NEUROLOGICAL SYMPTOMS in SJOGREN'S SYNDROME (SS) The involvement of the nerves and nervous system.

Did you know that Neurological Symptoms Strike One in Five Primary Sjogren Patients according to a 2016 study

Neurological symptoms seen in SS include:

Neurologic complications: A PRIMER ON THE NEUROLOGICAL COMPLICATIONS OF SJÖGREN’S By Julius Birnbaum, MD Johns Hopkins Neurology-Rheumatology Clinic

The neurological complications of Sjogren’s syndrome are extensive and range from cognitive difficulties to burning toes and feet.                                                                                                                                       The nervous system is divided into two anatomic compartments:

  1. The “Central Nervous System” – or CNS – includes the brain and the spinal cord;
  2. The “Peripheral Nervous System” – or PNS – includes larger and smaller nerves, connecting muscles to the spinal cord.

Sjögren’s syndrome can cause inflammation and damage to both the CNS and PNS.


Prevalence of neurological manifestations in primary Sjogren's syndrome  (PSS) varies widely from 10 to 60%, with pure or predominantly sensory polyneuropathies as the most common neurologic manifestation (e.g. sensory ataxic or small fiber sensory painful neuropathy). 

Mononeuropathy multiplex, polyradiculopathy, symptomatic dysautonomia, cranial neuropathy, myopathy, and central nervous system involvement are less common. PUBMED ARTICLE
Neurological involvement in Sjögren syndrome

Dr. Tilman Hottenrott Doctor, University Hospital Freiburg, Department of Neurology and Neurophysiology. Talk on Saturday, March 17, 2018 in Freiburg, Germany. 

The good news in advance: Nervous system involvement is only in 10-20% of those affected with Sjogren's. In this case, the peripheral nerves are affected more frequently than the central nervous system. 
The symptoms are often already noticeable before the diagnosis is made and can be expressed by pain in the feet, arms and hands, tingling and numbness, ants running and burning of the skin. The regulation of blood pressure when getting up and standing for a long time may get worse. The pupils of the eyes may contract more than is normal. Gait insecurity and discomfort are other symptoms

Only 1-5% of patients complain of central nervous system symptoms. These can manifest themselves in cognitive disorders, epileptic seizures and inflammation of the muscles or spinal cord. 
These symptoms need to be clarified and differentiated from other conditions that can cause these symptoms as well. ​​​​​​​
Articles on Neurological Symptoms


Neurological Manifestations Of Sjögren's Syndrome

Steven Mandel, M.D.
Clinical Professor of Neurology
Jefferson Medical College

Myopathy is defined as injury to muscle and myalgia as pain in muscle.

Individuals with muscle problems may have pain on palpation or spontaneous pain (myalgias). They may be unable to climb stairs or carry things (weakness). Individuals may or may not have symptoms. 

Individuals may have fever, fatigue, arthralgias, myalgias, or lymphadenopathy. Weakness is more prominent proximally than distally. The course is generally mild and insidious. 

Weakness can occur in those with renal involvement, renal tubular acidosis, and hypokalemia. Muscle biopsy may show myositis, but positive biopsy can be found in the absence of clinical symptoms in 17-74% of patients.

When Sjogren's syndrome is suspected in muscle, a sed rate and electromyography should be performed, and muscle and nerve biopsy should be considered. Muscle involvement has been reported to include myositis, muscle fiber necrosis, and elevated muscle enzymes.