Sjogren’s syndrome is an autoimmune disorder that affects the moisture-producing glands in the body. This includes the tear glands and salivary glands, leading to the two hallmark symptoms of Sjogren’s: dry eyes and dry mouth. However, Sjogren’s is a systemic disease that can impact the entire body. One common question among Sjogren’s patients is whether the condition also affects the hands. In this article, we will examine the connection between Sjogren’s syndrome and hand symptoms.
Overview of Sjogren’s Syndrome
Sjogren’s syndrome is named after Swedish ophthalmologist Henrik Sjogren, who first described the condition in 1933. It is one of the most common autoimmune disorders, estimated to impact up to 4 million people in the United States. Women are 9 times more likely to develop Sjogren’s than men. The average age of diagnosis is the late 40s to early 50s.1
With Sjogren’s syndrome, the immune system mistakenly attacks the body’s moisture-producing glands. This includes not only the lacrimal (tear) glands and salivary glands, but also glands throughout the body. When these glands are damaged, they are unable to secrete normal levels of tears, saliva, and other fluids. This leads to the dryness that is the hallmark of Sjogren’s.2
In addition to dry eyes and dry mouth, common symptoms of Sjogren’s include:3
– Fatigue
– Joint pain
– Dry skin
– Digestive issues
– Vaginal dryness
– Respiratory problems
Sjogren’s is divided into two types:
– Primary Sjogren’s – This occurs by itself, not associated with another connective tissue disorder. About half of Sjogren’s cases are primary.
– Secondary Sjogren’s – This form develops in connection with another autoimmune rheumatic disease like rheumatoid arthritis, lupus, or scleroderma.
How Might Sjogren’s Affect the Hands?
The hands contain numerous small glands that contribute to keeping the skin moist and supple. These include eccrine sweat glands that produce sweat and sebaceous glands that secrete oils. In Sjogren’s syndrome, impaired glandular secretions could theoretically lead to dryness and other problems in the hands.
Some common hand complaints associated with Sjogren’s include:
– Dry, cracked skin
– Itching or stinging sensations
– Skin rashes
– Numbness, tingling, or pain
– Stiffness, swelling, and restricted movement
– Raynaud’s phenomenon (fingers turning white, blue, or red in response to cold temperatures or stress)
– Small bumps under the skin
– Increased susceptibility to eczema or warts on the hands
The dryness associated with Sjogren’s can cause the skin on the hands to become irritated and itchy. Lack of protective oils and moisture normally provided by glands may allow the development of rashes or cracking.
For some Sjogren’s patients, impaired circulation and nerve dysfunction in the hands can lead to numbness, pain, and Raynaud’s phenomenon. Joint inflammation and swelling related to Sjogren’s can also restrict finger movement.
Raynaud’s Phenomenon
Raynaud’s phenomenon is seen in about 20% of people with primary Sjogren’s.4 With Raynaud’s, vasospasms cause the small arteries in the fingers (and sometimes toes, ears, nose, or lips) to narrow sharply. This disrupts blood flow, causing the skin to turn pale or bluish, often in response to cold temperature or stress. The affected areas may also burn, sting, or feel numb.
While Raynaud’s can be primary on its own, it often develops secondarily in association with autoimmune disorders like Sjogren’s. Impaired nerve signals and circulatory dysfunction are believed to play a role in Raynaud’s linked to Sjogren’s. Managing the underlying autoimmune condition may help improve associated Raynaud’s symptoms.
Neuropathy
Up to 20% of Sjogren’s patients experience peripheral neuropathy, or nerve damage affecting the extremities.5 Small fiber sensory neuropathy is one of the most common neurological manifestations. This causes burning, tingling, numbness, and pain, most often in the hands and feet.
The neuropathy associated with Sjogren’s is believed to stem from inflammation-driven nerve damage. Autonomic neuropathy affecting the nerves that control involuntary bodily functions can also develop. This may contribute to Raynaud’s phenomenon and digestive issues. Controlling inflammation is key to managing neurological symptoms of Sjogren’s.
Diagnosing Sjogren’s Hand Involvement
To confirm that hand symptoms are related to Sjogren’s syndrome, a rheumatologist will perform a full medical evaluation. Key diagnostic tests include:
Blood Tests
Many Sjogren’s patients have elevated levels of autoantibodies like anti-SSA, anti-SSB, and rheumatoid factor. These biomarkers can help support a Sjogren’s diagnosis.
Imaging
X-rays or ultrasound may help detect joint inflammation and damage. Nerve conduction studies check for peripheral neuropathy.
Labial Salivary Gland Biopsy
Examining a minor salivary gland from the lip can reveal lymphocytic infiltration, a hallmark sign of Sjogren’s.
Tear Production
Measuring tear production with Schirmer strips helps confirm tear gland involvement.
Salivary Flow
Sialometry assesses salivary gland impairment by measuring unstimulated saliva production.
Sjogren’s Hand Symptoms and Treatments
The main medication treatments for Sjogren’s aim to alleviate dryness, modulate the immune system, and control inflammation and pain. Options may include:
Artificial Tears and Moisturizers
Frequent application of ocular lubricants relieves dry eye symptoms. Thick moisturizing creams and ointments soothe dry skin on the hands.
Cholinergics
Medications like pilocarpine promote saliva and tear production by stimulating gland activity.
Disease-Modifying Antirheumatic Drugs (DMARDs)
Immunosuppressants like hydroxychloroquine and methotrexate help control inflammation and may protect glands.
Biologics
TNF alpha inhibitors adalimumab and infliximab can reduce immune system overactivity.
Immunosuppressants
Drugs like azathioprine, cyclosporine, and cyclophosphamide limit the function of overactive immune cells.
Steroids
Short-term corticosteroids relieve inflammation but have significant side effects with prolonged use.
Pain Medications
NSAIDs treat joint/muscle pain. Low doses of gabapentin or pregabalin help neuropathic pain.
Vasodilators
Calcium channel blockers can improve blood flow in Raynaud’s.
Lifestyle measures like moist heat, stress reduction, and gloves for Raynaud’s can also help manage Sjogren’s hand symptoms.
Key Takeaways
In summary, while dry eyes and dry mouth are the hallmark features of Sjogren’s syndrome, many patients also experience hand problems due to impaired gland function and inflammation. Common hand complaints include:
– Dry, cracked, or itchy skin
– Rashes
– Numbness and pain
– Stiffness and swelling
– Raynaud’s phenomenon
Sjogren’s-related neuropathy and circulatory dysfunction contribute to these symptoms. Diagnosing Sjogren’s requires blood tests, lip biopsy, and evaluation of tear and saliva production. Treatments aim to control dryness, immune system dysfunction, inflammation, and pain. Ongoing management helps most Sjogren’s patients live well despite hand discomforts.
References
1. Rasmussen A, Ice JA, Li H, Grundahl K, Kelly JA, Radfar L, Stone DU, Scofield RH, Sivils KL, Farris AD, Segal B, Rohrer M, Lessard CJ, Harley JB, Sjögren’s International Collaborative Clinical Alliance Research Groups. Comparison of the American-European Consensus Group Sjogren’s syndrome classification criteria to newly proposed American College of Rheumatology criteria in a large, carefully characterised sicca cohort. Ann Rheum Dis. 2014 Jan;73(1):31-8. doi: 10.1136/annrheumdis-2013-203845. Epub 2013 Oct 14. PMID: 24131684; PMCID: PMC3872654.
2. Nocturne, G., Mariette, X. Sjögren Syndrome: An Update on Its Pathogenesis. F1000Research 7 (2018): F1000 Faculty Rev-1167. PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6096574/
3. NHS Inform. Sjögren’s syndrome. https://www.nhsinform.scot/illnesses-and-conditions/immune-system/sjogrens-syndrome
4. García-Carrasco M, Ramos-Casals M, Rosas J, Pallarés L, Calvo-Alen J, Cervera R, Font J, Ingelmo M. Primary Sjögren syndrome: clinical and immunologic disease patterns in a cohort of 400 patients. Medicine (Baltimore). 2002 Jul;81(4):270-80. doi: 10.1097/00005792-200207000-00004. PMID: 12169883.
5. Gøransson LG, Herigstad A, Tjensvoll AB, Harboe E, Mellgren SI, Omdal R. Peripheral neuropathy in primary Sjögren syndrome: a population-based study. Arch Neurol. 2006 Dec;63(12):1612-5. doi: 10.1001/archneur.63.12.1612. PMID: 17172606.