Question

I know that joint pains sometimes occur in ME/CFS and this is a symptom that I’ve occasionally had over many years – but without any swelling, redness or deformity occurring. But I’ve also developed more persistent joint pain, dry eyes and my fatigue levels are considerably worse. My GP is questioning whether I might now have a condition cause Sjögren’s Syndrome which he says can sometimes be misdiagnosed as ME/CFS. But can it co-exist with ME/CFS?

Answer

Sjögren’s syndrome is a fairly rare type of autoimmune disease – where the body starts producing what are called autoantibodies. These are an unusual type of antibody that attacks the body’s healthy tissues – instead of protecting against harmful infections.

Sjögren’s Syndrome has a number of symptoms that also occur in ME/CFS – debilitating fatigue, joint pain and dry eyes – so it does need to be considered and investigated as a possible explanation of ME/CFS symptoms where joint pains and dry eyes are present. There is another interesting overlap with ME/CFS in that dorsal root ganglionitis, inflammation in bundles of nerve cells that lie outside the spinal cord, has been found in post-mortem tissue samples in both conditions. However, there are other symptoms which are not normally found in ME/CFS – e.g., dry skin, vaginal dryness, swollen salivary glands (between the jaw and ear) and sun-related skin rashes.

Early diagnosis is important to lessen the effect of Sjögrens Syndrome on the eyes, mouth and other organs. Where the diagnosis is possible, clinical assessment should include a detailed medical history and examination, which should include:

• Changes in the eyes, mouth and salivary glands
• Joint inflammation
• Muscle weakness
• Swelling of lymph nodes in the neck

Various tests can help to confirm a diagnosis.

•  Autoantibodies: The anti-SSA (also called anti-Ro) or anti-SSB (also called anti-La) blood tests are the most specific ones for Sjögren’s syndrome. Other autoantibody tests include antinuclear antibody (ANA) and rheumatoid factor (RF). Blood tests are also checked for signs of inflammation, such as increased levels of immunoglobulin or C-reactive proteins (CRP). An erythrocyte sedimentation rate (ESR) test may also be done to check for general signs of increased inflammation.
• Dry-eye tests: The Schirmer test is used to determine how well the eyes produce tears. A slit-lamp test checks the surface of the eye (cornea) for dryness-related damage.
• Saliva tests: This measures saliva output, how well the salivary glands are functioning and whether there is inflammation.
• Chest X-ray: Because Sjögren’s can affect the lungs, this test will check for inflammation.

More information

• The NHS: Sjögren’s syndrome: Overview, Symptoms, Diagnosis, Treatment, Complications | April 2020
• The British Sjögren's Syndrome Association (BSSA).