Sjögren’s Syndrome is a chronic autoimmune disorder where the immune system mistakenly attacks healthy tissues. True, sustained remission—a complete and permanent absence of the disease—is complex and often unattainable. The primary focus for patients and clinicians is achieving the highest possible state of disease control, which involves managing symptoms and reducing systemic inflammation.
Understanding Sjogren’s Syndrome
Sjögren’s Syndrome is characterized by the immune system targeting the exocrine glands responsible for producing moisture. Immune cells infiltrate the lacrimal glands (tears) and salivary glands, leading to inflammation and damage. This glandular damage results in the hallmark symptoms: severe dryness of the eyes and mouth, known as sicca symptoms.
The condition is a systemic disorder that extends beyond the moisture-producing glands. Systemic involvement includes inflammation of the joints (arthralgia or arthritis), or affecting major organs like the lungs, kidneys, and liver. Neurological complications, such as peripheral neuropathy, can also occur. Since the underlying cause involves permanent tissue damage and persistent immune system dysregulation, the disease follows a long-term course.
Defining Remission and Low Disease Activity
Sjögren’s Syndrome is considered incurable, and true, medication-free remission is rare. Glandular destruction causing dryness is often irreversible, limiting the potential for a complete return to normal function. Therefore, the medical community distinguishes between clinical remission and the more realistic goal of Low Disease Activity (LDA).
LDA is measured using standardized clinical scoring tools that assess systemic inflammation and patient-reported symptoms. The European League Against Rheumatism Sjögren’s Syndrome Disease Activity Index (ESSDAI) evaluates systemic disease activity across twelve organ systems. A low activity state is defined by an ESSDAI score of less than five.
Another measure is the European League Against Rheumatism Sjögren’s Syndrome Patient-Reported Index (ESSPRI), which focuses on the patient’s subjective experience of pain, fatigue, and dryness. A score of less than five on the ESSPRI defines a Patient-Acceptable Symptom State (PASS), which is the functional equivalent of remission from the patient’s perspective. Achieving this state means the disease’s impact on daily life is significantly reduced, representing the most successful outcome for most patients.
Current Medical Strategies for Managing Disease
Medical intervention for Sjögren’s Syndrome employs a dual approach: managing dryness symptoms and controlling underlying systemic inflammation. Symptomatic management focuses on replacing or stimulating moisture production to protect the eyes and mouth from damage. This includes the use of artificial tears, gels, and saliva substitutes.
For patients whose glands still retain some function, secretagogues like pilocarpine or cevimeline can be prescribed to stimulate increased tear and saliva flow. When the disease involves systemic manifestations, such as organ involvement or joint pain, treatment shifts to controlling the autoimmune response. This systemic control often involves disease-modifying antirheumatic drugs (DMARDs), such as hydroxychloroquine, as a first-line therapy.
More aggressive systemic involvement may necessitate the use of immunosuppressants or biological therapies, such as B-cell targeted treatments like rituximab. The goal of these systemic treatments is to prevent flares, halt progressive organ damage, and suppress the immune response. These strategies maintain the patient in a stable state of low disease activity, limiting the disease’s functional impact.
Patient-Driven Factors Influencing Disease Severity
Complementing medical therapies, patient-driven lifestyle factors significantly influence disease severity and the frequency of flares. Stress management is a recognized component, as chronic stress can trigger the immune system and increase the risk of autoimmune flares. Developing effective coping mechanisms and prioritizing mental well-being helps stabilize the disease course.
Adequate sleep is important, as sleep disturbances are common in Sjögren’s and can worsen fatigue and pain levels. Addressing sleep quality helps reduce the severity of both physical and psychological symptoms. Maintaining excellent oral hygiene is necessary due to reduced saliva production, which increases the risk for dental decay and oral infections.
Some patients find that optimizing their diet, often through anti-inflammatory approaches, helps reduce systemic symptoms. While not a substitute for medication, these non-pharmaceutical strategies provide patients with practical steps to maintain a state of low disease activity and improve their quality of life.