Sjögren’s syndrome is a chronic autoimmune disease that affects the moisture-producing glands in the body, leading to dry eyes, dry mouth, and potentially more widespread organ involvement. While its exact cause remains unknown, researchers believe that a combination of genetic, environmental, hormonal, and immune system factors contribute to the development of the condition. Understanding these possible causes can help patients and healthcare providers better manage the disease and monitor potential complications.

What Is Sjögren’s Syndrome?

Sjögren’s syndrome occurs when the immune system mistakenly attacks the body’s own tissues, particularly the exocrine glands responsible for producing saliva and tears. This autoimmune attack leads to chronic inflammation, reduced gland function, and damage to other parts of the body, including joints, skin, lungs, kidneys, and nerves.

There are two types of Sjögren’s syndrome:

  • Primary Sjögren’s syndrome: Occurs alone without the presence of another autoimmune disease.

  • Secondary Sjögren’s syndrome: Develops alongside another autoimmune disorder, such as rheumatoid arthritis or lupus.

Possible Causes of Sjögren’s Syndrome

Although no single cause has been identified, several contributing factors appear to be involved in triggering Sjögren’s syndrome.

1. Genetic Factors

Genetics likely play a role in determining who is at risk for developing Sjögren’s. People with a family history of autoimmune diseases are more likely to develop one themselves. Specific genetic markers, such as variations in the HLA (human leukocyte antigen) system, have been linked to a higher risk of autoimmune conditions, including Sjögren’s.

However, having a genetic predisposition does not guarantee that a person will develop the disease. It simply means their immune system may be more prone to reacting abnormally when triggered by other factors.

2. Environmental Triggers

Environmental influences are thought to play a significant role in initiating autoimmune responses in genetically predisposed individuals. These may include:

  • Viral infections: Certain viruses, such as Epstein-Barr virus (EBV), cytomegalovirus (CMV), and hepatitis C, have been linked to autoimmune reactions that could contribute to the onset of Sjögren’s syndrome.

  • Bacterial infections: Some bacterial pathogens may also disrupt immune regulation, although the evidence is less conclusive.

  • Toxic exposures: Exposure to environmental toxins, like heavy metals or industrial chemicals, may impact immune system function and increase the risk of autoimmune disease.

It’s important to note that no specific virus or toxin has been definitively proven to cause Sjögren’s, but these factors may trigger disease in susceptible individuals.

3. Hormonal Influences

Hormonal factors are believed to contribute to Sjögren’s syndrome, particularly because the condition is far more common in women than in men. Around 90% of Sjögren’s patients are female, with the disease typically developing during middle age.

Estrogen, a hormone that fluctuates during menstruation, pregnancy, and menopause, may play a role in immune system regulation. Hormonal changes during perimenopause and menopause are often associated with the appearance or worsening of autoimmune symptoms, although the exact mechanisms are still being studied.

4. Immune System Dysregulation

At the heart of Sjögren’s syndrome is a malfunctioning immune system. For reasons not yet fully understood, the immune system begins to attack healthy tissues, mistaking them for threats. This dysregulation leads to:

  • Chronic inflammation: Persistent immune activity causes inflammation and damage to the salivary and tear glands.

  • Autoantibody production: The immune system produces abnormal antibodies, such as anti-SSA (Ro) and anti-SSB (La), which are commonly found in people with Sjögren’s.

This autoimmune behavior not only leads to glandular damage but can also affect multiple organ systems in the body.

5. Other Autoimmune Diseases

Sjögren’s syndrome often occurs alongside other autoimmune conditions, especially in secondary Sjögren’s. Common coexisting diseases include:

  • Rheumatoid arthritis

  • Systemic lupus erythematosus (lupus)

  • Scleroderma

  • Autoimmune thyroid disease

The coexistence of these diseases suggests that there may be shared immune system pathways or triggers among various autoimmune disorders.

6. Age and Gender

Most people diagnosed with Sjögren’s syndrome are women over the age of 40. This suggests that age and sex-related factors may influence disease onset. While men and younger individuals can also develop Sjögren’s, it is far less common.

The high prevalence in middle-aged women reinforces the idea that hormonal and age-related changes play a key role in disease development.

7. Stress and Lifestyle Factors

While stress alone is not known to cause Sjögren’s syndrome, chronic physical or emotional stress may exacerbate symptoms or trigger flares in people with autoimmune tendencies. Other lifestyle-related factors, such as smoking or poor diet, may also negatively impact immune function.

Managing stress, maintaining a balanced diet, getting regular sleep, and avoiding smoking may help reduce the risk or severity of symptoms, although these strategies cannot prevent the disease outright.

Is There a Single Cause?

The short answer is no. Sjögren’s syndrome does not have a single, identifiable cause. Instead, it is the result of a complex interplay of multiple factors, including:

  • Genetic susceptibility

  • Environmental exposures

  • Hormonal changes

  • Immune system malfunction

These components interact in unique ways for each person, making the disease unpredictable and highly individualized. This complexity also explains why some people have mild symptoms limited to dryness, while others experience systemic and more severe complications.

Can Sjögren’s Syndrome Be Prevented?

Currently, there is no known way to prevent Sjögren’s syndrome. However, early detection and management can help control symptoms and reduce the risk of complications. People with a family history of autoimmune disease or other risk factors should be vigilant about new symptoms and seek medical advice if dryness, fatigue, or joint pain becomes persistent.

Healthcare providers may perform blood tests and other diagnostics to rule out or confirm autoimmune activity.

Conclusion

Sjögren’s syndrome is a complex autoimmune disorder with no single cause. It arises from a combination of genetic, environmental, hormonal, and immunological factors. While the disease cannot currently be prevented, understanding these contributing factors helps in early diagnosis, personalized treatment, and effective symptom management.

For individuals living with Sjögren’s or at risk of developing it, being informed and proactive about health is one of the most powerful tools available. Working closely with healthcare providers and maintaining a healthy lifestyle can support better long-term outcomes and quality of life.