Sjögren’s syndrome is commonly known for causing dry eyes and dry mouth, but it can also affect the nervous system. When this happens, patients may experience burning, tingling, numbness, weakness, imbalance, or autonomic symptoms like dizziness or heart palpitations. These neurologic complications are often underdiagnosed or mistaken for other conditions such as diabetic neuropathy, fibromyalgia, or multiple sclerosis.

Sjögren’s syndrome is an autoimmune disease, meaning the immune system mistakenly attacks the body’s own tissues. While moisture-producing glands are most often affected, inflammation can also involve the joints, lungs, skin, kidneys, heart, and nervous system. When nerves are involved, this is referred to as neurologic Sjögren’s.

Types of Neurologic Involvement in Sjögren’s

Neurologic Sjögren’s can affect different parts of the nervous system:

• Peripheral neuropathy: Burning, tingling, numbness, or weakness in the hands and feet

• Small fiber neuropathy: Burning or electric pain with normal nerve conduction studies

• Sensory neuropathy: Imbalance and coordination problems, often described as “walking on foam”

• Mononeuritis multiplex: Patchy nerve inflammation causing sudden weakness like foot drop

• Cranial neuropathy: Facial numbness, weakness, or hearing changes

• Autonomic neuropathy: Dizziness, abnormal sweating, heart rate changes, or digestive symptoms

Recognizing the pattern of symptoms is essential for accurate diagnosis.

How Neurologic Sjögren’s Is Diagnosed

There is no single test that confirms neurologic Sjögren’s. Diagnosis requires a structured, step-by-step approach:

• Detailed history: Symptom onset, symmetry, activity-related pain, dryness, fatigue, or joint pain

• Physical exam: Rheumatologic signs (dryness, rashes, Raynaud’s) and neurologic findings such as sensory loss, reduced reflexes, coordination issues, or a positive Romberg sign

• Blood tests: SSA, SSB, ANA, rheumatoid factor, inflammatory markers, and labs to rule out other causes like B12 deficiency or diabetes

• Salivary gland biopsy: Often the most definitive test when blood work is negative

• Nerve testing: EMG and nerve conduction studies for large fiber neuropathy

• Skin biopsy: Confirms small fiber neuropathy when EMG is normal

• Imaging: MRI or MR neurography when central or vasculitic involvement is suspected

• Autonomic testing: Tilt table or sweat testing when autonomic symptoms are present

Collaboration between neurology and rheumatology is critical to ensure an accurate diagnosis.

Treatment Options for Neurologic Sjögren’s

Treatment depends on the type and severity of nerve involvement. The primary goals are to reduce immune-driven inflammation and support nerve healing.

Foundational care includes:

• Anti-inflammatory nutrition

• Gentle exercise, balance training, and movement

• Supplements such as omega-3s, B vitamins, alpha-lipoic acid, and acetyl-L-carnitine

• Optimizing sleep and stress management

Medical treatments may include:

• Hydroxychloroquine for systemic inflammation

• Low-dose naltrexone for nerve pain and immune modulation

• IVIG for small fiber or sensory neuropathy

• Steroids for severe vasculitic neuropathy

• Immunomodulators like rituximab or mycophenolate in select cases

Regenerative options, such as platelet lysate injections, may support peripheral nerve health and reduce localized inflammation but are used as adjuncts—not replacements—for systemic treatment.

Final Thoughts

Sjögren’s syndrome is more than a dryness condition. When the nervous system is involved, early recognition and a comprehensive diagnostic approach are essential. With personalized treatment and ongoing monitoring, many patients can experience meaningful improvement in nerve pain, balance, and overall function.

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