Ziel ist es, die betroffenen Schleimhäute feucht zu halten. After diagnosing Sjögren syndrome, treatment is aimed at maintaining the integrity of the tear film through preservation, augmentation, and/or replacement of the deficient tear secretion. Sjogren’s Syndrome Treatment. In fact, the Sjögren’s Syndrome Foundation states it takes nearly three years to receive a diagnosis. Many people manage the dry eye and dry mouth of Sjogren's syndrome by using over-the-counter eyedrops and sipping water more frequently. https://www.niams.nih.gov/health_info/Sjogrens_Syndrome/sjogrens_syndrome_ff.asp. There is currently no cure for Sjogren’s syndrome. The review of diagnostic and treatment strategies for Sjögren's syndrome is excellent. It is important to treat the ongoing dry eye of Sjögren's syndrome.Otherwise, your eyes will remain irritated and very uncomfortable. There is no known curefor Sjögren's syndrome, nor is there a treatment to restore secretion of moisture by the glands. A Sjögren’s patient’s treatment path should be decided on a case-by-case basis after the potential benefits and side-effects are weighed by patients and their healthcare providers. How soon can I expect my symptoms to improve with treatment? Please note that many biologics and small molecule therapies are currently under investigation for treating Sjögren’s. Depending on your symptoms, you might start by seeing your family doctor, dentist or eye doctor. … You'll need to take medicine throughout your life to help you manage your symptoms. The selection of remedy is. DMARDs modify the way the immune system functions, so instead of simply treating symptoms, DMARDs regulate abnormal immune responses. Collagen or silicone plugs are inserted into the ducts to help preserve your tears. Accessed 7/22/2020. The following products are considered to be alternative treatments or natural remedies for Sjogren's Syndrome. Corticosteroids, a class of drugs that includes prednisone, are fast-acting and may be highly successful in halting severe symptoms of Sjögren’s and/or a flare. Treatment: Artificial tears, medications to reduce inflammation, surgery: Prognosis: Normal life expectancy: Frequency ~0.7%: Sjögren's syndrome (SjS, SS) is a long-term autoimmune disease that affects the body's moisture-producing (lacrimal and salivary) glands, and often seriously affects other organs systems, such as the lungs, kidneys, and nervous system. As with treating dry eye, there are over-the-counter options for dry mouth symptoms. Unlike corticosteroids, these drugs do not produce an immediate effect but take time to have an impact on symptoms and before a patient feels a difference. Dry skin and itchiness are common problems in patients with Sjogren’s syndrome and can be best addressed with the use of moisturizing agents. Conventional Treatment. Accessed May 23, 2017. Most people can manage the dry eye and dry mouth of Sjögren’s syndrome by using over-the-counter eyedrops and sipping water more frequently. PLoS One. Below are a few of the prescription treatments available, but by no means is this an exhaustive list. Because of their thicker consistency, eye lubricants can blur your vision and collect on your eyelashes, so you might want to use them only overnight. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are recommended for the joint pain that … Living with Sjögren’s syndrome can be easier by taking good care of your eyes and mouth, by protecting your voice, and understanding what medicines cause dryness. In some cases, lifestyle changes can help certain symptoms such as fatigue and gastro-intestinal reflux, and over-the-counter products can help alleviate symptoms such as dryness. Natural treatment for Sjogren’s syndrome should be multifactorial including gut treatment, infection treatment, toxin treatment and resetting the immune system. A Sjögren’s patient’s treatment path should be decided on a case-by-case basis after the potential benefits and side-effects are weighed by patients and their healthcare providers. As the Sjögren’s Foundation continues to release Sjögren’s Clinical Practice Guideline Sheets and post these on this website, be sure to share them with your physician and ask about the recommended management and treatment options listed. A single copy of these materials may be reprinted for noncommercial personal use only. Accessed 7/22/2020. A number of different medications are available that can be used to manage symptoms. Since Sjögren’s affects each patient differently, a personalized plan should be developed by you and your physician, dentist, eye care provider and other specialists about how to treat your various symptoms. This book, written by a woman who has Sjögren's, presents and evaluates a full range of treatment options, conventional and alternative, providing unbiased assessments of their possible benefits and side-effects. You don't have to apply eye lubricants as often as artificial tears. https://www.uptodate.com/home. Background: Sjögren's syndrome is one of the more common inflammatory rheumatological diseases, with a prevalence of at least 0.4% in Germany. Print this page. Mayo Clinic does not endorse companies or products. Sjögren’s syndrome is an autoimmune disorder that primarily affects the glands that help the body create moisture in the eyes and mouth, in the form of saliva and tears. Sjögrens syndrome is a chronic, autoimmune disease that causes dryness of the eyes, mouth and other body parts. They include: Sucking on sugarless candy and chewing sugar free gum. Treatment for Sjogren’s focuses on managing the symptoms and preventing complications. «Syndrom» meint die gleichzeitige Bündelung verschiedener Symptome zu einem eigenen Krankheitsbild. In Sjogren's syndrome, the mucous membranes and moisture-secreting glands of your eyes and mouth are usually affected first — resulting in decreased tears and saliva. Advances in understanding the pathogenesis of primary Sjogren's syndrome. Ursachen. Ramos-Casals M, Tzioufas AG, Stone JH, et al; Treatment of primary Sjogren syndrome: a systematic review. Most patients will need prescription medications at some point in their disease course to help control their disease and reduce the potential for complications. Share on Facebook Tweet ... There’s no research showing that complementary treatments can ease the symptoms of Sjögren’s syndrome. Autoimmune Resource and Research Centre. Early diagnosis and treatment are important for preventing future complications. 2 Hintergrund. Along with symptoms of extensive dryness, other serious complications include profound fatigue, chronic pain, major organ involvement, neuropathies, and lymphomas. Do any close relatives have rheumatoid arthritis, lupus or a similar disease? Unfortunately, there is no single test that can give you an answer. It is often prescribed as an initial and long-term therapy in Sjögren’s. Sjogren’s syndrome is very difficult to diagnose as many of the signs and symptoms are very similar to other diseases. Accessed May 23, 2017. For many years… Special attention is drawn to updated classification criteria and current treatment recommendations. Artificial tears in various forms help replace decreased tear production. Most individuals with Sjögren syndrome present with sicca symptoms, such as xerophthalmia (dry eyes), xerostomia (dry mouth), and parotid gland enlargement, which is seen in the image below. Rheumatologists, ophthalmologists, dentists and other specialists often work together to manage … While by no means can this article act as a standalone treatment for Sjogren’s syndrome, these are some of my most common recommendations for the natural treatment of Sjogren’s syndrome. If you have Sjögren's syndrome, several different professionals probably will be involved in your care. Do your symptoms follow a pattern — worsening throughout the day or when you go outdoors? Sjogren syndrome is a systemic autoimmune disorder, Nocturne G, Mariette X. The therapeutic management of SjS has not changed substantially in recent decades 6 and is still based on symptomatic treatment of sicca symptomatology and broad-spectrum immunosuppression for systemic disease, with insufficient information on the differential efficacy and safety of the therapeutic options available. Advertising revenue supports our not-for-profit mission. Sjogren's syndrome. Sjögren’s (pronounced sher-grenz) syndrome is an autoimmune condition. A Sjögren’s patient’s treatment path should be decided on a case-by-case basis after the potential benefits and side-effects are weighed by patients and their healthcare providers. Sjogren’s Syndrome Treatment. Es ist dann nicht unbedingt erforderlich, weitergehende Untersuchungen wie zum Beispiel eine Lippenbiopsie durchzuführen. Suite 170, Reston, VA 20191. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Sjogrens-Syndrome. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. If a patient is prescribed corticosteroids for long-term use, the patient will start at a higher dose and taper down to a lower, maintenance dose. Vaginal moisturizers and lubricants help women who have vaginal dryness. Interessenkonflikte: Die referierte Studie wurde von der Sjögren’s Syndrome Foundation Typische Symptome sind trockene Augen und trockener Mund. NSAIDs are often a first-line therapy used in Sjögren’s and reduce inflammation which is often high in Sjögren’s. Accessed May 23, 2017. Currently, no single medication has been conclusively proven to slow the progression of Sjögren’s or treat all aspects of the disease. Treatment is generally aimed at controlling symptoms and targeting specific organ involvement. To learn more about participating in a Biologics Clinical Trial, please visit our Clinical Trials page. More Survival Tips . Prior to … TASSA - The Australian Sjögrens Syndrome Association - they help provide information to patients with the disease & initiate research in Australia to find treatments and a cure. (Nach Krüger, K.: Das Sjögren-Syndrom. Das Sjögren-Syndrom (Sicca-Syndrom, autoimmune Exokrinopathie) ist eine Autoimmunerkrankung, die fast nur Frauen betrifft. 7 Treatment decisions remain challenging in clinical … Advances in understanding the pathogenesis of primary Sjogren's syndrome. How can I best manage them together? Taking medications – as well as avoiding others that can cause dryness — can also be part of the treatment plan. Your doctor might recommend artificial tears without preservatives, which can irritate the eyes of people with dry eye syndrome. Many new treatments will be available in the near future. : Treatment guidelines for rheumatologic manifestations of Sjögren’s syndrome: use of biologic agents, management of fatigue, and inflammatory musculoskeletal pain. American College of Rheumatology. A doctor specializing in the treatment of eye disorders (ophthalmologist) might also examine the surface of your eyes with a magnifying device called a slit lamp. Treatment of dry mouth and other non-ocular sicca symptoms in Sjögren's syndrome. Treatments … based upon the theory of individualization and symptoms similarity by using holistic approach. Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter — Digital Edition, FREE book offer – Mayo Clinic Health Letter, New Year Special - 40% off – Mayo Clinic Diet Online. Treatment for Sjögren’s syndrome depends on the affected areas. Sjogren’s syndrome can be very tough to diagnose, and many patients suffer for years with symptoms that include dry eyes, dry mouth, persistent fatigue and chronic pain due to inflammation. Arthritis Care Res (Hoboken) 2017; 69(4): 517–527. Treating Dry Mouth. For this test, a sliver of tissue is removed from salivary glands in your lip and examined under a microscope. Wie bei vielen anderen Krankheiten mit autoimmunen Zügen lässt sich nicht erklären, warum welche Personen am Sjögren-Syndrom erkranken. Dry mouth increases your risk of dental cavities and tooth loss. Autoimmune Inner Ear Disease. Fluid-ventilated, gas permeable scleral lenses have been successful in treating severe ocular surface diseases including Sjögren syndrome. The most commonly prescribed DMARD is hydroxychloroquine (Plaquenil®). Other than increasing nutrients and healthy proteins in your diet, the Sjögren’s diet reduces or eliminates foods that can cause inflammation or trigger allergic reactions. But some people need prescription medications, or even surgical procedures. And there are certain medications that mimic the signs. Also see the Sjögren’s Foundation’s Brochures and Resource Sheets that provide management tools to help with specific symptoms. Sjögren's syndrome is a lifelong autoimmune disorder that reduces the amount of moisture produced by glands in the eyes and mouth. Dry mouth and eyes can also be the side effects of medications for other problems, such as depression and high blood pressure. Other symptoms you might find are delayed stomach emptying and severe heartburn. While hydroxychloroquine is an old drug that has been used successfully in rheumatic diseases for many years and is generally considered very safe and effective, a rare side effect of this drug can be retinal damage, so the most appropriate dose for each individual should be considered carefully along with regular monitoring by an ocular specialist. Use rubber gloves when doing dishes or housecleaning. In this Review, we summarize the available data on topical and systemic medications, according to clinical signs and disease activity, and we describe the ongoing studies using biologic drugs in the treatment of pSS. Finally, some lifestyle habits and dietary supplements may be appropriate to support overall health. Nat Rev Rheumatol. © 1998-2021 Mayo Foundation for Medical Education and Research (MFMER). Treatment for Sjogren's syndrome depends on the parts of the body affected. ARRC - Autoimmune Resource & Research Centre - they help improve health & quality of life of patients with autoimmune diseases through education, empowerment, advocacy, screening & research. Sjogren's syndrome. The SS-A antigen is a protein that binds to hYRNA. Continue to Part 2 in Order To Discover Common Toxins Associated With Sjogren’s Syndrome . Quelle: Carsons SE et al. Depending on your specific issues, your doctor may recommend one or more of these therapies. Tests can help rule out other conditions and help pinpoint a diagnosis of Sjogren's syndrome. Infections, which can complicate Sjögren's syndrome, are addressed with appropriate antibiotics. Sjögren’s syndrome. Combined with traditional treatment methods, the Sjögren’s syndrome diet can help provide a higher quality of life and optimal health. Although you can develop Sjogren's syndrome at any age, most people are older than 40 at the time of diagnosis. What treatment approach do you recommend? Sjogren’s syndrome cannot be cured, but many people find relief in treatments ranging from over-the-counter eye drops to surgical procedures. Sie führt zu einer Entzündung insbesondere der Speicheldrüsen und Tränendrüsen. Sjogren’s syndrome is an autoimmune disorder characterized by symptoms such as dryness in the mouth and throat, eyes, skin, vagina, and other organs.Dryness in these organs can lead to irritation, soreness, and pain. Treatment for Sjogren's syndrome depends on the parts of the body affected. Treatment differs for each person and depends on what parts of your body are affected and focuses on getting rid of symptoms. Pat your skin — don't rub — with a towel, and apply moisturizer when your skin is still damp. Homeopathy is one of the most popular holistic systems of medicine. Join Today . Sjögren’s (“SHOW-grins”) is a systemic autoimmune disease that affects the entire body. Am I at risk of long-term complications from this condition? Methods: This review is based on pertinent articles retrieved by a selective search in PubMed. Treatments for dry eyes: Artificial tears: Over-the-counter artificial tear eye solutions and artificial tear eye ointments moisturize dry eyes. Sjogren’s Syndrome Treatment. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Primary Sjögren syndrome (pSS) is a progressive autoimmune disease characterized by sicca and systemic manifestations. 10701 Parkridge Blvd. It can also cause side effects such as tummy pain and feeling sick. Have you recently started new medications? Allein in der Schweiz haben schätzungsweise 15’000 Menschen das Sjögren-Syndrom. Gastrointestinal disease in Sjogren's syndrome: related to … Sjogren’s syndrome is an autoimmune disease that affects the tear, salivary, and other secretory glands in the body. Talk to your physician for more information. Sjogren's Syndrome is an autoimmune disorder (much like arthritis or lupus) that characteristically attacks the mucous membranes and results in symptoms of dry mouth and sore, dry eyes. Sjögren’s patients are often managed with a combination of management strategies, over-the-counter products and prescription drugs. Definition. Corticosteroids have many potential side effects ranging from minor to more severe, so physicians may try to find a steroid-sparing drug that reduces a patient’s symptoms if a patient is on corticosteroids for a long period. Treatment mainly symptomatic. Kim-lee C, Suresh L, Ambrus JL. Sjögrens syndrome, Glandular hypofunction, Mechanisms, Stimulus-secretion coupling, Antimuscarinic antibodies, Aquaporins, Cytokine Introduction The ‘ classical ’ model to explain glandular hypofunction in Sjögrens syndrome (SS) is tissue loss secondary to immune attack mediated by a combination of apoptosis and cytotoxic cell death (reviewed recently by Ramos-Casals and Font [ 1 ]). In Sjogren's syndrome, the mucous membranes and moisture-secreting glands of your eyes and mouth are usually affected first — resulting in decreased tears and saliva.Although … Mit der richtigen Therapie lassen sich aber die Beschwerden der Betroffenen lindern. The Sjögren’s Foundation is working closely with these companies to ensure new therapies are developed. Definition. The most common side effect of NSAIDs is stomach upset, and, rarely, NSAIDs might cause stomach or gastrointestinal bleeding or ulceration. Treatment. Bei trockenen Atemwegen können Inhalationen helfen. The therapeutic management of Sjögren syndrome (SjS) has not changed substantially in recent decades: treatment decisions remain challenging in clinical practice, without a specific therapeutic target beyond the relief of symptoms as the most important goal. 1965 wurde die klinische Trias aus Keratokonjunktivitis sicca mit trockenen Augen, verminderter Speichelsekretion mit Xerostomie und rheumatoider Arthritis oder anderen Bindegewebserkrankungen … Artificial tears — in eyedrop form — and eye lubricants — in eyedrop, gel or ointment form — help relieve the discomfort of dry eyes. But some people need medications, or even surgical procedures to live normally. Die Betroffenen sollten beispielsweise ausreichend trinken. Accessed May 23, 2017. Your doctor might also do a lip biopsy to detect the presence of clusters of inflammatory cells, which can indicate Sjogren's syndrome. For Sjogren's syndrome, basic questions include: Your doctor is likely to ask you a number of questions, including. Dtsch Arztebl Int 2017; 114: 354–61. Normally, people can treat their symptoms the same way as those without Sjögren’s syndrome, such as watching what they eat and using nonprescription medications. Souza FB, Porfirio GJ, Andriolo BN, et al; Rituximab Effectiveness and Safety for Treating Primary Sjogren's Syndrome (pSS): Systematic Review and Meta-Analysis. Accessed May 23, 2017. Become a member today to enjoy exclusive member benefits and be a part of conquering Sjögren's. 2016 Mar 2111(3):e0150749. Since Sjögren’s affects each patient differently, a personalized plan should be developed by you and your physician, dentist, eye care provider and other specialists about how to treat your various symptoms. Eine Heilung ist bislang nicht möglich. In Sjögren's Syndrome, the body's immune system attacks its own moisture-producing glands. Do you have brochures or other printed materials that I can have? Diagnosing Sjogren’s syndrome . He or she may place drops in your eye that make it easier to see damage to your cornea. It is important to find a doctor who is both a good partner in treating your disease, as well as a good listener! This drug might or might not be prescribed at the same time as hydroxychloroquine. Sjogren syndrome is a systemic auto-immune disorder Nocturne G, Mariette X. Sjögren syndrome is an area of active immunology research. The chronic autoimmune disorder known as Sjogren's syndrome causes reduced tear and saliva production, leading to dry eyes, nose, mouth, throat, and vagina. The favorable results with medical therapy alone are worth noting. This means that the immune system, which is the body’s natural self-defence system, gets confused and starts to … Eating Healthy When You Have Sjogren’s Syndrome. The typical symptoms include having a dry nose, dry eyes, and a dry mouth. All rights reserved. Their efficacy may not have been scientifically tested to the same degree as the drugs listed in the table above. Research has suggested that rituximab may be beneficial for many features of Sjögren syndrome. Serious complications of Sjögren's syndrome, such as vasculitis, can require immune-suppression medications, including cortisone ( prednisone and others) and/or azathioprine (Imuran) or cyclophosphamide ( Cytoxan ). Sjögren's Syndrome Treatment. It can be difficult to diagnose Sjogren’s syndrome as the symptoms can imitate those of other conditions such as lupus and fibromyalgia. It is named for Henrik Sjögren, a Swedish eye doctor who first described the condition. Presence of antibodies common in Sjogren's syndrome, Indications of problems with your liver and kidneys, Brush your teeth and floss after every meal, Schedule regular dental appointments, at least every six months, Use daily topical fluoride treatments and antimicrobial mouthwashes, Detailed descriptions of your symptoms and when they began, Information about your current and past medical problems, Information about your parents' or siblings' medical history, All medications and dietary supplements you take, including doses. Frauen erkranken daran zehnmal so häufig wie Männer. One class of NSAIDs, cox-2 inhibitors, is less likely to cause stomach problems but may have different potential side effects that should be discussed with your doctor. Sjögren syndrome is named after a Swedish ophthalmologist, Henrik Sjögren. The only strong therapeutic recommendation for fatigue in Sjogren’s syndrome is exercise. Your doctor might order blood tests to check for: Your doctor can measure the dryness of your eyes with a test called a Schirmer tear test. Depending on your symptoms, your doctor might suggest medications that: A minor procedure to seal the tear ducts that drain tears from your eyes (punctal occlusion) might help relieve your dry eyes. Become a Member. Sjogren’s treatment aims to lubricate the affected areas and prevent the onset of complications. If you don’t find that effective, prescription medications are available that can help increase your saliva production. There is no cure for Sjögren’s syndrome, but treatments can relieve symptoms. Solange ein Sjögren-Syndrom auf die sekretbildenden Drüsen beschränkt bleibt, werden überwiegend die Symptome behandelt. Hydroxychloroquine is the most widely prescribed treatment in the U.S. to manage fatigue in Sjogren’s syndrome, but this practice is largely made based on clinical experience. Arthritis Foundation. This content does not have an Arabic version. Sjogrens Syndrome Treatment is a medical procedure / surgery that requires coordination between specialist surgeons, anesthetists and various other specialist medical professionals. 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. http://www.sjogrens.org/home/about-sjogrens/symptoms. To help prevent those types of problems: If dry skin is a problem, avoid hot water when you bathe and shower. Treatment for Sjogren’s focuses on managing the symptoms and preventing complications. Alternative treatments for Sjogren's Syndrome. Das Sjögren-Syndrom ist eine chronische Autoimmunerkrankung aus der Gruppe der Kollagenosen. Terry robes will dry you gently, or after the shower, let yourself dry naturally since the moisture from the water will be absorbed by your skin. Diagnosis and classification of Sjogren's syndrome. Baer AN. It is named for Henrik Sjögren, a Swedish eye doctor who first described the condition. Finally, some lifestyle habits and dietary supplements may be appropriate to support overall health. There are many opportunities for you to learn more about Sjögren's, volunteer your time, or help us raise awareness for this common, yet little-known disease. Venus Williams gives a TV interview during which she discusses her autoimmune disease, Sjogren's Syndrome. Sjogren's syndrome. For the most part, treatment is designed to help relieve symptoms. Auch innere Organe können beim Sjögren-Syndrom betroffen sein. Side effects of a number of medications also mimic some signs and symptoms of Sjogren's syndrome. An anderer Stelle heißt es, dass die Diagnose sekundäres Sjögren-Syndrom als gesichert angesehen werden kann, wenn typische Beschwerden (zum Beispiel Trockenheitsprobleme) und SS-A/Ro- bzw. Many people manage the dry eye and dry mouth of Sjogren's syndrome by using over-the-counter eyedrops and sipping water more frequently. Do you have chronic conditions such as high blood pressure or arthritis? Restasis® (cyclosporine ophthalmic emulsion. Sjogren's syndrome. Sjogren's syndrome is also called Sjogren's disease. Whether a patient is newly diagnosed or has been suffering from Sjögren's for years, the Sjögren's Foundation wants to help you continue living your life to the fullest. Sjögren's syndrome (SjS, SS) is a long-term autoimmune disease that affects the body's moisture-producing (lacrimal and salivary) glands, and often seriously affects other organs systems, such as the lungs, kidneys, and nervous system. Make a donation. Vor allem in der Heizperiode ist auf eine gute Luftfeuchtigkeit zu achten. Homeopathic Remedies & Homeopathy Treatment for Sjogren’s syndrome. I will cover how to do this is part 2. Treating Dry Mouth and Related Symptoms Caused by Sjögren’s Syndrome. Primary Sjögren syndrome (pSS) is a progressive autoimmune disease characterized by sicca and systemic manifestations. Stages and Types of Sjogren’s Syndrome There are two types of Sjogren’s syndrome: primary and secondary. SS-B/La-Antikörper vorliegen. The following DMARDs might be tried in any potential order and is dependent on physician preference and the individual patient: Mycophenolate (examples include Cellcept®, Myfortic®), Cyclosporine (examples include Sandimmune®, Neoral®). What is Sjögren's syndrome? In this Review, we summarize the available data on topical and systemic medications, according to clinical signs and disease activity, and we describe the ongoing studies using biologic drugs in the treatment of pSS. NSAIDs include common over-the-counter medications such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve), but many prescription NSAID drugs are available. Share this page. Diagnosis requires blood tests, eye tests, imaging tests and, sometimes, biopsies. These products relieve irritation and discomfort. Treatment for Sjogren’s syndrome attempts to relieve the effects of chronic dryness of the mouth and eyes by increasing the lubrication and moisturization of the affected tissues: Fluid intake is often necessary both with and between meals because of the decrease in salivary gland secretion. A small piece of filter paper is placed under your lower eyelid to measure your tear production. Patients with primary Sjogren’s syndrome report fatigue as one of the most difficult symptoms they have to cope with..