Sjögren’s disease causes persistent dryness of the eyes and mouth, but it can also affect joints, nerves, skin, and internal organs. It’s an autoimmune condition in which the immune system attacks the glands that produce moisture, and in many cases, the inflammation extends well beyond those glands. Most people are diagnosed after age 40, with an average diagnosis age of about 53 in women and 58 in men. Women are roughly six times more likely to develop the condition than men.
Dry Eyes and Dry Mouth
The two hallmark symptoms are dry eyes and dry mouth. The eye dryness often feels like burning, itching, or a gritty sensation, as if sand is trapped under the eyelids. It tends to worsen in dry or windy environments, after long stretches of screen time, or later in the day.
Dry mouth can feel like your mouth is stuffed with cotton. Swallowing and speaking become harder, and you may notice unusually thick or stringy saliva. These symptoms develop gradually, which is one reason the average time between first symptoms and diagnosis can stretch for years. Many people attribute early dryness to aging, medication side effects, or seasonal allergies before recognizing a pattern.
Dental and Oral Health Problems
Saliva does more than keep your mouth comfortable. It neutralizes acid, washes away bacteria, and helps repair tooth enamel. When saliva production drops, the consequences for your teeth can be significant. People with Sjögren’s are prone to cavities forming in unusual locations: along the roots of teeth, at the gum line, and on the biting edges or tips of teeth. Plaque accumulates faster, and gum disease progresses more easily.
Other oral complications include fungal infections (oral thrush), cracking at the corners of the mouth, swollen salivary glands, and sores on the inner cheeks and tongue. If you wear dentures, you may find they no longer fit well or irritate your gums more than before. Using prescription-strength fluoride and keeping up with frequent dental visits are considered essential for protecting teeth when saliva flow is reduced.
Fatigue
Fatigue is one of the most common and disabling symptoms, yet it’s easy to overlook because it doesn’t show up on standard blood tests or imaging. This isn’t ordinary tiredness. Many people describe it as a deep, unrelenting exhaustion that doesn’t improve with sleep. It can fluctuate throughout the day and worsen with activity, heat, or stress. Some people also report cognitive difficulties, often called “brain fog,” including trouble concentrating, word-finding problems, and mental sluggishness.
Joint and Muscle Pain
Joint pain and stiffness affect a substantial number of people with Sjögren’s. The pattern often resembles rheumatoid arthritis, with swelling and tenderness in smaller joints like the fingers and wrists, though larger joints can be involved too. Sjögren’s can occur on its own (primary form) or alongside another autoimmune disease like rheumatoid arthritis, lupus, or scleroderma (secondary form). When it’s secondary, joint symptoms may be driven by both conditions simultaneously, making it harder to tease apart what’s causing what.
Skin Changes
Dry skin is common, but Sjögren’s can also cause more specific skin findings. About 10% of patients develop vasculitis, an inflammation of small blood vessels that shows up on the skin. The most frequent skin manifestation is purpura: small, reddish-purple spots, usually on the lower legs, caused by tiny amounts of blood leaking from inflamed vessels. Less commonly, people develop hive-like rashes, red nodules under the skin, or small ulcers. Purpura tends to cluster with other markers of more active disease, including neuropathy and certain blood test abnormalities.
Nerve Damage and Neurological Symptoms
Neurological complications affect roughly 10 to 20% of people with Sjögren’s, and peripheral nerve damage (neuropathy) accounts for a significant portion of those cases. The symptoms depend on which type of nerve fibers are involved.
Small-fiber neuropathy is one of the more characteristic patterns. It causes burning, prickling, or a “skin on fire” sensation, most often in the feet and lower legs. Standard nerve tests can come back normal because they don’t measure small fibers well, which means this type of neuropathy sometimes goes undiagnosed for a while. Large-fiber neuropathy, by contrast, produces more diffuse numbness and muscle weakness, along with difficulty with balance and coordination.
Some people develop autonomic neuropathy, which disrupts the nerves controlling involuntary functions. Symptoms include lightheadedness when standing up, abnormal sweating (too much or too little), and feeling uncomfortably full after eating only a small amount. Facial numbness or severe facial pain, called trigeminal neuralgia, is another recognized complication. Up to 20% of patients with small-fiber neuropathy also experience trigeminal involvement.
Digestive Symptoms
Dryness doesn’t stop at the mouth. Reduced moisture throughout the digestive tract can cause difficulty swallowing, which is a common complaint and likely related to impaired function of the esophagus. Further down, chronic inflammation of the stomach lining can produce nausea, upper abdominal pain, and indigestion. Some people develop subclinical or overt inflammation of the pancreas. These digestive symptoms are easy to attribute to other conditions like acid reflux or irritable bowel syndrome, so they may not be connected to Sjögren’s right away.
Other Organ Involvement
In some cases, the same immune process that targets moisture-producing glands extends to internal organs. The kidneys can develop a form of inflammation called interstitial nephritis, which affects the tissue surrounding the filtering units rather than the filters themselves. The liver may be involved through an overlap with primary biliary cholangitis, an autoimmune liver condition. Lung involvement can take the form of persistent dry cough, shortness of breath, or, less commonly, a condition in which immune cells infiltrate the lung tissue.
One of the more serious long-term risks is lymphoma, a cancer of the immune system. People with Sjögren’s have a higher lifetime risk than the general population, though the absolute risk remains relatively low. Persistent swelling of the salivary glands, unexplained weight loss, or night sweats warrant prompt evaluation.
Primary vs. Secondary Sjögren’s
Primary Sjögren’s occurs on its own. Secondary Sjögren’s develops alongside another autoimmune condition, most commonly rheumatoid arthritis, lupus, scleroderma, or an inflammatory muscle disease. The core dryness symptoms are similar in both forms, but the overall symptom picture can be more complex in secondary Sjögren’s because two autoimmune processes are running simultaneously. If you already have one autoimmune diagnosis and develop new dryness symptoms, it’s worth raising the possibility of overlapping Sjögren’s with your care team.