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Sjögren’s Syndrome

Sjögren’s (SHOW-grins) is an autoimmune condition in which the body attacks the glands that make tears and saliva, leaving eyes and mouth dry. It can also bring joint pain, fatigue and, for some people, effects on other organs. There is no cure, but eye and mouth care, regular dental visits and medicines can ease symptoms and protect your eyes and teeth.

Get urgent help — call 911 or go to an emergency room — for:

  • Sudden changes to your sight (wavy lines, flashing or loss of vision), pain when you look at light, a red eye together with a severe headache and feeling sick, a very dark red eye, or an eye injury. The NHS lists these as emergency signs for anyone with dry or sore eyes (NHS).
  • Signs of a stroke: sudden weakness or numbness on one side of the body, a drooping face, weakness in one arm, slurred speech or confusion (NHS). Numbness or tingling that comes on gradually in the hands or feet is a known Sjögren’s symptom and should be reported to your doctor soon, but sudden one-sided weakness is an emergency (NIDCR, NHS).
  • Swollen glands that make it very hard to swallow or breathe (NHS).

See a doctor promptly (MBHA suggests the same day) for a swollen, painful or red salivary gland with a high temperature. The NHS lists pain, redness or pus and a high temperature or chills as signs that a blocked salivary gland has become infected (NHS), and says a doctor can prescribe medicines to ease the pain and swelling of a salivary gland infection (NHS). Salivary gland problems can also cause a bad taste, facial pain and swelling of the face or neck, and can be due to infection, a blockage or cancer, as well as Sjögren’s (MedlinePlus).

Lymph nodes (“glands”) that keep growing deserve a check. People with Sjögren’s have a higher chance of lymphoma, a cancer of the lymph system, but the risk is low (MedlinePlus, ACR). The NHS says to see a doctor about swollen glands that are getting bigger, have not gone down within a week, feel hard or do not move, or come with night sweats (NHS). A painless lump in the neck, armpit or groin is the most common sign of non-Hodgkin lymphoma (NHS). A review of 18 studies found enlarged lymph nodes and enlarged parotid (cheek) glands among the most consistent warning signs in people with Sjögren’s (Nishishinya et al., 2015).

Never wait for a chiropractic, acupuncture or massage appointment, or try a supplement, when any of the signs above appear.

What is Sjögren’s syndrome?

Sjögren’s (SHOW-grins) is an autoimmune condition: the immune system mistakenly attacks the glands that make tears and saliva, so the eyes and mouth become dry (NIDCR, MedlinePlus). The name is changing. NIDCR and MedlinePlus now say Sjögren’s disease, “previously known as Sjögren’s syndrome”; the NHS uses both names (NIDCR, MedlinePlus, NHS). MBHA uses “syndrome” in the title so people searching for it can find this guide.

NIDCR estimates it affects 1 to 4 million people in the United States, most are over 50 when diagnosed, and women are about nine times more likely than men to have it (NIDCR). The ACR says about 10 times more often and usually between 45 and 55 (ACR). The cause is not known; researchers think genes and something in the environment, such as a past virus or bacterial infection, both play a role (MedlinePlus, MedlinePlus Genetics).

Some people have Sjögren’s on its own; others have it along with another autoimmune disease such as rheumatoid arthritis or lupus (MedlinePlus). Overlap can make it harder to diagnose, and about half of people with Sjögren’s have another autoimmune disorder (MedlinePlus, MedlinePlus Genetics). See our Lupus and Arthritis guides.

What does it feel like?

For many people dry eyes and a dry mouth are the main problems, and general health and life expectancy are largely unaffected (MedlinePlus Genetics). The NHS says most people with Sjögren’s live into old age with the same life expectancy as the general population (NHS). It can still weigh on everyday life, and the NHS notes depression is more common (NHS). See our Depression and Anxiety guides.

Dry mouth and dry eyes have many other causes. Hundreds of medicines and diseases such as diabetes can dry the mouth (NIDCR); dry eye can also come from medicines, diabetes, thyroid problems, long hours at screens or windy, smoky air (NEI). So dryness alone does not mean you have Sjögren’s. Our Eyes guide covers dry eye in general, and a Teeth guide is planned.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) A team approach: a rheumatologist, an eye doctor and a dentist. Artificial tears, gels and ointments; prescription eye drops and tear-duct plugs; saliva substitutes and prescription pilocarpine or cevimeline for dry mouth; pain relief; and, for more serious body-wide disease, medicines that quiet the immune system. Medicare doesn’t cover routine dental care in most cases, which matters for a condition that raises cavity risk. Other costs: cost estimate being researched. Treatment eases symptoms and prevents complications; there is no cure. Pilocarpine has strong evidence for dry-mouth symptoms but side effects are common. Hydroxychloroquine did not beat placebo in one trial. Regular eye and dental check-ups are the backbone.
Chiropractic No role in treating the dryness or the immune system. Some people with joint or muscle aches may consider it for comfort. About $55 to $100 per follow-up visit paying cash, per The Pricer. Medicare covers only spinal adjustments for a subluxation. We found little research on chiropractic care for Sjögren’s. Side effects are usually mild, serious ones are very rare. Tell the chiropractor about your condition and any steroid medicine, which can weaken bones.
Acupuncture Fine needles used for dryness, pain and fatigue, usually alongside regular care. About $90 to $185 per follow-up visit paying cash, per The Pricer. Medicare covers acupuncture only for chronic low back pain. Mixed. A 120-person sham-controlled trial found no difference on its main measure; a smaller one reported better dryness scores. Reviews call the evidence inconclusive. Side effects are usually mild.
Herbal medicine Mostly traditional Chinese herbal formulas have been studied; many people also try omega-3 or “immune” supplements. None replaces eye, dental or medical care. Cost estimate being researched. Reviews of Chinese herbal trials call the results promising but the trials low quality. A large trial found omega-3 capsules no better than placebo for dry eye. Tell your doctor about every product, including those that may interact with dry-mouth medicines.
Massage therapy Relaxing massage for sore muscles, tension and stress, plus gentle eyelid self-massage taught by eye doctors. Not a treatment for the dryness. One national chain: about $70 to $90 a month on a 12-month membership, per The Pricer. Original Medicare doesn’t cover massage therapy. We found little research on massage for Sjögren’s. Risk is low, but avoid pressure on a swollen, painful gland until a doctor has looked at it.
MBHA Wellness Coach Daily habits that protect eyes, mouth and energy: dental routines, sipping water, moisture and screen breaks, medicine lists, exercise and pacing, sleep, mood and preparing for appointments. Cost estimate being researched. Supports — never replaces — medical, eye and dental care. Exercise showed benefits for pain and fatigue in a small meta-analysis, though another review found the fatigue result not significant.

Approach 1 of 6

Conventional medicine (AMA)

Treatment focuses on relieving symptoms and preventing complications, and it differs from person to person depending on which parts of the body are affected (MedlinePlus). There is no cure (NIDCR, NHS). The ACR suggests regular dental check-ups, regular eye exams with an ophthalmologist to check for cornea damage or infection, and regular follow-up with a rheumatologist (ACR). We list no doses; your own team decides those.

Dry eyes

Dry mouth

Pain, reflux and the rest of the body

  • Anti-inflammatory pain relievers may ease joint pain (NIDCR); the NHS names paracetamol (acetaminophen in the U.S.) for muscle and joint aches (NHS). People with reflux may use acid-reducing medicines (ACR).
  • Immune-quieting medicines. If symptoms are severe, corticosteroids or immunosuppressive drugs may be prescribed (NIDCR). Depending on symptoms and organs involved, the ACR lists hydroxychloroquine, corticosteroids, methotrexate, azathioprine and mycophenolate, with rituximab in life-threatening cases and intravenous immunoglobulin for some nervous-system problems; several newer medicines are in clinical trials (ACR). EULAR’s recommendations cover these classes and biologic drugs (Ramos-Casals et al., 2020).
  • The honest evidence. In a trial of 120 people with primary Sjögren’s, hydroxychloroquine did not improve dryness, pain or fatigue more than placebo over 24 weeks, and the authors called for longer-term studies (Gottenberg et al., 2014). MedlinePlus lists malaria, lupus and rheumatoid arthritis, not Sjögren’s, among its uses and warns it can cause serious, potentially irreversible eye problems, so regular eye exams are needed (MedlinePlus). The 2019 review found rituximab and interferon-alpha increased saliva flow more than placebo, with a smaller effect than pilocarpine (Al Hamad et al., 2019).
  • Steroids and bones. Glucocorticoids can weaken bones and lead to osteoporosis; the ACR says treatment can help protect bones (ACR). See our Osteoporosis guide.

What it costs

Medicare does not cover routine cleanings, fillings, extractions or dentures in most cases (Medicare.gov). Other costs: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care does not treat the dryness or the immune system. We found little research on chiropractic care for Sjögren’s. Some people who also have aching joints or muscles (MedlinePlus) may consider it for comfort.

Safety

NCCIH reports that mild to moderate side effects such as soreness, stiffness or headache often occur after spinal manipulation and mostly go away within 24 hours. Serious problems are very rare, may be more likely in people with underlying health problems, and NCCIH says patients should share their health conditions and medications with the practitioner (NCCIH). If you take steroid medicine for Sjögren’s, the ACR notes it can weaken bones (ACR), so MBHA suggests telling the chiropractor and asking your doctor which techniques are appropriate. For neck or back pain, see our Neck and Back Pain guides.

What it costs

The Pricer lists about $55 to $100 for a self-pay follow-up visit and $90 to $200 for a first appointment (The Pricer). Medicare covers only spinal adjustments by a chiropractor to correct a subluxation (Medicare.gov).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture has been tested for dry mouth, dry eyes, pain and fatigue in Sjögren’s. The results are mixed.

  • The larger trial: 120 people with primary Sjögren’s received real or sham acupuncture for 8 weeks. About 28% on acupuncture and 32% on sham met the main goal (a 30% improvement in at least two of dryness, pain and fatigue), which was not a significant difference. The authors concluded acupuncture did not satisfactorily improve symptoms compared with placebo (Zhou et al., 2022).
  • A smaller trial: 46 people were randomized (27 finished). Those given real acupuncture had better dryness scores than those given sham, and the effect lasted at least four weeks. The authors called for larger studies (Gomes-Silva et al., 2025).
  • Reviews: A Cochrane review found low-quality evidence that acupuncture was no different from placebo for dry-mouth symptoms; those acupuncture trials were in people with dry mouth after radiotherapy, and evidence on electrical stimulation in Sjögren’s was insufficient (Furness et al., 2013). A later systematic review of 10 trials called the evidence inconclusive (Assy and Brand, 2018). In dry eye generally (not Sjögren’s specifically), a 2021 meta-analysis of 21 trials found acupuncture improved some tear measures compared with artificial tears alone (Na et al., 2021).

So acupuncture may help some people feel more comfortable, but it should not replace eye drops, dental care or your rheumatologist’s plan.

Safety

Relatively few complications are reported, and those that occurred mostly came from nonsterile needles or poor technique; the FDA requires acupuncture needles to be sterile and single-use (NCCIH). In the Cochrane review, side effects were tiny bruises and tiredness that were mild and temporary (Furness et al., 2013).

What it costs

The Pricer lists about $90 to $185 per follow-up visit and up to about $230 for a first private appointment, with community acupuncture around $50 to $90 (The Pricer). Medicare covers acupuncture only for chronic low back pain (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement has been shown to cure Sjögren’s or to replace eye, dental and medical care. NCCIH reminds people that “natural” does not always mean safe, and that supplements may interact with your medications (NCCIH).

What studies found

  • Chinese herbal medicine. A review of 52 randomized trials in primary Sjögren’s found the overall quality of the trials was low. Many reported better response rates and tear or saliva measures with herbal treatment, others found no difference, and side effects were mostly minor digestive upsets. The authors called the results preliminary and promising and asked for better-designed trials (Luo et al., 2012). A 2023 meta-analysis of 13 trials (780 people) reported better effective rates and tear and saliva measures for traditional Chinese medicine (including combined Chinese and Western approaches) than for Western medicine; the abstract does not rate how reliable the trials were (Liu et al., 2023). MBHA suggests asking any practitioner for the full ingredient list and showing it to your pharmacist.
  • Omega-3 supplements. The NHS suggests foods rich in omega-3, such as oily fish and walnuts (NHS). NEI lists too little omega-3 among the risks for dry eye (NEI). But in the NEI-funded DREAM trial of 535 people with moderate to severe dry eye, fish-derived omega-3 supplements worked no better than an olive-oil placebo after 12 months; the trial was in dry eye generally, and adverse events were similar (Asbell et al., 2018).

Safety

  • Tell your doctor and pharmacist about every herb and supplement you take. MedlinePlus says St. John’s wort may interact with cevimeline and asks people on pilocarpine to report herbal products (MedlinePlus, MedlinePlus).
  • Products promoted as “immune boosters” deserve extra caution: NCCIH found rigorous evidence for only 8 of 27 common ingredients with immune claims, and even those studies were not strong enough for firm conclusions (NCCIH). Because Sjögren’s is an immune system that is attacking the body’s own glands (MedlinePlus), MBHA suggests checking with your rheumatologist first.
  • Caffeine can dry out the mouth (NIDCR), so MBHA suggests being careful with caffeinated herbal blends and energy products.

What it costs

Cost estimate being researched.

Approach 5 of 6

Massage therapy

Massage does not treat the dryness or the immune system. We found little research on massage for Sjögren’s. It may still help with the aches, tension and stress that can come with a long-term condition. NCCIH says massage has been studied for several types of pain, and that a 2014 review of 9 studies found massage lasting at least 5 weeks improved pain, anxiety and depression in people with fibromyalgia, though not sleep (NCCIH). That is a different condition, so treat it as a hint, not proof.

A gentle eyelid massage

For dry eyes the NHS describes a warm cloth over the eyes, then gently massaging the eyelids with a finger or cotton bud to push oil out of the glands, and cleaning away crusts. It also advises giving your eyes breaks from screens (NHS). Ask your eye doctor first if your eyes are sore or red.

Safety

  • NCCIH says massage risk appears low, but rare serious problems — a blood clot, nerve injury or bone fracture — have been reported, some after vigorous deep-tissue work or in older people (NCCIH). If you take steroid medicine, which can weaken bones (ACR), MBHA suggests asking for lighter pressure.
  • Skip firm pressure on swollen glands in the face or neck. A swollen, painful or red gland with fever may be infected (NHS), and swollen glands that keep growing need a doctor (NHS). MBHA suggests waiting until a doctor has looked at it.

What it costs

One national chain’s membership runs about $70 to $90 a month on a 12-month term (The Pricer). Original Medicare does not cover massage therapy (Medicare.gov).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you build the daily habits that protect your eyes, mouth and energy — alongside, never instead of, your rheumatologist, eye doctor and dentist. A coach does not diagnose or prescribe.

Mouth and teeth every day

NIDCR suggests keeping water nearby and sipping regularly, brushing with fluoride toothpaste after meals and before bed, flossing, avoiding sugary foods and drinks, choosing sugar-free gum or candy, using lip balm and asking your dentist about fluoride rinses, gels or varnish (NIDCR). The NHS adds alcohol-free mouthwash, ice cubes or sugar-free ice lollies, and avoiding acidic, spicy, salty or sugary foods, alcohol and caffeine, and not sleeping with dentures in (NHS). A coach can help you turn this into a routine you can keep.

Eyes and air

NIDCR advises blinking regularly when reading or using a computer, protecting your eyes from drafts and wind, using humidifiers and avoiding smoke (NIDCR). The NHS adds sunglasses with enclosed sides and plants to add moisture to indoor air, and warns against long periods on screens (NHS). Staying away from smoke also helps dry mouth (NIDCR). Our Eyes guide has more.

Move, pace and rest

A 2025 meta-analysis of five trials (269 women with primary Sjögren’s) found exercise improved pain, fatigue, quality of life and aerobic capacity compared with no treatment, with resistance exercise appearing most effective (Nacar et al., 2025). A 59-person randomized trial of a 16-week strength program reported less fatigue and pain with no serious side effects (Dardin et al., 2022). However, a 2023 review for European rheumatology recommendations found the fatigue benefit of exercise was not statistically significant in Sjögren’s, while it was in rheumatoid arthritis, lupus and spondyloarthritis (Santos et al., 2023). Check with your doctor before starting, and see our Chronic Fatigue and Sleep Problems guides. Because overdoing it may trigger flare-ups (NHS), a coach can help you pace activity and rest.

Eating

The NHS suggests a healthy, balanced diet including omega-3-rich foods, and going easy on sugary, salty and acidic foods and drinks (NHS). NIDCR says sipping water or a sugarless drink during meals can make chewing and swallowing easier (NIDCR).

Medicines, appointments and mood

A coach can help you keep an up-to-date list of every medicine and supplement, track symptoms and prepare questions for your rheumatologist, eye doctor and dentist. If you feel low, tell your doctor; the NHS notes depression is more common in Sjögren’s (NHS). Support groups and national charities can also help (NHS); NIDCR lists the Sjögren’s Foundation as a resource (NIDCR).

What it costs

Cost estimate being researched.

Another approach

How Sjögren’s is diagnosed

There is no single test. A doctor uses your medical history and symptoms, a physical exam, and tests (MedlinePlus). These can include eye tests to measure tears and look for dryness damage, salivary gland tests that measure saliva (sometimes with imaging or a biopsy), and blood tests (MedlinePlus). The NHS describes spitting into a container for 5 minutes to measure saliva, an X-ray of the salivary glands and a lip biopsy that takes a small piece of tissue containing salivary glands (NHS).

The ACR says the most common blood tests that point toward Sjögren’s are a positive antinuclear antibody (ANA), anti-SSA (Ro) and anti-SSB (La) antibodies and rheumatoid factor, but some people have negative antibodies, so a salivary gland biopsy is needed to confirm the diagnosis (ACR). Researchers use a scoring system (the 2016 ACR/EULAR classification criteria) that combines the anti-SSA antibody, a salivary gland biopsy and measurements of eye staining, tear production and saliva flow; it was developed for people with symptoms suggestive of Sjögren’s, and its authors call it well suited to choosing people for research studies (Shiboski et al., 2017).

Because other conditions cause similar symptoms, and because having another autoimmune disease can make it harder to spot, the NHS says your doctor will first check for more common causes and may refer you to specialists (NHS, MedlinePlus).

Another approach

Why dental care matters so much

Saliva washes away food, helps swallowing and contains minerals that keep teeth strong and fight decay; without enough, the risk of tooth decay and fungal infections in the mouth goes up (NIDCR). People with Sjögren’s are at higher risk of cavities, tooth loss and mouth infections (NIDCR). The ACR also lists gum disease (ACR).

Another approach

Pregnancy and Sjögren’s

The NHS says that with Sjögren’s, the chance of some pregnancy complications, including miscarriage, is higher, and advises talking to your care team if you are planning to get pregnant or are in early pregnancy (NHS). The American College of Rheumatology’s guideline on reproductive health supports pre-pregnancy counseling, trying to conceive when the condition is quiet and while on pregnancy-compatible medicines, and working with obstetrics; it includes recommendations specific to people with anti-Ro/SSA or anti-La/SSB antibodies (Sammaritano et al., 2020).

Studies are small. A French study of 54 pregnancies in 19 women with primary Sjögren’s found more spontaneous abortions and earlier delivery than in comparison women; it notes that these antibodies increase the risk of congenital heart block in the baby, though none occurred in that study (Ballester et al., 2017). A Portuguese study of 26 pregnancies found more miscarriages and three cases of congenital heart block, and concluded that successful pregnancy was possible with prenatal monitoring and a multidisciplinary approach (Barros et al., 2022). Don’t stop or start any medicine on your own; MedlinePlus says to tell your doctor if you are pregnant or plan to become pregnant while taking pilocarpine or cevimeline (MedlinePlus, MedlinePlus). A Pregnancy guide is planned.

Another approach

When it affects more than the eyes and mouth

Sjögren’s can affect the kidneys, blood vessels, lungs, liver, pancreas and brain (NIDCR). The NHS lists other problems that are more likely: eye problems such as a sore on the eye or eyelid inflammation, other immune conditions, digestion problems such as irritable bowel syndrome, loss of feeling in the arms and legs (peripheral neuropathy), depression and, rarely, lymphoma (NHS). Tell your doctor about a dry cough that won’t go away, new numbness or tingling, rashes or unusual tiredness (NIDCR, MedlinePlus). See our Nerve Damage guide.

A rheumatologist can monitor for complications (ACR). Bring this list to appointments: all medicines and supplements, any new swelling or lumps, eye changes, mouth sores, joint pain, dry cough and changes in energy or mood.

Member stories

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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