitutes

    Sprays, gels and lozenges provide symptomatic relief when residual saliva production is low.

  • Pilocarpine or cevimeline

    Muscarinic agonists stimulate residual glandular tissue to increase saliva and tear production.

  • Dental prevention

    Regular hygienist visits, fluoride toothpaste and sugar-free chewing gum reduce the sharp rise in caries risk.

  • Hydroxychloroquine for joint pain

    An immunomodulator that helps arthralgia and fatigue in a subset of patients.

  • Systemic immunosuppression

    Methotrexate, azathioprine or mycophenolate for significant extra-glandular disease (lung, kidney, nerve).

  • Rituximab (specific severe cases)

    A B-cell-depleting biologic reserved for severe systemic disease not controlled by other therapies.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or rheumatology team knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE CKS. Sjögren’s syndrome.

  • British Society for Rheumatology. Guidelines library.

  • EULAR. Recommendations for the management of Sjögren’s syndrome.

  • British Sjögren’s Syndrome Association. Patient information.

Red flags

When Sjögren’s becomes urgent.

Sjögren’s is usually a slow chronic disease — but these situations need same-day or urgent specialist attention.

  • Parotid swelling or lymphadenopathy

    Persistent or asymmetric gland swelling — needs urgent work-up for MALT lymphoma.

  • Interstitial lung disease

    New or progressive breathlessness or dry cough — arrange pulmonary function tests and HRCT.

  • Renal tubular acidosis

    Muscle weakness, kidney stones or unexplained low potassium — bloods and urinary pH needed.

  • Neonatal congenital heart block

    Anti-Ro positive pregnancy — needs specialist fetal cardiac monitoring from 16 weeks.

  • Peripheral neuropathy progression

    New numbness, weakness or gait instability — urgent neurology assessment.

  • Severe corneal damage

    Acute pain, photophobia or vision change — same-day ophthalmology review.

  • Systemic vasculitis

    Palpable purpura, skin ulcers or mononeuritis multiplex — urgent rheumatology review.

  • Post-immunosuppression infection

    Fever, night sweats or new cough on immunosuppressive therapy — contact your team.

  • Pregnancy planning

    Anti-Ro or anti-La antibodies change antenatal monitoring — plan ahead with your team.

Living with it

A long-term condition, but a very manageable one.

Four things that make the biggest difference day to day — eye care, mouth care, pacing for fatigue, and regular reviews.

A quiet reminder

Consistency beats intensity, every time.

Small, steady changes — kept up for months — do more than a heroic week that does not last.

  1. 01 Eye care

    Little and often

    Preservative-free drops used through the day work better than occasional heavy use.

  2. 02 Mouth care

    Dentist every 3–6 months

    Reduced saliva accelerates decay — a preventive dental plan is non-negotiable.

  3. 03 Fatigue

    Pace, do not push

    Structured pacing, sleep hygiene and gentle exercise help more than pushing through.

  4. 04 Reviews

    Annual specialist review

    Regular checks monitor for extra-glandular disease and screen for lymphoma risk factors.

Frequently asked

Everything we get asked about Sjögren’s syndrome.

Quick answers on diagnosis, autoantibodies, treatment options, lymphoma risk and pregnancy planning.

  • What is Sjögren’s syndrome?

    Sjögren’s syndrome is a chronic autoimmune disease in which the immune system attacks the exocrine glands — mainly the salivary and lacrimal glands — causing dry eyes, dry mouth and a range of systemic features.

  • How is Sjögren’s diagnosed?

    Diagnosis combines symptom history, objective tests of tear and saliva production (Schirmer test and salivary flow), autoantibody bloods (anti-Ro/SS-A and anti-La/SS-B), salivary gland ultrasound and, if needed, a minor salivary gland biopsy.

  • What is the difference between primary and secondary Sjögren’s?

    Primary Sjögren’s occurs on its own. Secondary Sjögren’s coexists with another autoimmune disease such as rheumatoid arthritis, systemic lupus erythematosus or systemic sclerosis.

  • Why does Sjögren’s carry a lymphoma risk?

    Chronic B-cell stimulation in the salivary glands can, over years, evolve into a mucosa-associated lymphoid tissue (MALT) lymphoma. Persistent parotid swelling or lymphadenopathy needs prompt investigation.

  • What treatments actually help?

    Preservative-free artificial tears, punctal plugs, saliva substitutes and muscarinic agonists such as pilocarpine control dryness. Hydroxychloroquine helps arthralgia and fatigue, and systemic immunosuppression or rituximab is reserved for extra-glandular disease.

  • Does Sjögren’s affect pregnancy?

    Yes. Anti-Ro and anti-La antibodies can cross the placenta and cause neonatal lupus or congenital heart block — pregnancies need specialist obstetric and fetal cardiac monitoring.

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