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Dehydration and Sjogren’s syndrome

Sjogren’s syndrome is an autoimmune disease that affects various parts of the body, especially the glands that produce saliva and tears [1]. For people with Sjogren’s syndrome, the symptoms can make them feel like they are constantly dehydrated. We decided to look into the scientific literature about the links between Sjogren’s syndrome and dehydration.

 

Sjogren’s syndrome arises when certain immune cells mistake the body’s own cells for foreign intruders and begin to attack them [1]. Sjogren’s syndrome can lead to attacks on many kinds of cells, but they most commonly target cells in salivary glands, which produce spit, and lacrimal glands, which produce tears [1]. Although this sounds like it should just mean someone doesn’t have to worry about dribbling or emotional films, it’s actually a lot more complex. 

 

crying baby with tears

 

Saliva has a much more important role than simply spitting! Saliva contains a range of electrolytes, sugars and enzymes that help us speak and eat, and that protect the mouth from infection [2][3][4]. Tears similarly aren’t just for crying [5][6]. A layer of tear fluid over the outer surface of the eye helps keep the eye well-lubricated in its socket as it moves around, and helps the eye fight off infection [5]. In many with Sjogren’s syndrome, as glands are attacked and destroyed they don’t produce enough of these fluids to keep everything nice and moist. This can lead to a range of problems: eye infections, mouth infections, ulcerations of the eye and mouth, dental cavities and a weakened voice [2][3][4][5][6]. 

 

In many ways, dehydration mimics certain aspects of Sjogren’s syndrome. Dehydration is not just when you don’t have the right amount of water, but also when you don’t have the right balance of electrolytes. Dehydration mimics the dry mouth and dry eyes of Sjogren’s to such a degree that doctors will often use how dry our mouth is as a marker of our overall hydration. 

 

lips

 

We’ve all known that dry-mouth feeling that tells us we’re in need of a glass of water to top us back up to hydrated. Similarly, when we’re dehydrated our eyes can start to feel scratchy and uncomfortable, especially in hot and dry environments. Dehydration and Sjogren’s syndrome can also be similar in the gut, with both having the potential to lead to stomach pain and crampy bloating as the gut struggles to push food through without enough water [2]. However, it’s still unclear exactly what is contributing to this in Sjogren’s. It could be a problem with the lining of the gut, or it could be related to the abnormally high immune system activity. 

 

There is much we can learn about our day-to-day hydration from the treatment of Sjogren’s syndrome. To be sure, directly compare dehydration and Sjogren’s syndrome risks undermining the severity of this potentially disabling disease. We should be clear that Sjogren’s syndrome is worse than simple dehydration, and is a chronic condition rather than simply being a glass of water away from being solved. However, we can learn a lot about what kind of factors can dehydrate us, and what we can do to rehydrate ourselves. 

 

Sjogren’s syndrome is often treated with lubricating eye drops and with artificial saliva to make swallowing and speaking easier. Drugs that stimulate the salivary glands can be helpful [5][7][8]. But for day-to-day hydration, no one is suggesting we all start pumping our mouths full of fake spit. For those of us without Sjogren’s, a dry mouth is just the result of being dehydrated, which we can easily fix. Those with Sjogren’s will produce less saliva than someone without the condition, no matter how well-hydrated they are. 

 

eye of a man

 

But we can learn about lifestyle choices, people with Sjogren’s make, to ease their symptoms. Many avoid triggers such as prolonged reading, prolonged screen time or other activities where forgetting to blink can lead to dry-eye discomfort [5]. If possible, they avoid certain drugs such as tricyclic antidepressants, which can dry eyes by reducing the amount of tear fluid they make [5]. To help keep their mouths as comfortable and hydrated as possible, many are advised to abstain from irritating substances such as coffee, alcohol, and nicotine [5]. 

 

So clearly, we can see there are some lessons to be learned from how Sjogren’s patients handle their symptoms. There is evidence that treating dehydration directly where it occurs improves symptoms temporarily. For example, several studies show using water vapor to artificially hydrate the mouth and throat leads to improvements in the quality of speech production [9][10].

 

But for those of us without problems producing fluids, the answer isn’t to carry around a flask of water vapor to breathe. Quite simply, the best way for most of us to avoid the problems of dry mouth, dry eyes, and upset stomachs is to make sure we stay hydrated. Meanwhile, keep in mind it’s not just a case of keep ourselves topped up with water, but also with important electrolytes that make up saliva and tear fluid, and help prevent crampy feelings in the gut. 

 

So Sjogren’s syndrome is an autoimmune disease that leads to those experiencing it feeling constantly dehydrated in many of the normally wet surfaces of their body. Although many of the treatments of Sjogren’s are beyond what someone might normally need, we can all learn to avoid dehydrating triggers and make sure that we keep ourselves topped up where we can.

 

Please seek advice from your doctor before making any changes to your diet or lifestyle, especially if they have previously advised you on your diet, fluid intake, or lifestyle. 

 

Is your routine dehydrating?

 

Some of us have more dehydrating routines than others, take our quiz to find out if you are meeting your hydration needs daily.

 


  
Writer: Alex Rowe
Alex Rowe researches in the Department of Pharmacology at the University of Oxford. His research examines the handling of electrolytes by the heart, how this can go wrong in certain diseases.
 
 

References

 

[1] Shen, L., Suresh, L., Lindemann, M., Xuan, J., Kowal, P., Malyavantham, K. and Ambrus Jr, J.L., 2012. Novel autoantibodies in Sjogren's syndrome. Clinical immunology, 145(3), pp.251-255.
[2] Slieikh, S.H. and Shaw-Stiffel, T.A., 1995. The gastrointestinal manifestations of Sjögren's syndrome. American Journal of Gastroenterology, 90(1).
[3] Hradský, M., Hybášek, I., Černoch, V., Sazmova, V. and Juran, J., 1967. . Scandinavian journal of gastroenterology, 2(3), pp.200-203.
[4] Ohashi, Y., Dogru, M. and Tsubota, K., 2006. Laboratory findings in tear fluid analysis. Clinica chimica acta, 369(1), pp.17-28.
[5] Thanou-Stavraki, A. and James, J.A., 2008, April. Primary Sjogren’s syndrome: current and prospective therapies. In Seminars in arthritis and rheumatism (Vol. 37, No. 5, pp. 273-292). WB Saunders.
[6] Villani, E., Galimberti, D., Viola, F., Mapelli, C. and Ratiglia, R., 2007. The cornea in Sjogren’s syndrome: an in vivo confocal study. Investigative ophthalmology & visual science, 48(5), pp.2017-2022.
[7] Yerxa, B.R., Rideout, J.L. and Jones, A.C., Inspire Pharmaceuticals, 2002. Method of promoting mucosal hydration with certain uridine, adenine and cytidine diphosphates and analogs thereof. U.S. Patent 6,436,910.
[8] Ramos-Casals, M., Brito-Zerón, P., Siso-Almirall, A., Bosch, X. and Tzioufas, A.G., 2012. Topical and systemic medications for the treatment of primary Sjögren's syndrome. Nature Reviews Rheumatology, 8(7), p.399.
[9] Tanner, K., Roy, N., Merrill, R.M., Kendall, K., Miller, K.L., Clegg, D.O., Heller, A., Houtz, D.R. and Elstad, M., 2013. Comparing nebulized water versus saline after laryngeal desiccation challenge in Sjögren's Syndrome. The Laryngoscope, 123(11), pp.2787-2792.
[10] Tanner, K., Nissen, S.L., Merrill, R.M., Miner, A., Channell, R.W., Miller, K.L., Elstad, M., Kendall, K.A. and Roy, N., 2015. Nebulized isotonic saline improves voice production in S jögren's syndrome. The Laryngoscope, 125(10), pp.2333-2340.


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