Sjögren’s Syndrome (SS) is a chronic autoimmune disorder primarily recognized for causing severe dryness of the eyes and mouth due to immune-mediated damage to moisture-producing glands. While these glandular symptoms represent the most common presentation, SS is a systemic condition that can affect multiple organs and neurological systems throughout the body. The inflammation associated with this disorder can extend beyond the exocrine glands, impacting the nervous system and structures responsible for maintaining equilibrium. Therefore, the answer to whether Sjögren’s Syndrome can cause dizziness is affirmative, and this manifestation often indicates broader involvement of the body’s control systems.
Is Dizziness a Common Symptom of Sjogren’s?
Dizziness, or vertigo, is not typically listed among the hallmark features of Sjögren’s Syndrome, but it is a recognized and frequently reported neurological manifestation of the disease. The syndrome’s systemic nature means that symptoms often extend far beyond the initial glandular complaints of dryness. Dizziness and lightheadedness are often linked to a disruption in the body’s involuntary functions, a condition that can be present in up to 50% of patients with Sjögren’s Syndrome. This symptom often arises from the autoimmune process affecting the peripheral nervous system rather than the central structures of the brain; the prevalence of true vertigo, a spinning sensation, has been observed to be higher in patients with Sjögren’s than in control populations. Because this symptom is not a traditional diagnostic criterion, it is sometimes underreported or misattributed to other causes, delaying appropriate investigation and management.
How Sjogren’s Affects Balance and Equilibrium
Autonomic Nervous System Dysfunction
The most common mechanism linking Sjögren’s Syndrome to dizziness is the development of Autonomic Nervous System (ANS) dysfunction, also known as dysautonomia. The ANS controls involuntary bodily functions, including heart rate, blood pressure, digestion, and temperature regulation. In Sjögren’s Syndrome, the same autoimmune response that targets the glands can damage the autonomic nerves, resulting in a condition called autonomic neuropathy. This nerve damage can impair the body’s ability to stabilize blood pressure upon changing posture, leading to orthostatic intolerance. One specific manifestation is Orthostatic Hypotension (OH), where blood pressure drops significantly when a person stands up, causing temporary lightheadedness or dizziness. Another common form is Postural Orthostatic Tachycardia Syndrome (POTS), characterized by an abnormally large increase in heart rate—typically 30 beats per minute or more—within ten minutes of standing, often accompanied by dizziness and fatigue. These conditions occur because damaged autonomic nerves fail to signal blood vessels to constrict and maintain adequate blood flow to the brain against gravity.
Inner Ear and Vestibular Involvement
Dizziness can also result from the direct autoimmune attack on the inner ear structures responsible for balance, collectively known as the vestibular system. This is often categorized as an otologic manifestation of the syndrome. The inner ear contains the semicircular canals and the vestibule, which use fluid and fine hairs to sense head movement and orientation. The inflammatory process in Sjögren’s Syndrome may cause a form of autoimmune inner ear disease (AIED) or vasculitis within the small blood vessels of the inner ear. This inflammation can disrupt the function of the vestibulocochlear nerve (Cranial Nerve VIII) or the labyrinth itself, leading to symptoms of true spinning vertigo or persistent disequilibrium. Specialized tests have shown measurable impairments in vestibular function in SS patients.
Central Nervous System Involvement
In less common instances, dizziness may be a sign of Central Nervous System (CNS) involvement related to Sjögren’s Syndrome. Autoimmune inflammation or vasculitis in the CNS can affect areas of the brain that process balance information and coordinate movement. These regions include the cerebellum and brainstem, which integrate sensory input from the eyes, inner ear, and body to maintain stable posture. Damage to these areas can manifest as vertigo, unsteadiness, or gait instability, which are symptoms that may sometimes mimic other neurological disorders.
Diagnostic Steps and Treatment Approaches
Determining the precise cause of dizziness in Sjögren’s patients requires a targeted investigation to differentiate between dysautonomia, vestibular issues, or CNS involvement. To diagnose autonomic dysfunction, clinicians often begin with simple bedside tests, such as measuring the patient’s heart rate and blood pressure while lying down and immediately after standing. A more formal diagnosis for OH or POTS is often confirmed using a Tilt Table Test, which continuously monitors these vital signs as the patient is passively tilted upright.
If inner ear involvement is suspected, specialized audiology and neurology assessments are employed. These diagnostic tools include:
- Video Head Impulse Test (vHIT) to assess the function of the semicircular canals and the Vestibulo-Ocular Reflex.
- Sensory Organization Testing (SOT) to evaluate how well the patient integrates sensory input from their vision, inner ear, and body to maintain balance.
- Magnetic Resonance Imaging (MRI) to check for rare instances of inflammation, lesions, or vasculitis in the brain or brainstem, indicating CNS involvement.
Management strategies are tailored to the underlying mechanism causing the dizziness. For dysautonomia, foundational non-medication strategies are often the first line of treatment:
- A significant increase in daily fluid and salt intake to boost blood volume, which helps stabilize blood pressure.
- Wearing medical-grade compression garments, particularly abdominal binders and stockings extending above the waist, to prevent blood from pooling in the lower extremities upon standing.
Medications for dysautonomia may include fludrocortisone, which helps the body retain salt and water, and midodrine, which constricts blood vessels to raise blood pressure. If the dizziness stems from vestibular damage, Vestibular Rehabilitation Therapy (VRT) with a specialized physical therapist can help the brain compensate for the inner ear deficit. Controlling the underlying autoimmune disease is paramount for all neurological manifestations, often involving systemic immunomodulatory drugs like hydroxychloroquine or potent immunosuppressants such as rituximab or intravenous immunoglobulin (IVIG) to reduce nerve-damaging inflammation.