More than dryness¹

Sjögren's disease (SjD), which you might know as Sjögren's syndrome, often features sicca symptoms such as mouth (xerostomia) and ocular (keratoconjunctivitis) dryness. But it may extend far beyond dryness.^1,6

No 2 patients present with the same systemic manifestations. The disease's heterogeneity often makes progression unpredictable. Existing symptoms can worsen, and new manifestations can emerge.^2,7

Beyond sicca, inflammation or damage can also occur in the joints, skin, lymph nodes, lungs, brain, or other organ systems.^6,8,9

Almost all patients with SjD report ocular and/or mouth dryness (~90%), fatigue (up to 80%), and joint pain (up to 96%).^6,10,11

While chronic inflammation does not always result in organ damage, once this morphological change has occurred, it is irreversible.^20,21

Complications of SjD can be irreversible^20,22

Beyond symptoms, patients may face severe systemic manifestations that can significantly impact long-term health and lead to a reduced life expectancy.²²

Explore key questions to deepen insight into your patients' disease burden

WHY:
Your patients might not realize their symptoms are linked to SjD or may struggle to describe what they're feeling. By asking clear questions and encouraging a deeper discussion, you can fully realize the impact of the disease on patients' lives.

HOW:
EULAR Sjögren's syndrome disease activity index (ESSDAI) is the gold standard in clinical trials for assessing disease activity across 12 domains. While you may not use it directly, you can ask simple ESSDAI-based questions^‡ to foster better conversations with your patients²⁷:

*Based on a systematic review and meta-analysis assessing cardiovascular morbidity in patients with SjD (14 studies; N=67,124).^25
†Based on a systematic review and meta-analysis assessing all-cause mortality risk in patients with SjD (14 studies; N=14,584).^26
‡ESSDAI is a validated systemic disease activity index for patients with SjD. Each of the 12 domains requires a comprehensive evaluation of SjD-related signs and symptoms using detailed definitions to rate the level of activity within each domain.²⁶

EULAR, European Alliance of Associations for Rheumatology.

References: 1. Carsons SE, Patel BC. Sjögren syndrome. StatPearls Publishing; 2025. National Library of Medicine. Updated July 31, 2023. Accessed June 2, 2025. https://www.ncbi.nlm.nih.gov/books/NBK431049/?report=printable 2. Brito-Zerón P, Baldini C, Bootsma H, et al. Sjögren syndrome. Nat Rev Dis Primers. 2016;2:16047. doi:10.1038/nrdp.2016.47 3. Ramos-Casals M, Brito-Zerón P, Bombardieri S, et al. EULAR recommendations for the management of Sjögren's syndrome with topical and systemic therapies. Ann Rheum Dis. 2020;79:3-18. 4. Thalayasingam N, Baldwin K, Judd C, Ng WF. New developments in Sjögren's syndrome. Rheumatology (Oxford). 2021;60(suppl 6):vi53-vi61. 5. Kassan SS, Moutsopoulos HM. Clinical manifestations and early diagnosis of Sjögren syndrome. Arch Intern Med. 2004;164(12):1275-1284. 6. Negrini S, Emmi G, Greco M, et al. Sjögren's syndrome: a systemic autoimmune disease. Clin Exp Med. 2022;22(1):9-25. 7. Maleki-Fischbach M, Kastsianok L, Koslow M, Chan ED. Manifestations and management of Sjögren's disease. Arthritis Res Ther. 2024;26(1):43. 8. Vitali C, Minniti A, Pignataro F, Maglione W, Del Papa N. Management of Sjögren's syndrome: present issues and future perspectives. Front Med (Lausanne). 2021;8:676885. doi:10.3389/fmed.2021.676885 9. Mariette X, Criswell LA. Primary Sjögren's syndrome. N Engl J Med. 2018;378(10):931-939. 10. McCoy SS, Woodham M, Bunya VY, et al. A comprehensive overview of living with Sjögren's: results of a National Sjögren's Foundation survey. Clin Rheumatol. 2022;41(7):2071-2078. 11. Rozis M, Vlamis J, Vasiliadis E, Mavragani C, Pneumaticos S, Evangelopoulos DS. Musculoskeletal manifestations in Sjögren's syndrome: an orthopedic point of view. J Clin Med. 2021;10(8):1574. 12. Flament T, Bigot A, Chaigne B, Henique H, Diot E, Marchand-Adam S. Pulmonary manifestations of Sjögren's syndrome. Eur Respir Rev. 2016;25(140):110-123. 13. André F, Böckle BC. Sjögren's syndrome. J Dtsch Dermatol Ges. 2022;20(7):980-1002. 14. Ramos-Casals M, Brito-Zerón P, Seror R, et al. Characterization of systemic disease in primary Sjögren's syndrome: EULAR-SS task force recommendations for articular, cutaneous, pulmonary and renal involvements. Rheumatology (Oxford). 2015;54(12):2230-2238. 15. Retamozo S, Acar-Denizli N, Rasmussen A, et al. Systemic manifestations of primary Sjögren's syndrome out of the ESSDAI classification: prevalence and clinical relevance in a large international, multi-ethnic cohort of patients. Clin Exp Rheumatol. 2019;37(suppl 118)(3):S97-S106. 16. Stergiou IE, Chatzis LG, Pezoulas VC, et al. The clinical phenotype of primary Sjögren's syndrome patients with lymphadenopathy. Clin Exp Rheumatol. 2022;40(12):2357-2362. 17. Aiyegbusi O, McGregor L, McGeoch L, Kipgen D, Geddes CC, Stevens KI. Renal Disease in primary Sjögren's syndrome. Rheumatol Ther. 2021;8(1):63-80. 18. McCoy SS, Baer AN. Neurological complications of Sjögren's syndrome: diagnosis and management. Curr Treatm Opt Rheumatol. 2017;3(4):275-288. 19. Colafrancesco S, Priori R, Gattamelata A, et al. Myositis in primary Sjögren's syndrome: data from a multicentre cohort. Clin Exp Rheumatol. 2015;33(4):457-464. 20. Ma D, Feng Y, Lin X. Immune and non-immune mediators in the fibrosis pathogenesis of salivary gland in Sjögren's syndrome. Front Immunol. 2024;15:1421436. doi:10.3389/fimmu.2024.1421436 21. Both T, Dalm VASH, van Hagen PM, van Daele PLA. Reviewing primary Sjögren's syndrome: beyond the dryness – from pathophysiology to diagnosis and treatment. Int J Med Sci. 2017;14(3):191-200. 22. Brito-Zerón P, Flores-Chávez A, Horváth IF, et al. Mortality risk factors in primary Sjögren syndrome: a real-world, retrospective, cohort study. EClinicalMedicine. 2023;61:102062. doi: 10.1016/j.eclinm.2023.102062 23. Retamozo S, Brito-Zerón P, Ramos-Casals M. Prognostic markers of lymphoma development in primary Sjögren syndrome. Lupus. 2019;28(8):923-936. 24. Stojan G, Baer AN, Danoff SK. Pulmonary manifestations of Sjögren's syndrome. Curr Allergy Asthma Rep. 2013;13(4):354-360. 25. Beltai A, Barnetche T, Daien C, et al. Cardiovascular morbidity and mortality in primary Sjögren's syndrome: a systematic review and meta-analysis. Arthritis Care Res (Hoboken). 2020;72(1):131-139. 26. Huang H, Xie W, Geng Y, Fan Y, Zhang Z. Mortality in patients with primary Sjögren's syndrome: a systematic review and meta-analysis. Rheumatology (Oxford). 2021;60(9):4029-4038. 27. Seror R, Bowman SJ, Brito-Zerón P, et al. EULAR Sjögren's syndrome disease activity index (ESSDAI): a user guide. RMD Open. 2015;1:e000022. doi:10.1136/rmdopen-2014-000022