A HANDBOOK ON THE NEUROLOGICAL COMPLICATIONS OF SJÖGREN'S SYNDROME
Por Julius Birnbaum, MD
Johns Hopkins Neurology and Rheumatology Clinic
The neurological complications of Sjögren's syndrome are extensive, ranging from cognitive difficulties to burning pain in the toes and feet.
Introduction to the Nervous System
The nervous system is divided into two anatomical compartments:
- Los"CcentralnorteervosoSsystem” – theSNC– includes the brain and spinal cord;
- Los"PperipheralnorteervosoSsystem” – theSNP–includes major and minor nerves, which connect muscles to the spinal cord.
Sjögren's syndrome can cause inflammation and damage in both the CNS and PNS.
Sjögren's Syndrome Peripheral Neuropathy
What is neuropathy?
Neuropathy, which means inflammation and/or damage to the peripheral nerves, can affect patients with Sjögren's syndrome. Neuropathy can cause a variety of symptoms, from “numbness” to “cold”; In its most severe form, the neuropathy has been described as "burning", "narrowing" or "feeling like my skin is on fire". Neuropathy can also cause weakness and clumsiness.
How does my doctor diagnose neuropathy?
The first step is to take a careful history and perform a physical exam. The pattern and description of symptoms, which may include pain and weakness, may suggest peripheral nerve damage. A neurological examination is crucial to provide objective evidence of peripheral neuropathy. There may be weakness, which is usually greater in the fingers and toes than in the larger muscle groups of the arms and legs. Your doctor can test your reflexes. Normally, a reflex hammer should elicit emphatic movements of the arms and legs. However, patients with neuropathy may not have any reflexes. Your doctor may also test your ability to appreciate temperature, a sharp pin, and vibration. If the neurological exam confirms peripheral neuropathy, you may have a nerve conduction test to check the integrity of the nerves and muscles.
Why is neuropathy underdiagnosed or undertreated in Sjögren's syndrome?
1. Sjögren's syndrome can only affect nerves that are not tested in normal nerve conduction tests.
Neuropathy can affect nerves of greater or lesser caliber, called "large fiber" neuropathy and "small fiber" neuropathy, respectively. Symptoms of long fiber neuropathy include weakness and poorly localized numbness and are associated with abnormal nerve conduction tests. On the other hand, patients with small fiber neuropathy may experience symptoms of pain, burning, and tingling even without weakness. The nerve conduction test is only sensitive to damage to large nerve fibers. and does not detect anomalies in smaller nerves.
At Johns Hopkins, we obtain skin biopsies when patients with symptoms of small fiber neuropathy have normal nerve conduction tests. Skin biopsy allows the doctor to assess damage to the small sensory nerve fibers that innervate the skin. This is an excellent marker of small sensory fiber neuropathy, common in patients with Sjögren's syndrome.
2. The lack of definitive blood tests
Sjögren's syndrome is an example of an autoimmune syndrome. In autoimmune disorders, the immune system, which normally protects the body from infections and cancers, can cause damage to the body's own tissues. In addition to the nervous system, organs that can be affected by Sjögren's syndrome include the eyes, lungs, heart, kidneys, and joints. Many patients with Sjögren's syndrome have autoantibodies, which attach to cells and tissues in the body's organs. Some examples of autoantibodies in Sjögren's syndrome include anti-Ro (or SS-A antibodies) and anti-La (or SS-B antibodies).
However, more than 50% of patients with neurological manifestations of Sjögren's syndromecouldn'thave autoantibodies. In patients with neuropathy and convincing glandular symptoms of dry eyes and dry mouth, negative blood tests for SS-A and SS-B antibodies do not exclude the diagnosis of Sjögren's syndrome. Against the background of sicca symptoms, additional diagnostic studies are needed, including a Schirmer's test and a minor salivary gland biopsy.
What other neuropathies can occur with Sjögren's syndrome?
1. Autonomic neuropathy
Sjögren's syndrome can cause damage to the nerves that regulate the coordination of heartbeat, breathing and gastric motility. This is called "autonomic neuropathy". Examples of symptoms include dizziness when standing up, decreased or increased sweating, and feeling full despite eating small meals. The diagnosis of autonomic neuropathy should be made by a neuromuscular specialist.
2. Trigeminal neuralgia and glossopharyngeal neuralgia
Sjögren's syndrome can cause numbness or burning in the face, called "trigeminal neuralgia". Pain in the back of the throat, which may be worse when swallowing, is called "glossopharyngeal neuralgia". Patients with trigeminal or glossopharyngeal neuralgia may experience agonizing pain in the mouth and face. These neuropathies can coexist with other neuropathies in different parts of the body. For example, up to 20% of patients with “small fiber” neuropathy may also have trigeminal neuropathy.
Medications that can help relieve the symptoms of small fiber neuropathy can also be effective in trigeminal neuralgia. These medications can include a class of agents commonly used to treat seizures and include gabapentin, topiramate, and pregabalin. In seizure disorders, irregular, paroxysmal bursts of electrical activity in nerves in the brain can cause seizures to spread. Likewise, in Sjögren's neuropathy, irritating electrical signals produced by nerves in the skin rather than the brain may similarly contribute to pain. Just as anticonvulsant medications can dampen the electrical activity of brain cells, dampening the electrical activity produced by pain fibers can ease burning pain. It is important to note that using these symptomatic medications does not treat the neuroinflammation that may be contributing to the neuropathy. In these cases, the judicious use of immunosuppressive drugs should be considered.
3. Mononeuritis multiplex
“Mononeuritis multiplex” refers to severe patterns of weakness or clumsiness that cause weakness or paralysis of different muscles. These more cataclysmic episodes of numbness or weakness require extensive diagnostic evaluation, both by nerve conduction testing and often by nerve and/or muscle biopsy. Mononeuritis multiplex occurs when there is inflammation of small blood vessels. The muscles and nerves fed by these blood vessels can be deprived of oxygen and nutrients, and it is similar to "nervous system shock". In such cases, the improvement of pain symptoms is not enough: immunosuppressive therapy is always justified in cases of mononeuritis multiplex.
The recovery rate from mononeuritis multiplex can be frustratingly slow. In some cases, it can be difficult to determine if the slow rate of recovery is a manifestation of the slow healing and "reconnection" process or if it is due to ongoing and ineffectively treated inflammation. In such cases, repeat nerve conduction tests may be important. Immunosuppressive drugs that may be used in the mononeuritis multiplex pattern include cyclophosphamide, azathioprine, and prednisone.
How is Sjögren's syndrome neuropathy treated?
In general, a neurologist and/or rheumatologist should determine the “pattern” of the neuropathy (ie, mononeuritis multiplex versus small fiber neuropathy). The distinction between these patterns is of paramount importance, due to the distinction of mechanisms that may require different therapeutic strategies. The pain of neuropathy can be especially severe and may require different pain relievers and antiseizure medications. However, symptomatic pain management should not preclude the institution of drugs to dampen the immune system when there is evidence of ongoing neuroinflammation.
CNS or Central Nervous System Complications of Sjögren's Syndrome
Patients with Sjögren's syndrome may have "myelitis", which is an inflammation of the spinal cord. Myelitis can cause weakness, numbness, and difficulty urinating and/or having a bowel movement. Myelitis can come on quickly (ie, within a few hours). However, symptoms due to spinal cord inflammation may progress more slowly, progressing over weeks or months. This slower progression can be difficult to distinguish from multiple sclerosis (MS). Unfortunately, patients with myelitis and Sjögren's syndrome can be misdiagnosed as having MS. Appropriate tests, which may include a lumbar puncture and an MRI of the brain/spinal cord, can lead to diagnostic clarity. The importance of accurately distinguishing between multiple sclerosis and Sjögren's syndrome is paramount. MS and Sjögren have completely different treatments. Approved treatments for MS are ineffective for Sjögren's syndrome and can actually cause "flare-ups" or worsening of Sjögren's syndrome.
Patients with Sjögren's syndrome may have another autoimmune disorder called "Devic's syndrome" or "neuromyelitis optica". Neuromyelitis optica (NMO) causes inflammation of the nerves that connect the eye to the brain, or "optic neuritis", as well as myelitis. The pattern of myelitis that can occur in neuromyelitis optica is very different from that in multiple sclerosis. Typically, the myelitis in neuromyelitis optica is more severe, causing severe weakness and may lead to future relapses.
Again, the treatment of neuromyelitis optica is very different from that of MS. Patients with Sjögren's syndrome diagnosed with MS should be skeptical about receiving these dual diagnoses. Here is some helpful advice, which may cast doubt on the diagnosis of MS.
Red flags for a diagnosis of neuromyelitis optica
Answering "yes" to the following questions should lead to special consideration for the diagnosis of neuromyelitis optica.
(1) Were the myelitis episodes especially severe (ie, associated with an inability to lift arms or legs in the air)?
(2) Were there multiple relapses?
(3) Have myelitis episodes been associated with “optic neuritis” or inflammation of the nerves that connect the eye to the brain?
(4) Did MRIs of the spine show inflammation that extends beyond the three “back bones” or vertebral bodies?
Any patient with Sjögren's syndrome who has a history of myelitis and who answers "Yes" to the above questions should have a blood test which can help diagnose neuromyelitis optica. The name of this blood test is NMO-IgG antibody and it is performed at the Mayo Clinic. It detects neuromyelitis optica in 70 percent of cases. This means that it is not a perfect blood test and will be negative in 30% of cases. In such cases, consultation with a neurologist trained in neuroimmunological diseases is essential.
Red flags against a diagnosis of primary progressive multiple sclerosis
Multiple Sclerosis is not a single disease, but has different presentations with different progressions. The most common type of MS is called “lapping-remitting” MS and is characterized by episodes of distinct deterioration (called “flares”), versus periods of marked improvement and inactive disease. However, a different type of MS can be confused with Sjögren's syndrome. This pattern is called “primary progressive” MS. In these cases, the waxing and waning typical of “relapsing-remitting” MS is not apparent. Instead, there may be a period of slower, more gradual deterioration, reflecting inflammation and damage to the spine (ie, progressive myelitis).
Patients with Sjögren's syndrome who receive a dual diagnosis of primary progressive MS must be especially vigilant against misdiagnosis of the diagnosis. Specifically, there is no effective treatment for primary progressive MS. Any patient with Sjögren's syndrome diagnosed with primary progressive MS deserves a trial of immunosuppressive medication, which may be helpful if progressive myelitis occurs due to Sjögren's syndrome.
It is often difficult to distinguish between primary progressive MS and Sjögren's syndrome. Patients with Sjögren's syndromeMayothey have less brain disease on MRI compared with patients with primary progressive MS. In addition, patients with Sjögren's syndromeMayothey have smaller amounts of protein in the cerebrospinal fluid, called "oligoclonal" bands. Therefore, any Sjögren patient diagnosed with primary progressive MS should undergo brain MRI as well as lumbar puncture.
The most common CNS complications of Sjögren's syndrome include myelitis and optic neuritis, which are syndromes that can occur in MS. Because of this symptomatic overlap, patients with Sjögren's syndrome may be misdiagnosed as having MS. Because MS treatments are not only ineffective for Sjögren's syndrome, but can actually precipitate flare-ups of Sjögren's disease, it is crucial to accurately distinguish between MS and Sjögren's syndrome. When the myelitis is particularly severe, associated with optic neuritis, or involves extensive regions of the spine, the diagnosis of Neuromyelitis Optica should be considered. Spinal taps and MRIs of the brain can help distinguish between primary progressive MS and Sjögren's syndrome. All patients with myelitis in the context of Sjögren's syndrome deserve a trial of immunosuppressive therapy.
The observed neurological symptoms include paresis of limbs, aphasia, ataxia, and internuclear ophthalmoplegia; their course is chronic, relapsing-remitting, similar to multiple sclerosis (MS).Can Sjogren's disease affect the brain? ›
Sjögren's syndrome (SS) is a rheumatic disease that may include central nervous system (CNS) complications, including demyelinating diseases that can affect the brain and the spinal-cord.What does Sjogren's neuropathy feel like? ›
Sjögren patients can suffer from severe neuropathic pain, with small-fiber neuropathy causing lancinating or burning pain which can disproportionately affect the proximal torso or extremities, and the face (ie, in a "non-length-dependent distribution").How is Sjogren's neuropathy treated? ›
Neurological manifestations of primary Sjogren's syndrome appear to be wide ranging. Treatment is recommended for those with progressive neurological impairment: usually immunosuppressive treatments including cyclophosphamide, steroids, azathioprine, and anti-TNF agents.What are the symptoms of Sjogrens nerve? ›
Sjogren's (SHOW-grins) syndrome is a disorder of your immune system identified by its two most common symptoms — dry eyes and a dry mouth. The condition often accompanies other immune system disorders, such as rheumatoid arthritis and lupus.What are red flags in neurological examination? ›
The three most important 'red flag' symptoms that indicate that a patient may need neuro-ophthalmological assessment are: Sudden onset of double vision (diplopia) Headache accompanied by vision loss (without an ocular cause) Visual loss after ocular causes have been excluded.What is the cognitive impairment with Sjogren's syndrome? ›
Global cognitive impairment in Sjögren's
Most patients experience “brain fog” symptoms, which manifest as memory lapses, forgetfulness, mental confusion, and difficulties in concentrating, organizing, or anticipating future events.
Association between Sjögren's syndrome and dementia
The overall pooled results showed that SS was associated with an increased risk of dementia (HR = 1.24, 95% CI: 1.15–1.33, p < 0.001).
Neuropathic pain in patients with primary Sjögren's syndrome is typically treated with gabapentin, pregabalin, or duloxetine, which are associated with less dryness of the mouth and eyes than small doses of amitriptyline.Can Sjogren's affect your legs? ›
Sjögren's syndrome can also cause swollen or painful joints, muscle pain or weakness, dry skin, rashes, brain fog (poor concentration or memory), numbness and tingling sensations in the arms and legs due to nerve involvement, heartburn, kidney problems and swollen lymph nodes.
A wide variety of nervous system complications are characteristic features of Sjogren's syndrome, of which peripheral neuropathy — damage of the peripheral nerves — is a major one. Peripheral neuropathy can cause weakness, numbness, and pain, usually in the hands and feet.How does Sjogren's affect the hands? ›
In Sjögren syndrome, extraglandular involvement may result in painful inflammation of the joints and muscles; dry, itchy skin and skin rashes; chronic cough; a hoarse voice; kidney and liver problems; numbness or tingling in the hands and feet; and, in women, vaginal dryness.What vitamins help with Sjögren's syndrome? ›
Since antioxidants like omega-3 fatty acids and vitamin E in the diet may improve symptoms of dry mouth and inflammation, focus on having more salmon and other fatty fish, as well as nuts and oils to help improve symptoms over time.What can make Sjogrens worse? ›
Caffeinated drinks and alcohol can dry your mouth, and you should avoid them. You should also avoid spices and acidic foods such as citrus, as these can irritate a dry, sore mouth.Can Sjogren's be debilitating? ›
Over time, the immune system for people with Sjogren's syndrome can damage other parts of your body, including joints, nerves, skin, and organs such as kidneys, liver, and lungs. These long-term consequences can be quite debilitating.Can Sjogren's cause neuropathy? ›
Sensory peripheral neuropathy has been recognized among patients with Sjögren's syndrome with reported rates of peripheral neuropathy between 1.6 and 31% when analyzing patients with Sjögren's syndrome in general (21–25).What is the root cause of Sjogren's syndrome? ›
A person who develops Sjögren's syndrome most likely inherits the risk from one or both of their parents, but in addition, there's been some sort of environmental impact—such as a viral or bacterial infection—that causes it to become active.What organs does Sjogren's affect? ›
The disorder can affect the nervous system, muscles, joints, kidneys, lungs, blood vessels, liver, and pancreas. Sjögren's syndrome is a long-lasting disorder that affects females more often than men.What are two signs that would indicate the nervous system has been damaged? ›
- Persistent or sudden onset of a headache.
- A headache that changes or is different.
- Loss of feeling or tingling.
- Weakness or loss of muscle strength.
- Loss of sight or double vision.
- Memory loss.
- Impaired mental ability.
- Lack of coordination.
Common presenting complaints-headache, nausea/vomiting, dizziness, loss of concentration, disorientation, irritability, memory loss. Changes in neurological state can be rapid and dramatic or subtle, developing over minutes, hours days, weeks or even longer.
Numbness, tingling, weakness, or inability to move a part or all of one side of the body (paralysis). Dimness, blurring, double vision, or loss of vision in one or both eyes. Loss of speech, trouble talking, or trouble understanding speech. Sudden, severe headache.Can sjogrens cause brain atrophy? ›
Conclusion: Patients with primary Sjögren syndrome have WMHIs and gray and white matter atrophy, probably related to cerebral vasculitis.How do you get rid of brain fog from Sjogren's? ›
Being mentally active
Exercising is a good way to keep “brain fog” at bay. Take an active part in daily activities, interact with people, and socialize. Learning new skills and reading books are great ways to keep the brain active.
Many patients remain stable in stages I or II for as long as 10 or 20 years. Therefore, we can assume that there are factors which trigger patients in stages I or II to progress to stages II or III and that only those patients who have such factors progress from stages I or II to stages II or III, respectively.What are the long term effects of Sjogren's syndrome? ›
If Sjögren's syndrome isn't treated appropriately, significant, long-term complications could result that affect your eyes, mouth, lungs, kidneys, liver or lymph nodes — complications including blindness, significant dental destruction and non-Hodgkin lymphoma.Can Sjogren's cause ataxia? ›
Primary Sjogren's syndrome patients commonly develop ataxia, which is a lack of voluntary coordination of muscle movements that includes gait abnormalities. But this is usually not associated with cerebellar atrophy, which takes place in the area of the brain responsible for muscle coordination and balance.What is the long term prognosis for Sjogren's syndrome? ›
Life expectancy in primary Sjogren's syndrome is comparable to that of the general population, but it can take up to seven years to correctly diagnose Sjogren's. Although life expectancy is not typically affected, patients' quality of life is, and considerably.What is the best medicine for Sjögren's syndrome? ›
Hydroxychloroquine (Plaquenil), a drug designed to treat malaria, is often helpful in treating Sjogren's syndrome. Drugs that suppress the immune system, such as methotrexate (Trexall), also might be prescribed.What medications trigger sjogrens? ›
These medications include:
- tricyclic antidepressants such as amitriptyline (Elavil) and nortriptyline (Pamelor)
- antihistamines such as diphenhydramine (Benadryl) and cetirizine (Zyrtec)
- oral contraceptives.
- blood pressure medications.
Avoid over-the-counter medicines that can cause dryness. These include antihistamines, such as Benadryl.
Sjogren's shares several characteristics with other autoimmune disorders affecting the joints and may accompany autoimmune disorders including rheumatoid arthritis and lupus. Generalized pain may lead to individuals being limited in motor functioning. Fatigue and weakness are other common symptoms.Can Sjogren's affect your tendons and ligaments? ›
It primarily affects the moisture producing glands in the mouth and eyes. However, because Sjogren's is a rheumatic disease it can also affect the joints, tendons, ligaments, bones and muscles causing pain, swelling, redness and interfere with function.What joints hurt with Sjogren's? ›
In Sjögren's syndrome, this type of arthritis usually affects the fingers, wrists and ankles. The shoulders, hips and knees may also be painful. Some patients with Sjögren's syndrome may have joint paint as a result of fibromyalgia.What nerve pain is Sjogren's syndrome? ›
A wide variety of nervous system complications are characteristic features of Sjögren's syndrome. Small fiber neuropathy — damage to the peripheral nerves — is a major one. Peripheral neuropathy can cause weakness, tingling, burning, and pain, usually in the hands and feet.What is the best body lotion for Sjogren's syndrome? ›
Lotions are not typically moisturizing enough for patients with Sjögren's. The best ointments are Vaseline® or Aquaphor®. If an ointment is too greasy for your taste, cream moisturizers like CeraVe®, VanicreamTM, Eucerin®, or Aveeno®can be used.Can Sjogren's affect the ears? ›
Most patients display the typical mucosal dryness. Ear lesions, leading to severe sensorineural hearing loss may be an early manifestation of SS, even if it is also a less common feature of other autoimmune disorders such as systemic lupus erythematosus (SLE) and rheumatoid arthritis.How often does Sjogren's turn into lymphoma? ›
Research shows people with Sjögren's syndrome are about 5 times more likely to get non-Hodgkin lymphoma than people who do not have the condition. But the chances of getting it are still small. See a GP if you have symptoms of non-Hodgkin lymphoma, such as: painless swollen glands, usually in your neck, armpit or groin.Does Sjogren's affect muscles? ›
Muscle involvement is one of the clinical features of Sjögren's syndrome. The frequency of muscle changes is estimated at 3 % . IBM, dermatomyositis and polymyositis belong to the forms of immune-mediated myositis . In most cases, the symptoms of dryness precede the symptoms of IBM.How does hydroxychloroquine help Sjogren's? ›
It's used in people with Sjogren's syndrome, rheumatoid arthritis, and lupus to relieve joint pain, fatigue, and rashes. It may take up to 12 weeks for you to notice the effects of hydroxychloroquine. Hydroxychloroquine is safe, even for pregnant women with Sjogren's syndrome.What is an alternative to Plaquenil for Sjogren's? ›
Immunosuppressant drugs: These are stronger than Plaquenil and actually decrease (or suppress) immune system activity rather than just calm it down. These medicines are called immunosuppressants. They include methotrexate, mycophenolate mofetil, azathioprine, and cyclophosphamide.
A list of homeopathic medicines which have shown advantageous effects in Sjogren's syndrome is Bryonia, Alumina, Ammonium carb, Pulsatilla, Antimonium crudum, Nux Moschata, etc. For individualized remedy choice and treatment, the patient has to seek advice from an experienced homeopathic doctor in person.Are there any natural remedies for Sjogren's syndrome? ›
9 Sjögren's Syndrome Self-Care Tips
Use natural eye drops to relieve dry eyes. Soothe dry lips with natural lip balms. Drink tea with lemon, honey and cinnamon oil. Use a humidifier to add moisture to your home.
The observed neurological symptoms include paresis of limbs, aphasia, ataxia, and internuclear ophthalmoplegia; their course is chronic, relapsing-remitting, similar to multiple sclerosis (MS).What are the symptoms of Sjögren's neuropathy? ›
Sjögren patients can suffer from severe neuropathic pain, with small-fiber neuropathy causing lancinating or burning pain which can disproportionately affect the proximal torso or extremities, and the face (ie, in a "non-length-dependent distribution").Does Sjogren's cause exhaustion? ›
The prevalence of fatigue in primary Sjögren's syndrome (pSS) is approximately 65-70%, and often reported as the most debilitating symptom (6). Next to pain and dryness, fatigue was one of the most common complaints that the patients would like to have improved (7).How do you fight fatigue with Sjogren's syndrome? ›
- Stay hydrated. Dehydration can contribute to mental and physical fatigue. ...
- Eat well. ...
- Get physically active. ...
- Get mentally active. ...
- Get adequate amounts of sleep.
Jonas: Well, like all autoimmune diseases, patients who feel stressed or are under unusual stress will often have exacerbation of their symptoms.Can Sjogren's syndrome cause brain lesions? ›
Large tumefactive brain lesions are a complication of pSS. Sjögren syndrome is an autoimmune disorder that may be primary or secondary to other connective tissue diseases. It is characterized by lymphocytic infiltration and destruction of salivary and lachrymal glands leading to xerostomia and xerophthalmia.What body system does Sjogren's affect? ›
The disorder can affect the nervous system, muscles, joints, kidneys, lungs, blood vessels, liver, and pancreas. Sjögren's syndrome is a long-lasting disorder that affects females more often than men.Can sjogrens be mistaken for MS? ›
Background: Primary Sjögren's syndrome (SS) with central nervous system involvement and antiphospholipid syndrome have been reported to mimic multiple sclerosis (MS). SS has also been found in patients diagnosed with definite MS.
MRI of patients with primary Sjögren syndrome has shown multiple areas of increased signal intensity in the periventricular and subcortical white matter (WM) on FLAIR and T2-weighted images [7–10]. These findings have been observed in both patients with and those without CNS impairment [7–10].How severe can Sjogren's get? ›
Sjogren's comes with serious complications if left untreated, including: an increased risk of lymphoma and multiple myeloma. oral yeast infections. dental cavities.Can sjogrens be debilitating? ›
Over time, the immune system for people with Sjogren's syndrome can damage other parts of your body, including joints, nerves, skin, and organs such as kidneys, liver, and lungs. These long-term consequences can be quite debilitating.What other autoimmune diseases are associated with Sjogren's syndrome? ›
Sjögren's can be accompanied by other autoimmune connective tissue disorders, such as systemic lupus erythematosus, rheumatoid arthritis, scleroderma, autoimmune thyroid disease, antiphospholipid syndrome, sarcoidosis, and celiac disease.What is similar to Sjogren's syndrome? ›
Multiple sclerosis (MS) is very similar to the Sjögren's syndrome (SS) by its clinical presentations.How is Sjogren's neuropathy diagnosed? ›
To make a Sjögren's syndrome diagnosis, doctors must see specific antibodies (blood proteins) in your blood. They also need to see a pattern of inflammation, found most often on the salivary glands of your lips, which is characteristic of Sjögren's syndrome.Does Sjogren's cause tremors? ›
Dysarthria (7, 59.8%), limb tremor (4, 30.8%), and nystagmus (2, 15.4%) were the other symptoms related to the cerebellum. Of the patients, 81.8% (9/11) had abnormal cerebrospinal fluid findings, and 11 patients (84.6%) had cerebellar atrophy on brain MRI.