Sjögren’s syndrome is a chronic autoimmune disorder primarily known for causing severe dryness in the eyes and mouth. The condition is systemic, meaning it can affect the entire body, including the nervous system. Dizziness is a recognized manifestation of Sjögren’s syndrome, often signaling underlying systemic complications. This symptom can present as lightheadedness, vertigo, or a feeling of unsteadiness.
Sjogren’s Syndrome and Autonomic Nervous System Dysfunction
The most frequent cause of dizziness in Sjögren’s patients relates to a malfunction of the Autonomic Nervous System (ANS), known as dysautonomia or autonomic neuropathy. The ANS is the body’s involuntary control center, regulating functions like heart rate, breathing, and blood pressure. In Sjögren’s, the autoimmune process can attack the peripheral nerves of the ANS, causing regulatory failure.
This nervous system damage often results in Orthostatic Intolerance (OI), the inability to maintain proper blood flow to the brain when standing upright. When a person with OI stands, the ANS fails to constrict blood vessels appropriately, leading to a sudden drop in blood pressure and a feeling of lightheadedness or presyncope. This specific type of dizziness occurs predominantly upon positional change.
A common manifestation of this autonomic failure is Postural Orthostatic Tachycardia Syndrome (POTS). In POTS, the heart rate increases abnormally rapidly upon standing to compensate for failing blood pressure. The resulting dizziness is lightheadedness or a feeling of near-fainting, not a spinning sensation. Studies suggest that up to 50% of Sjögren’s patients may experience some form of autonomic dysfunction.
Other Systemic Factors Contributing to Dizziness
Dizziness in Sjögren’s can stem from mechanisms separate from ANS dysfunction, including direct inflammation and medication side effects. The inner ear, which houses the vestibular system responsible for balance, can be affected by the disease’s systemic inflammation. Autoimmune activity may cause direct damage to inner ear structures, leading to a true spinning sensation known as vertigo or chronic imbalance.
Specialized testing often reveals measurable impairments in vestibular function in Sjögren’s patients, even in those who do not report overt vertigo symptoms. The systemic nature of the disease, including chronic fatigue and widespread inflammation, can also contribute to a general feeling of unsteadiness or “brain fog.”
Reviewing medications is necessary when investigating dizziness, as many drugs used to manage Sjögren’s or its associated symptoms list it as a side effect. Common treatments like immunosuppressants, nonsteroidal anti-inflammatory drugs (NSAIDs), or medications for concurrent conditions can induce lightheadedness or vertigo. A careful review of all prescriptions is necessary to rule out drug-induced symptoms.
Assessment and Management Strategies
Diagnosing the source of dizziness requires differentiating between a cardiovascular cause (ANS) and a balance-related cause (vestibular/inner ear). To assess for autonomic dysfunction, a physician may use a tilt table test, which monitors heart rate and blood pressure continuously. For suspected inner ear involvement, specialized neurological evaluations, such as the video head impulse test (vHIT), can measure vestibular function.
Management is tailored to the specific cause identified. For ANS-related dizziness, non-pharmacological strategies are the starting point. These include increasing salt and fluid intake to boost blood volume and wearing compression stockings to assist circulation. Patients should also make slow, deliberate movements when changing posture to allow the body time to adjust blood pressure.
If lifestyle changes are not sufficient, doctors may prescribe specific medications to improve blood pressure regulation, such as midodrine or fludrocortisone. For inner ear-related vertigo, vestibular rehabilitation therapy involves specific exercises to retrain the brain to process balance signals. Immunomodulatory therapies may be considered to target the underlying autoimmune process when dizziness is linked to severe neurological inflammation.