Candy Finley, RN, IgCN, Clinical Nurse Educator - June 26, 2026

Sjögren’s syndrome doesn’t get the attention it deserves. Most people including some clinicians — still think of it as just “dry eyes and dry mouth,” but anyone who’s cared for these patients knows it runs much deeper than that. It’s a systemic autoimmune disease, and nurses working with this population need to think beyond the glands.

What’s Happening:

At its core, Sjögren’s involves the immune system attacking the lacrimal and salivary glands. Patients test positive for SSA/Ro and SSB/La autoantibodies, and that same inflammatory process can quietly damage the joints, lungs, kidneys, and nervous system over time.

What to Look For:

The classic symptoms are easy to spot: gritty, irritated eyes (xerophthalmia) and a dry, sticky mouth that makes swallowing uncomfortable (xerostomia). Dental decay tends to follow because saliva plays a bigger protective role than most patients realize. But the extra glandular picture is where things get serious. Fatigue in these patients isn’t just tiredness — it can be genuinely debilitating. Watch for joint pain, burning or numbness in the extremities that suggest peripheral neuropathy, skin changes that could point to vasculitis, and less commonly, pulmonary or renal involvement. Research using tools like the EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI) has helped characterize just how broad systemic involvement can be, and it’s a useful framework for understanding disease severity across organ systems.

Managing Symptoms:

A big part of nursing care here is keeping the basics solid. Artificial tears and lubricating ointments help with eye comfort, and saliva substitutes can make a real difference for oral dryness. Encourage patients to sip water frequently and use sugar-free gum or lozenges to stimulate what saliva production remains. Check the oral mucosa regularly; candidiasis creeps in, and dental problems can escalate fast.

Medications and What to Monitor

Secretagogues like pilocarpine and cevimeline can boost tear and saliva production. Watch sweating and GI upset, and remember these are contraindicated in patients with uncontrolled asthma or narrow-angle glaucoma.

Hydroxychloroquine is commonly used for systemic symptoms; just make sure ophthalmology follow-up stays on the radar because retinal toxicity is a real risk with long-term use. NSAIDs help with joint symptoms but keep an eye on kidneys and GI tolerance.

For more aggressive diseases, immunosuppressants like methotrexate, azathioprine, or mycophenolate come into play. These require regular CBC and liver function monitoring, and patients need to understand their infection risk is elevated. Corticosteroids get used in flares blood glucose, bone density, and infection vigilance all apply.

Rituximab is sometimes used off label for refractory cases. As with any infusion therapy, watch for infusion reactions and signs of immunosuppression.

Why Getting IVIG Approval Is Hard:

IVIG isn't a first-line option for Sjögren's, but it does have a role in patients with severe neurological involvement with significant peripheral neuropathy, CNS complications, or vasculitis that hasn’t responded to conventional therapy. Neurological manifestations in Sjögren’s can be easy to miss or misattribute, which is part of why having a high index of suspicion matters. The challenge, once IVIG is clinically indicated, is getting it approved.

Because IVIG isn’t FDA-approved specifically for Sjögren’s, it’s considered off-label use, which means insurers scrutinize it heavily. Expect prior authorization requirements, documentation of failed first- and second-line treatments, objective diagnostic findings like EMG results or biopsy reports, and specialist sign-off from rheumatology or neurology. Approval often requires persistence and re-review.

Where Nurses Make the Difference:

This is where nursing advocacy becomes genuinely critical. Getting IVIG approved for a patient isn’t just a physician’s job it takes thorough, consistent documentation of symptoms, their frequency, and how they affect the patient’s daily function. Vague notes won’t move an insurance reviewer. Specific, functional language does. Coordinate with the specialist team and case managers early. Make sure all the required diagnostics are ordered and completed before the prior auth goes in, missing an EMG or lab result can delay approval by weeks. If a claim is denied, support the appeal process and help the patient understand that denials aren’t always final. During infusions, monitoring closely for reactions like headache, chills, and blood pressure changes are the most common. Thrombotic events are rare but serious. Hydration before and after infusion matters.

Patient Education:

Patients need to understand this is a long-term condition, not something that resolves. Oral hygiene and regular dental visits aren’t optional — they prevent real complications. Eyecare follow-up keeps small problems from becoming big ones. Medication adherence matters, and any new or worsening neurological or systemic symptoms should prompt a call, not a wait-and-see approach. Sjögren’s is manageable, but it takes consistent care, good communication across the care team, and a nurse who understands that what looks like a minor symptom on paper might be significantly impacting someone’s life.

References

• Ramos-Casals M, Brito-Zerón P, Seror R, et al. Characterization of systemic disease in primary Sjögren’s syndrome: EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI). Annals of the Rheumatic Diseases. 2015.
• Seror R, Bootsma H, Saraux A, et al. EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies. Annals of the Rheumatic Diseases. 2020.
• Mariette X, Criswell LA. Primary Sjögren’s Syndrome. New England Journal of Medicine. 2018;378:931–939.
• Vivino FB. Sjögren’s syndrome: Clinical aspects and treatment. UpToDate. Updated regularly.
• Baer AN, McAdams DeMarco M, Shiboski SC, et al. The SSB-positive/SSA-negative antibody profile in Sjögren’s syndrome. Arthritis Care & Research.
• Gono T, Kawaguchi Y, Katsumata Y, et al. Clinical manifestations of neurological involvement in primary Sjögren’s syndrome. Clinical Rheumatology.
• Katz U, Achiron A, Sherer Y, Shoenfeld Y. Safety of intravenous immunoglobulin (IVIG) therapy. Autoimmunity Reviews. 2007.
• Dalakas MC. IVIG in autoimmune neurological disorders. Journal of the American Medical Association.
• Sjögren’s Foundation. Clinical practice guidelines and patient resources. Available at: https://www.sjogrens.org U.S. Food and Drug Administration. Immune globulin intravenous (human): Prescribing information.