What causes Sjogren’s Syndrome?

The exact cause of Sjogren’s syndrome is not fully understood. Some research suggests that a combination of genetic susceptibility and an abnormal immune response triggered by a viral or bacterial infection may play a role in the development of the disorder. Additionally, hormones may also be involved as the condition is more common in women and tends to occur during the time of life when hormone levels are changing, such as menopause.
It is also classified as an autoimmune disorder, which means that the immune system mistakenly attacks healthy cells in the body. In the case of Sjogren’s, the immune system targets the glands that produce tears and saliva, leading to dryness in the mouth and eyes.
It is important to note that Sjogren’s Syndrome is a complex disorder, and the underlying cause is still under research.

What is the main cause of Sjögren’s Syndrome?

Sjögren’s Syndrome is an autoimmune disease where the immune system mistakenly attacks the body’s own moisture-producing glands, particularly those responsible for tears and saliva. This leads to chronic dryness and inflammation.

Why does the immune system target these glands?

The glands may become a target due to a combination of genetic susceptibility and environmental triggers. The immune system misidentifies normal cells as foreign invaders, initiating a damaging inflammatory response.

Are specific genes linked to it?

Yes. Certain gene variants, especially within the HLA complex and immune-regulating genes, have been associated with a higher risk of developing Sjögren’s. However, genetics alone are not the sole cause.

Is it strictly genetic?

No. While a genetic predisposition is important, environmental and hormonal factors also play a critical role in triggering the disease in susceptible individuals.

What environmental factors can trigger Sjögren’s?

Infections—particularly viral infections such as Epstein-Barr virus, hepatitis C, and others—may activate the immune system inappropriately, leading to autoimmune reactions that cause Sjögren’s.

Do bacteria also trigger Sjögren’s?

Some research suggests that bacterial infections may contribute to the onset of autoimmune responses, but viruses are more strongly implicated. The evidence on bacteria is still emerging.

Why does it affect mostly women?

Women are more susceptible to autoimmune diseases due to hormonal influences, particularly estrogen. These hormones play a role in regulating immune activity and may lead to higher autoimmune risk when levels fluctuate.

Can hormonal factors alone trigger it?

Hormonal imbalances, such as declining estrogen levels during menopause, may contribute to disease onset or worsening of symptoms, but they are not typically the sole cause.

Does family history increase risk?

Yes. Individuals with a close family member who has Sjögren’s or another autoimmune condition are at increased risk, suggesting a hereditary component.

Can stress trigger it?

Chronic stress doesn’t directly cause Sjögren’s, but it can disrupt immune function and potentially contribute to the development or worsening of autoimmune conditions.

What role do B cells and BAFF play?

B cells, which produce antibodies, become overactive in Sjögren’s. A protein called BAFF promotes this activity, leading to the production of autoantibodies that target healthy tissue.

Can epigenetic factors influence the disease?

Yes. Epigenetic changes like DNA methylation or histone modification may affect gene expression without altering DNA sequences, possibly triggering autoimmune responses.

What is microchimerism, and how is it relevant?

Microchimerism refers to the presence of a small number of cells from a genetically distinct individual—such as fetal cells in a mother’s body. These cells might influence autoimmune activity in some women.

Is it always “primary” Sjögren’s?

No. Primary Sjögren’s occurs on its own, while secondary Sjögren’s occurs in combination with other autoimmune diseases like lupus or rheumatoid arthritis.

Which infections are most linked to Sjögren’s?

Viruses such as Epstein-Barr, hepatitis C, cytomegalovirus (CMV), HTLV-1, and others have been linked as possible triggers for the onset of the disease.

At what age does it typically begin?

Sjögren’s usually begins between ages 40 and 60, though it can occur at any age. Symptoms often start subtly and gradually worsen.

Is gender a risk factor?

Yes. The condition predominantly affects women, accounting for around 90% of cases. Hormonal and genetic differences between genders contribute to this disparity.

Can medications cause similar symptoms?

Yes. Certain medications, including antidepressants and antihistamines, can cause dry mouth and eyes. However, these symptoms do not indicate an autoimmune disorder unless other signs are present.

What immune cells are involved?

Both T cells and B cells are involved, along with other immune cells like dendritic cells. They mistakenly attack glandular tissues, causing inflammation and destruction over time.

What overall process leads to gland damage?

The immune system sends inflammatory cells to the salivary and tear glands, where they accumulate, interfere with normal function, and gradually destroy the tissues.

How does Epstein-Barr virus relate to Sjögren’s Syndrome?

This common virus can alter immune function and mimic glandular proteins, potentially triggering an autoimmune attack in genetically susceptible individuals.

Is Sjögren’s Syndrome contagious?

No. Sjögren’s is an autoimmune condition and cannot be spread from person to person.

Can COVID-19 trigger Sjögren’s or similar symptoms?

In some individuals, COVID-19 may initiate an autoimmune response or intensify dryness and fatigue, mimicking symptoms seen in Sjögren’s Syndrome.

What autoimmune diseases are commonly linked with Sjögren’s?

Rheumatoid arthritis, systemic lupus erythematosus, scleroderma, and autoimmune thyroid disease often co-occur with Sjögren’s.

What are anti-SSA/Ro and anti-SSB/La antibodies?

These autoantibodies are commonly found in Sjögren’s patients and are used in diagnosis. They indicate immune system activity against the body’s own tissues.

Can pregnancy influence the onset of Sjögren’s?

While pregnancy does not directly cause Sjögren’s, hormonal and immune shifts during or after pregnancy may contribute to symptom onset or flares.

Can hormonal birth control increase the risk?

There is no strong evidence linking birth control to increased risk, but hormonal changes may influence symptom patterns in sensitive individuals.

Can menopause trigger Sjögren’s symptoms?

Yes. Estrogen decline during menopause can worsen dryness and may unmask or exacerbate autoimmune conditions like Sjögren’s.

What role does estrogen play in immune regulation?

Estrogen helps regulate immune response. Lower estrogen levels may reduce immune tolerance, increasing susceptibility to autoimmune diseases.

Do male patients get Sjögren’s Syndrome?

Yes. Although less common, men can develop the disease. They may experience more systemic symptoms or complications when diagnosed.

How does stress contribute to the disease process?

Stress can alter immune regulation and increase inflammation, potentially aggravating autoimmune activity and symptom severity.

What’s the significance of HLA-DRB1 in Sjögren’s?

This gene is part of the immune response system. Variants of HLA-DRB1 are linked to increased risk of autoimmune diseases, including Sjögren’s.

Can Sjögren’s skip generations in families?

Yes. A person may carry genetic risk factors without developing the disease, so it may appear to skip generations.

Is it possible to have symptoms without a positive antibody test?

Yes. Some people have “seronegative” Sjögren’s, meaning they show symptoms and gland damage but lack detectable antibodies.

Are there any vaccines linked to triggering Sjögren’s?

No vaccines have been proven to cause Sjögren’s. Rare autoimmune reactions post-vaccination may occur, but are extremely uncommon and not well understood.

What are interferons, and why are they important?

Interferons are proteins that help fight viruses. In autoimmune diseases, high interferon levels may lead to excessive immune activity and tissue damage.

What is the "interferon signature"?

This term refers to elevated expression of interferon-stimulated genes in the blood and tissues, commonly seen in Sjögren’s and used as a marker of immune system activation.

How do epithelial cells initiate autoimmunity in Sjögren’s?

Epithelial cells in the glands may present abnormal signals or antigens, attracting immune cells that mistake them for threats, starting the autoimmune process.

What is lymphocytic infiltration?

This refers to the accumulation of lymphocytes (a type of white blood cell) in the salivary or tear glands, leading to inflammation and tissue damage.

Can gut microbiome imbalances influence Sjögren’s development?

Yes. Imbalances in gut bacteria may disrupt immune regulation and contribute to the chronic inflammation seen in autoimmune conditions.

Is smoking a risk factor for Sjögren’s?

Smoking can worsen symptoms and may reduce treatment effectiveness, though it’s not considered a direct cause of the disease.

Can exposure to environmental toxins cause it?

Exposure to pesticides or industrial chemicals may increase autoimmune risk in some people, though more research is needed to confirm specific links.

What is the “B-cell hyperactivity” theory?

In Sjögren’s, B-cells become overactive and produce harmful antibodies. This hyperactivity is believed to play a central role in disease development.

Can childhood illness increase later risk?

Severe or chronic infections in childhood may influence immune development and potentially increase the risk of autoimmune diseases later in life.

What is the difference between primary and secondary causes?

Primary causes are direct autoimmune activity without another disease, while secondary causes are related to the presence of another autoimmune disorder.

Does ethnicity influence Sjögren’s risk?

Yes. The disease is more frequently diagnosed in certain populations, possibly due to genetic, environmental, or healthcare access differences.

Can dental issues trigger symptoms?

While dental problems don’t cause Sjögren’s, the dry mouth associated with the disease can lead to tooth decay, gum disease, and oral discomfort.

Is there a way to prevent the disease if you're high-risk?

Currently, there is no known way to prevent Sjögren’s. However, early detection, regular monitoring, and a healthy lifestyle can reduce complications.

Are researchers working to fully understand what causes it?

Yes. Ongoing research is focused on uncovering genetic, viral, hormonal, and environmental factors to better understand, treat, and potentially prevent Sjögren’s Syndrome in the future.