Lupus and The Exocrine Gland System: Sjögren’s Disease

posted in All on November 22, 2024 by

Gavin Abson

Updated January 30, 2025

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Lupus, an autoimmune disease, can cause dry mouth, eyes, and skin by attacking the body’s moisture-producing glands. These symptoms can lead to discomfort and health issues. Moisture-producing glands are called exocrine glands and are part of the exocrine system. Understanding their causes and management can improve your quality of life.

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NOTE: “The Lupus Encyclopedia” is published by Johns Hopkins Press, a non-profit publishing house whose proceeds go towards important endeavors like the “Muse Project.” Thank you for your support.

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This blog post article was edited and contributed to by Donald Thomas, MD; author of “The Lupus Encyclopedia.” Parts of this blog post come from “The Lupus Encyclopedia: A Comprehensive Guide for Patients and Health Care Providers, edition 2“

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What is the Exocrine Gland System?

The body’s gland system is divided into two large groups: endocrine glands and exocrine glands. The Lupus Encyclopedia explains this in more detail:

“The two large groups of body glands are endocrine glands and exocrine glands. Endocrine glands (endo-­ from the Greek for “inside” and -­ crine is used in medicine meaning “to secrete”) produce substances that are secreted into the blood. Examples include the thyroid (secretes thyroid hormones), adrenal glands (secrete cortisol and other substances), and the ovaries (secrete female hormones). Endocrine involvement by SLE is discussed in chapter 17.

“The exocrine glands (exo-­ meaning “outside”) secrete fluids outside the body (such as outside the skin or into the gastrointestinal tract, which is a tube from the mouth to the anus, and technically outside the body). The main autoimmune prob­lem with exocrine glands is Sjögren’s disease, which is the subject of this chapter.”

The Lupus Encyclopedia (2nd ed.), p. 302

Sjögren’s Disease and the Exocrine Gland System

The most common autoimmune disorder involving exocrine glands is Sjögren’s disease, which frequently occurs in conjunction with lupus. Sjögren’s disease specifically targets glands that produce moisture, such as the salivary and tear glands. Lupus patients with Sjögren’s disease may experience xerostomia (dry mouth) and keratoconjunctivitis sicca (dry eyes). These symptoms can lead to discomfort, difficulty in swallowing, dental problems, and even vision issues if left untreated.

According to The Lupus Encyclopedia (Chapter 14), understanding the distinction between the endocrine and exocrine systems is crucial for recognizing how autoimmune diseases like lupus can manifest in various glands. Lupus-related exocrine dysfunction can lead to an array of symptoms, further complicating the clinical picture for both patients and physicians.

How Lupus Affects the Exocrine Gland System

Lupus can cause inflammation in the exocrine glands, leading to diminished fluid secretion. For example, lupus can affect the salivary glands, reducing saliva production, which can cause dry mouth, trouble swallowing, and a higher risk of cavities and infections. Similarly, lupus can cause lacrimal gland dysfunction, leading to reduced tear production and dry eyes. In severe cases, the damage to these glands can result in permanent dryness and a need for continuous treatment.

Patients with lupus often experience these symptoms without realizing that they are linked to exocrine gland dysfunction. Early recognition and treatment of these symptoms are crucial for preventing complications. The Lupus Encyclopedia emphasizes the importance of monitoring exocrine function in lupus patients, especially those who exhibit signs of dry eyes or dry mouth.

The Role of Inflammation

Inflammation is the primary mechanism through which lupus affects the exocrine glands. As lupus triggers an immune response, inflammation can develop in the glands, obstructing their ability to function correctly. This chronic inflammation can damage the glands over time, leading to permanent dysfunction.

In particular, lupus-induced inflammation may target the pancreas, leading to exocrine pancreatic insufficiency (EPI). The pancreas is responsible for producing digestive enzymes that aid in the digestion of food. When lupus affects the pancreas, patients may experience difficulty digesting fats, leading to symptoms like diarrhea, weight loss, and malnutrition.

Managing Exocrine Gland Involvement in Lupus

Effective management of lupus-related exocrine dysfunction requires a multifaceted approach. Treatment strategies often involve addressing both the underlying lupus and the specific symptoms related to exocrine gland involvement.

Medications

To reduce inflammation and slow the immune system’s attack on exocrine glands, hydroxychloroquine (Plaquenil), and/or immunosuppressive drugs such as corticosteroids and disease-modifying antirheumatic drugs (DMARDs) are often prescribed. These medications can help prevent further glandular damage and alleviate symptoms.

In cases of severe dry eyes or dry mouth, artificial tears and saliva substitutes can provide relief. Medications that stimulate saliva production, such as pilocarpine, may also be recommended. These treatments help manage the symptoms of Sjögren’s disease and other forms of exocrine dysfunction.

Lifestyle Changes

Lifestyle modifications can also play a significant role in managing exocrine gland involvement in lupus. Patients can benefit from maintaining good hydration and avoiding irritants that can worsen dryness, such as caffeine, alcohol, and smoking. In addition, maintaining a balanced diet and practicing good oral hygiene can reduce the risk of dental problems related to dry mouth.

Regular eye exams and dental check-ups are essential for lupus patients, especially those with Sjögren’s disease or exocrine dysfunction. Early detection of complications can lead to better outcomes and prevent more severe problems from developing.

Managing Dry Mouth

Dry mouth, or xerostomia, can lead to difficulties in speaking, chewing, and swallowing, as well as an increased risk of dental issues.

Dry Mouth Management Tips:

• Stay Hydrated: Sip water regularly throughout the day.
• Stimulate Saliva Production: Chew sugar-free gum or suck on sugar-free candies to encourage saliva flow. Ask your doctor to prescribe medications that stimulate saliva flow: cevimeline (Evoxac) and pilocarpine (Salagen)
• Use Saliva Substitutes: Over-the-counter saliva substitutes can provide relief.
• Maintain Oral Hygiene: Brush and floss after meals and snacks. See a dentist at least twice a year. For more practical advice, go to:

lupusencyclopedia.com/prevent-early-tooth-loss-when-you-have-dry-mouth-from-lupus-or-sjogrens-syndrome

For more detailed guidance, refer to the American Dental Association’s guidelines on managing dry mouth.

Managing Dry Eyes

Dry eyes can cause irritation, redness, gritty sensations in the eye, and blurred vision.

Management Tips:

• Use Artificial Tears: Regularly apply over-the-counter lubricating eye drops.
• Control Inflammation: Most patients should take medications to reduce inflammation may be prescribed: cyclosporine (Restasis and Cequa) or lifitigrast (Xiidra)
• Protect Your Eyes: Wear sunglasses to shield your eyes from wind and sun exposure.

For more practical advice on how to help dry eyes, go to:

lupusencyclopedia.com/dry-eyes-and-lupus

The Mayo Clinic provides comprehensive information on the diagnosis and treatment of dry eyes.

Managing Dry Skin

Dry skin can lead to itching, flaking, and increased sensitivity.

Management Tips:

• Moisturize Regularly: Apply fragrance-free moisturizers after bathing and throughout the day.
• Avoid Hot Showers: Use lukewarm water to prevent stripping natural oils from your skin.
• Use Gentle Cleansers: Opt for soap-free cleansers to maintain skin moisture.

For additional advice, visit Itchy, Dry Skin in Lupus and Sjögren’s: What is the Relationship?.

Prognosis for Lupus Patients with Exocrine Gland Involvement

The prognosis for lupus patients with exocrine gland involvement varies depending on the extent of glandular damage and the effectiveness of treatment. With proper management, many patients can control their symptoms and prevent complications. However, some patients may experience persistent symptoms, such as chronic dryness or digestive issues, which can affect their quality of life.

The Lupus Encyclopedia emphasizes the importance of early intervention and consistent monitoring for patients with lupus and exocrine gland involvement. By addressing symptoms early and employing a comprehensive treatment plan, patients can reduce the risk of permanent glandular damage and maintain a better quality of life.

The Importance of Regular Monitoring

Monitoring the exocrine gland system in lupus patients is vital to catch any signs of glandular dysfunction early. As mentioned in The Lupus Encyclopedia, autoimmune damage to these glands can be insidious and may develop gradually. Regular follow-ups with a rheumatologist, as well as other specialists like ophthalmologists and dentists, are critical for ensuring that symptoms are managed effectively.

Lupus and the exocrine gland system are closely linked, with lupus often causing inflammation and dysfunction in glands that secrete fluids. This can lead to a variety of symptoms, including dry mouth, dry eyes, and digestive issues. Managing exocrine gland involvement in lupus requires a comprehensive approach, including medications, lifestyle changes, and regular monitoring. By understanding the connection between lupus and the exocrine glands, patients can take proactive steps to manage their condition and prevent complications.

When to Consult a Healthcare Provider

If dryness symptoms persist or worsen, consult your healthcare provider. They can recommend treatments such as prescription medications to stimulate saliva or tear production, or other interventions tailored to your needs.

By understanding the connection between lupus and the exocrine gland system, you can take proactive steps to manage dryness symptoms and maintain your health.

The Sjögren’s Foundation: Advocating for Patients

Make sure to join the Sjogren’s Foundation. They are 100% committed to helping people suffering from Sjögren’s disease. They have regular virtual patient education seminars, chock full of the latest research and latest advice. They have been instrumental in working on and publishing management guidelines so other healthcare providers can know the best ways to help Sjogren’s. They are also instrumental in helping with new research to find better treatments.

Whether you’re a patient, caregiver, or healthcare provider, The Lupus Encyclopedia is an invaluable resource for understanding how lupus affects the body’s many systems, including the exocrine glands.

For more in-depth information on Lupus and The Exocrine Gland System: Sjögren’s Disease:

Read more in The Lupus Encyclopedia, edition 2

Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia

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