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Sjögren’s Syndrome (Sjögren Disease): Integrative Rheumatology Care in Mumbai and Online

Medically reviewed by Dr Krushal Pabari, MD, PGCP - Rheumatic & Musculoskeletal Diseases · Last reviewed: 4 November 2026

Key facts

Sjögren’s syndrome, now also called Sjögren disease, is a long-term autoimmune condition in which the immune system attacks the glands that make tears and saliva, causing dry eyes, a dry mouth, aching muscles and joints and extreme tiredness, according to the NHS [1]. A 2015 meta-analysis of 21 studies found about 61 people with primary Sjögren’s per 100,000, with women affected about 10 times more often than men [2]. Standard treatment, set out in the 2019 EULAR recommendations and the 2025 British Society for Rheumatology guideline, combines eye and mouth treatments with immune medicines such as hydroxychloroquine, methotrexate and rituximab for specific complications [3][4]. At Cure4Pain in Mumbai and online worldwide, Dr Krushal Pabari (MD, PGCP Rheumatic & Musculoskeletal Diseases) prescribes and adjusts the guideline medicines, working with AT. Chintan Dalal, N.D. (BNYS, R.AP). The plan adds supervised vitamin D therapy (Coimbra Protocol-based methods), diet, exercise and blood tests every 6 to 8 weeks, including markers linked with lymphoma risk; vitamin D therapy is not part of the guidelines and has not been tested in a Sjögren’s trial [3][4].

Watch our explainer videos
AT. Chintan Dalal, N.D.

Scientific explainer videos in our Resources section

In our Resources section, our clinical team discusses Sjögren's syndrome and its management in detail: functional nutrition and supervised vitamin D therapy (Coimbra Protocol-based methods), alongside guideline medicines and eye and dental care.

Watch our scientific explainer videos

What is Sjögren’s syndrome?

Sjögren’s syndrome is a condition in which the glands that produce fluid, such as tears and saliva, stop working properly because the immune system attacks them, according to the NHS [1]. In 2023 an international consensus recommended the name “Sjögren disease” in place of “Sjögren syndrome”, and “associated” in place of “secondary” when it occurs with another autoimmune disease such as rheumatoid arthritis or lupus [5].

  • How common: about 61 per 100,000 people overall in a 2015 meta-analysis of 21 studies, and about 43 per 100,000 in population-based studies; the average age was 56 [2].
  • Who gets it: women about 10 times more often than men [2]. Possible causes include certain genes, hormones and a viral or bacterial infection, according to the NHS [1].
  • Beyond dryness: at least 7 in 10 people have features outside the glands, such as inflammatory arthritis, skin, blood, nerve and lung involvement, according to the 2025 British Society for Rheumatology guideline [4].
  • In India: in a 2015 Vellore cohort of 332 people with primary Sjögren’s, onset was younger than in European reports, only 8.3% mentioned dryness on their own at the first visit, and over a third had severe systemic disease needing immune-suppressing treatment [6].

What are the symptoms of Sjögren’s syndrome?

Common symptoms are dry eyes, a dry mouth, aching muscles and joints and extreme tiredness; a very dry mouth can lead to difficulty swallowing, tooth decay and gum disease, according to the NHS [1].

  • Other symptoms: dry, itchy skin, a cough that does not go away, a quiet or hoarse voice, acid reflux, swollen salivary glands in the cheeks, neck and under the jaw, and vaginal dryness [1].
  • In women: Sjögren’s affects women about 10 times more often than men, according to a 2015 meta-analysis of 21 studies [2], and vaginal dryness is among the symptoms listed by the NHS [1].
  • Flares: symptoms can come and go, and overdoing it and not resting enough may make them worse [1].
  • Linked conditions: eye problems, other immune conditions such as rheumatoid arthritis, irritable bowel syndrome, loss of feeling in the arms and legs (peripheral neuropathy), low mood, and rarely cancer of the lymph glands (non-Hodgkin lymphoma) [1]. See our Neuropathy page.

How does Sjögren’s affect the joints?

Sjögren’s commonly causes aching muscles and joints, according to the NHS [1], and some people develop inflammatory arthritis, one of the features outside the glands described in the 2025 British Society for Rheumatology guideline [4]. The guideline advises methotrexate for inflammatory arthritis and notes a trend to less joint pain with hydroxychloroquine on longer follow-up in the JOQUER trial [4]. Joint pain with Sjögren’s can also come from rheumatoid arthritis or lupus occurring alongside it; see our Rheumatoid Arthritis and Lupus pages.

How is Sjögren’s syndrome diagnosed?

Tests include blood tests, eye tests, a saliva flow test, imaging of the salivary glands and a lip biopsy, in which a small piece of the inner lip containing salivary glands is examined, according to the NHS [1]. The 2016 ACR/EULAR classification criteria use anti-Ro (SSA) antibodies, the lip biopsy, an eye staining score, the Schirmer tear test and unstimulated saliva flow [7]. The 2025 British guideline advises measuring ENA antibodies even when ANA is negative if Sjögren’s is strongly suspected, and ultrasound of the salivary glands as useful extra information [4].

  • Tests at Cure4Pain: our standard panel of about 100 measures with ANA by the IFA method, including vitamin D, PTH, calcium, kidney function, vitamin B12 and thyroid tests, plus anti-Ro and anti-La antibodies, immunoglobulins, complement and protein electrophoresis, with your eye and dental reports and any biopsy results.
  • Outside India, the tests are done at a laboratory near you and the reports are uploaded to our patient portal.

What is the conventional treatment for Sjögren’s? Medicines as per guidelines

According to the 2019 EULAR recommendations, treatment starts with dryness, fatigue and pain and then manages any systemic disease, using eye and mouth treatments, saliva-stimulating tablets, hydroxychloroquine, steroids, immune-suppressing medicines and biological medicines [3]. The 2025 British Society for Rheumatology guideline sets the aims as conserving, replacing and stimulating secretions, preventing damage and suppressing systemic disease activity [4].

NeedTreatment as per guidelines (generic names)
Dry eyesPreservative-free lubricating eye drops used regularly and a heated eyelid compress daily; under an eye specialist, short-term steroid eye drops, ciclosporin eye drops or serum eye drops [4][3]
Dry mouth and teethSaliva substitutes; fluoride toothpaste, regular dental care and xylitol products in place of sugar [4]
Stimulating tears and salivaPilocarpine, or cevimeline where available, when some gland function remains [4][8][9]
Fatigue with systemic features, or high immunoglobulinsA trial of hydroxychloroquine for 6 to 12 months [4]
Inflammatory arthritisMethotrexate [4]
Specific organ complicationsShort-term steroids; azathioprine, mycophenolate, leflunomide or cyclophosphamide [3][4]
Severe, organ-threatening diseaseRituximab, now the treatment of choice in many of these situations; belimumab as rescue treatment when these have not worked, as suggested by European guidelines [4][3]
  • Steroids: the 2025 British guideline advises short courses for specific problems, not routine use, and notes that European and North American guidelines urge steroid-sparing medicines if steroids continue [4].
  • Immune-suppressing and biological medicines: recommended for specific systemic complications, not routinely for dryness alone [4].
  • Hydroxychloroquine eye checks: a 2020 joint statement of four US medical societies, including the American College of Rheumatology and the American Academy of Ophthalmology, advises a baseline eye test, then yearly screening starting no later than 5 years after starting it [10]; the Academy advises looking beyond the central retina in Asian patients [11].
  • Eye specialist and dentist: regular eye checks and dental check-ups are part of standard care [1][4].

At Cure4Pain, Dr Krushal Pabari prescribes and adjusts these medicines as per guidelines, under clinical guidance from Team Cure4Pain, in coordination with your existing consulting physician, eye specialist and dentist. Supervised vitamin D therapy (Coimbra Protocol-based methods) and the integrative plan are added alongside them, never in place of them; never stop or change your medicines on your own.

What do clinical trials of Sjögren’s medicines show?

Randomised trials of Sjögren’s medicines have had mixed results, which is why the 2025 British Society for Rheumatology guideline matches each medicine to a specific problem [4].

TrialWhoWhat it found
JOQUER, JAMA 2014 [12]120 people with primary Sjögren’s, hydroxychloroquine or placeboNo difference in dryness, pain or fatigue at 24 weeks; the 2025 British guideline notes a trend to less joint pain on longer follow-up [4]
TEARS, Ann Intern Med 2014 [13]120 people with recent or systemic disease, rituximab or placeboNo difference at 24 weeks; fatigue improved at earlier time points
RepurpSS-II, Lancet Rheumatol 2026 [14]46 people with systemically active diseaseLeflunomide with hydroxychloroquine lowered disease activity (ESSDAI) at 24 weeks compared with placebo
DAHLIAS, Lancet 2025 [15]163 people with moderate to severe diseaseNipocalimab, a new medicine in trials, lowered disease activity at the higher dose
NEPTUNUS-1 and NEPTUNUS-2, N Engl J Med 2026 [16]779 people with active diseaseIanalumab monthly lowered disease activity slightly more than placebo at 48 weeks; symptom scores did not differ
Pilocarpine trial, Arch Intern Med 1999 [8]373 people with Sjögren’sImproved dry mouth and dry eye symptoms, with sweating as the most common side effect
  • Newer medicines: a 2026 review notes positive phase 3 results for ianalumab and telitacicept [17]. Telitacicept was approved for Sjögren’s in China in June 2026, described by the companies as the first regulatory approval for the condition [18], and ianalumab received US FDA Breakthrough Therapy designation in January 2026 [19]. Their place in treatment will depend on guideline updates.

How does Cure4Pain manage Sjögren’s syndrome?

Cure4Pain manages Sjögren’s as a lifelong condition within integrative rheumatology: Dr Krushal Pabari prescribes and adjusts the guideline medicines, and the clinic adds supervised vitamin D therapy and a nutritional layer, never in place of standard treatment. We see primary Sjögren’s, Sjögren’s associated with lupus or rheumatoid arthritis, and children together with a children’s specialist. The plan includes:

  1. Assessment first: your antibody results, eye and dental reports, any biopsy, medicines and our full blood panel with ANA.
  2. Guideline medicines: prescribed and adjusted by Dr Krushal Pabari, with hydroxychloroquine eye checks.
  3. Supervised vitamin D therapy (Coimbra Protocol-based methods): no fixed dose for every person; the dose is set for each person and adjusted to blood tests, never on your own (see below).
  4. Cofactors in supervised doses: magnesium, vitamin K2, vitamin B12, folate, vitamin B2 and omega-3, within official upper limits where these exist.
  5. Dry eyes and dry mouth: practical daily care (see below), with referral to an eye specialist and a dentist.
  6. Diet: dairy removed to limit calcium (small amounts of fermented dairy such as yogurt or kefir may be allowed within the calcium limit set for you), at least 2.5 litres of fluid a day, wheat, sugar, cold foods and drinks, and nightshades removed, and cruciferous (Brassica) vegetables such as cabbage and cauliflower generally limited as an observational clinic practice.
  7. Gut health: fibre, probiotics and gut protocols managed by Dr Krushal Pabari.
  8. Exercise: we write an exercise programme with pacing, delivered by a local physiotherapist who reports back to us.
  9. Monitoring: the full panel with ANA every 6 to 8 weeks, which is mandatory during vitamin D therapy, including immunoglobulins, complement and protein electrophoresis, markers linked with lymphoma risk.

We do not offer acupuncture or needling for Sjögren’s.

Does vitamin D help Sjögren’s? What the research shows

It is not known whether vitamin D treatment helps Sjögren’s: no randomised trial was found in our PubMed search in October 2026, although a 2023 meta-analysis of 9 studies found vitamin D lower on average in Sjögren’s [20]. Vitamin D is not part of the 2019 EULAR or 2025 British treatment recommendations [3][4].

StudyWhoWhat it found
Meta-analysis, Nutrients 2023 [20]9 studies, 670 people with Sjögren’s and 857 controlsVitamin D lower in Sjögren’s than in healthy controls
Mendelian randomisation, 2023 [21]Large genetic data setsNo evidence that vitamin D levels cause Sjögren’s, or the other way round
Indian study, Vellore 2017 [22]235 people with primary Sjögren’sAverage vitamin D about 20 ng/mL, with 60% deficient; low levels went with higher biopsy grades, but also with lower disease activity scores
Study, J Autoimmun 2012 [23]176 people with primary Sjögren’sLower vitamin D in those with peripheral neuropathy and in those with lymphoma
  • What the 2025 British guideline says: it recommends checking vitamin D at baseline and notes the link between low vitamin D, neuropathy and lymphoma in Sjögren’s [4].
  • What this means: vitamin D is not a replacement for Sjögren’s medicines. At Cure4Pain it is used alongside them, under supervision, and further studies are needed.

What is the Coimbra Protocol, and how does Cure4Pain use it in Sjögren’s?

The Coimbra Protocol is a method of high-dose vitamin D therapy for autoimmune conditions, developed by Dr Cicero Galli Coimbra in Brazil, in which doses are adjusted to blood tests alongside a strict low-calcium diet and at least 2.5 litres of fluid a day [24]. Our methods are derived from the work of Dr Coimbra, and we give the Coimbra Protocol full credit. No trial of the Coimbra Protocol or of high-dose vitamin D in Sjögren’s has been published, according to our PubMed search in October 2026. For Sjögren’s, Cure4Pain uses supervised vitamin D therapy (Coimbra Protocol-based methods): there is no fixed dose for every person or condition, and the dose is set for each person by clinical judgement and adjusted to blood tests. Dr Krushal Pabari and AT. Chintan Dalal, N.D. apply these methods within an integrative rheumatology practice that manages medicines and drug interactions, with detailed blood monitoring. See our Coimbra Protocol page.

How is vitamin D therapy monitored for safety?

High doses of vitamin D can raise blood calcium and harm the kidneys, according to the US National Institutes of Health [25]. In a 2022 study of 319 people with autoimmune diseases treated with high-dose vitamin D under the Coimbra Protocol, with a strict low-calcium diet and at least 2.5 litres of fluid a day, average calcium and kidney results stayed within normal ranges for up to 3.5 years; the study was retrospective, came from one centre in Germany and had no comparison group [24].

  • Official limit: the upper limit for vitamin D without medical supervision is 1,000 to 4,000 IU a day depending on age, according to the US National Institutes of Health [25].
  • At Cure4Pain: the full panel, including vitamin D, calcium, PTH and kidney function, is mandatory every 6 to 8 weeks, and doses are adjusted to the results. Please never copy doses from the internet, from forums or from videos.

Which cofactors are used with vitamin D therapy?

Cofactors are given in supervised doses when tests or diet show a need, within official upper limits; trial evidence for each in Sjögren’s is limited.

  • Magnesium: magnesium is needed by the enzymes that activate and break down vitamin D, and in a 2018 randomised trial in adults without Sjögren’s, magnesium supplements changed vitamin D levels depending on the starting level [26]. The upper limit from supplements is 350 mg of elemental magnesium a day for adults, and a blood test does not show how much magnesium the body holds [27].
  • Vitamin K2: used with vitamin D as clinic practice; we found no trial in Sjögren’s. Vitamin K can interfere with blood thinners such as warfarin [28].
  • Vitamin B12, folate and vitamin B2: B12 deficiency can cause tiredness, weakness and nerve problems [29]; these are given as clinic practice when tests or diet show a need.
  • Omega-3: the 2025 British guideline suggests considering omega-3 supplements in Sjögren’s [4], but in the DREAM trial of 535 people with dry eye disease, omega-3 for 12 months did no better than an olive oil placebo [30], while a 2023 meta-analysis of 19 trials found improvements with wide differences between studies [31].

How can you ease dry eyes and dry mouth in Sjögren’s?

The NHS and the 2025 British guideline advise practical daily steps alongside treatment [1][4]:

  • Eyes: preservative-free lubricating eye drops used regularly, a heated eyelid compress daily, sunglasses with enclosed sides outdoors, breaks from screens and reading, and regular eye checks [4][1].
  • Mouth: plenty of water, sugar-free gum, brushing 2 or 3 times a day with fluoride toothpaste, dental check-ups every 6 months, and xylitol products in place of sugar [1][4].
  • Home: a humidifier, and less time in smoky, dusty, windy, air-conditioned or heated rooms [1].
  • Skin and vaginal dryness: emollients in place of drying soap, and vaginal moisturisers when needed [1][4].
  • At Cure4Pain: we review these steps at each visit and refer you to an eye specialist and a dentist.

What should you eat with Sjögren’s syndrome?

No specific diet has been proven to treat Sjögren’s: a 2025 systematic review of 19 studies found the evidence insufficient for specific diet recommendations for dry mouth [32]. Observational studies link a Mediterranean-style diet with lower odds of Sjögren’s and with lower disease activity, with fish intake showing the strongest link in one study [33][34], and the NHS advises foods rich in omega-3, such as oily fish and walnuts, and less sugary, salty and acidic food and drink [1]. As clinic practice during vitamin D therapy, Cure4Pain limits calcium and asks for plenty of fluids:

  • Calcium: dairy is removed to limit calcium; small amounts of fermented dairy such as yogurt or kefir may be allowed within the calcium limit set for you. A low-calcium diet and at least 2.5 litres of fluid a day were part of the protocol in the 2022 safety study [24].
  • Other exclusions: wheat, sugar, cold foods and drinks, and nightshades are removed, and, as an observational clinic practice, we generally suggest limiting cruciferous (Brassica) vegetables such as cabbage and cauliflower; we found no trial of these exclusions in Sjögren’s.
  • Dry mouth: sip water through the day, and choose sugar-free options to protect the teeth [1].

Can exercise help Sjögren’s fatigue?

Yes: a 2025 meta-analysis of 5 randomised trials in 269 women with primary Sjögren’s found that exercise improved pain, fatigue, quality of life and fitness, with resistance exercise the most effective [35]. The 2025 British guideline states that exercise is safe and potentially beneficial for people with Sjögren’s and fatigue, alongside pacing and attention to sleep [4].

  • At Cure4Pain: we write an exercise programme with pacing and refer you to a local physiotherapist, who monitors it and reports back to us.

Why does Cure4Pain check gut health in Sjögren’s?

Gut bacteria differ in Sjögren’s: in a 2022 study of 30 people with primary Sjögren’s and 20 healthy controls, the gut bacteria showed more inflammation-linked and fewer anti-inflammatory bacteria, and further studies are needed to know what this means [36]. Irritable bowel syndrome is also listed by the NHS among conditions linked with Sjögren’s [1].

  • At Cure4Pain: fibre, probiotics and gut protocols are managed by Dr Krushal Pabari; see our Gut Dysbiosis page.

Does Sjögren’s increase the risk of lymphoma?

People with Sjögren’s are more likely to develop non-Hodgkin lymphoma, a cancer of the lymph glands. The NHS describes it as rare [1], and the 2025 British Society for Rheumatology guideline gives a lifetime risk of 5% to 10% [4]. Most people with Sjögren’s will not develop it, but regular review matters.

  • Warning signs to report promptly: new or lasting swelling of the salivary glands [4], a painless lump in the neck, armpit or groin, fever or shivers, night sweats, shortness of breath, itchy skin and sudden unexplained weight loss [37].
  • What the guideline advises: early further tests for anyone with Sjögren’s who develops new salivary gland swelling or other possible signs of lymphoma; it lists findings such as salivary gland enlargement, cryoglobulins and low complement (C4) among predictors of lymphoma [4].
  • At Cure4Pain: immunoglobulins, complement and protein electrophoresis, markers linked with lymphoma risk, are checked in the 6 to 8 weekly panel; they do not diagnose lymphoma, so anyone with warning signs is referred promptly for specialist tests.

What are the pregnancy risks with Sjögren’s?

Anti-Ro antibodies can cross the placenta: in a study of 49 babies with heart block linked to these antibodies, all the mothers had anti-Ro antibodies, many were diagnosed with Sjögren’s only years later, and heart block recurred in 5 of 20 later pregnancies [38]. The 2025 British guideline advises considering hydroxychloroquine during pregnancy for women with anti-Ro antibodies, offering it in later pregnancies after a previous heart block, and urgent referral if heart block is found [4]. The NHS notes a higher risk of some pregnancy complications, such as miscarriage [1]. At Cure4Pain, pregnancy care is led by your obstetrician and rheumatologist, and vitamin D is given only at standard supplement doses during pregnancy.

Can children get Sjögren’s?

The 2025 British guideline covers juvenile Sjögren’s, in which recurrent swelling of the salivary glands is one of the most common features [4]. Dr Krushal Pabari sees children with Sjögren’s together with a children’s specialist, and vitamin D and all medicines for children are agreed with that specialist.

Is Sjögren’s syndrome serious? Outlook and life expectancy

Sjögren’s affects everyone differently: many people keep working and doing their usual activities, while more severe symptoms can affect daily life, and most people with Sjögren’s live into old age with the same life expectancy as the general population, according to the NHS [1]. At Cure4Pain, Sjögren’s is lifelong management, with regular monitoring and reviews.

Which doctor treats Sjögren’s syndrome?

Sjögren’s is managed in rheumatology: the 2025 British guideline advises follow-up within rheumatology, particularly for systemic disease, with eye specialists and dentists for dryness [4]. At Cure4Pain, Dr Krushal Pabari, whose training is in rheumatic and musculoskeletal diseases, prescribes and adjusts the guideline medicines and leads integrative care in Mumbai and online.

Online Sjögren’s care in India and worldwide: how it works

Cure4Pain sees people with Sjögren’s in person in Mumbai and online from any country, with consultations led by Dr Krushal Pabari.

  1. Register your case on our patient portal with your antibody results, eye and dental reports, any biopsy, medicines and recent blood tests.
  2. Blood tests near you: the panel is done at a laboratory in your city or country and uploaded to the portal; in India, home collection is available.
  3. Consultation online or in Mumbai with Dr Krushal Pabari and AT. Chintan Dalal, N.D.; available appointments are shown on the portal.
  4. Ongoing care: blood tests every 6 to 8 weeks and regular reviews, with your eye specialist and dentist kept in the loop.

How do I book a consultation?

Please register your case on our patient portal with your antibody results, eye and dental reports, blood tests and medical history. We take patients on only after reviewing these reports. Consultations are in person in Mumbai or online worldwide. Registrations and appointments are made only through our patient portal.

Evidence: key studies

StudyWhat it found
Ramos-Casals et al., Ann Rheum Dis 2020 [3]2019 EULAR recommendations for topical and systemic treatment of Sjögren’s.
Price et al., Rheumatology 2025 [4]British guideline: conserve, replace and stimulate secretions; medicines for specific complications; lymphoma lifetime risk 5% to 10%.
Gottenberg et al., JAMA 2014 [12]Hydroxychloroquine no better than placebo for symptoms at 24 weeks.
Wong et al., Lancet Rheumatol 2026 [14]Leflunomide with hydroxychloroquine lowered systemic disease activity.
Radić et al., Nutrients 2023 [20]Vitamin D lower on average in Sjögren’s.
Zhao et al., Arthritis Res Ther 2023 [21]No evidence that vitamin D levels cause Sjögren’s.
Nacar et al., Disabil Rehabil 2025 [35]Exercise, especially resistance exercise, improved pain and fatigue.
Amon et al., Nutrients 2022 [24]Average calcium and kidney results stayed normal in 319 supervised patients; single centre, no comparison group.

Sjögren’s Syndrome FAQs

Can vitamin D help Sjögren’s syndrome?

Vitamin D levels are lower on average in Sjögren’s [20], but a 2023 genetic study found no evidence that vitamin D levels cause it [21], and we found no randomised trial of vitamin D treatment in Sjögren’s. Cure4Pain uses supervised vitamin D therapy (Coimbra Protocol-based methods) alongside guideline medicines, never instead of them; further studies are needed.

Does Sjögren’s cause vitamin D deficiency?

Studies find lower vitamin D on average in people with Sjögren’s [20], and in an Indian study 60% of 235 people with primary Sjögren’s were deficient [22], but a 2023 genetic study found no evidence that Sjögren’s lowers vitamin D, or the other way round [21]. The 2025 British guideline recommends checking vitamin D at baseline [4].

Is hydroxychloroquine good for Sjögren’s?

Hydroxychloroquine is widely used, but in the JOQUER trial of 120 people it did not improve dryness, pain or fatigue more than placebo at 24 weeks [12]. The 2025 British guideline suggests a 6 to 12 month trial for people with significant fatigue and systemic symptoms or high immunoglobulins, with regular eye checks [4][10]. The dose is set by your doctor according to body weight [11]. At Cure4Pain, Dr Krushal Pabari prescribes and adjusts it as per guidelines.

Are there any new treatments for Sjögren’s?

Yes. A new combination of established medicines, leflunomide with hydroxychloroquine, lowered disease activity in a 2026 trial of 46 people [14]. Among new medicines, ianalumab slightly lowered disease activity in two 2026 phase 3 trials [16], nipocalimab did so at the higher dose in a 2025 trial [15], and telitacicept was approved in China in June 2026 [18]. None of these is yet in the European or British guidelines.

What are the best supplements for Sjögren’s?

No supplement has been proven to treat Sjögren’s. The 2025 British guideline suggests considering omega-3 [4], although the large DREAM trial found no benefit for dry eye disease [30]. At Cure4Pain, vitamin D, magnesium, vitamin K2, B vitamins and omega-3 are given in supervised doses based on your tests.

Does omega-3 help dry eyes in Sjögren’s?

The evidence is mixed: the DREAM trial of 535 people with dry eye disease found omega-3 for 12 months no better than an olive oil placebo [30], while a 2023 meta-analysis of 19 trials found improvements with wide differences between studies [31]. The 2025 British guideline suggests considering omega-3 in Sjögren’s [4].

What foods are bad for Sjögren’s?

No diet has been proven to treat Sjögren’s [32]. The NHS advises less sugary, salty and acidic food and drink, such as fizzy drinks [1]. During vitamin D therapy, Cure4Pain also removes dairy (with small amounts of fermented dairy allowed within your limit), wheat, sugar, cold foods and nightshades as clinic practice.

What is the best drink for Sjögren’s?

Water: the NHS advises drinking plenty of water and cutting down on sugary and fizzy drinks [1], and during vitamin D therapy Cure4Pain asks for at least 2.5 litres of fluid a day.

Which blood tests are done for Sjögren’s?

Blood tests look for antibodies such as ANA and anti-Ro (SSA), which are part of the 2016 classification criteria [7]; the 2025 British guideline advises measuring ENA antibodies even when ANA is negative if Sjögren’s is strongly suspected [4]. At Cure4Pain, our panel also includes immunoglobulins, complement and protein electrophoresis.

What is the Schirmer test?

The Schirmer test measures tear production with a small strip of paper placed at the edge of the lower eyelid; it is one of the tests in the 2016 classification criteria for Sjögren’s [7].

Can you have Sjögren’s with negative blood tests?

Yes. Some people have no anti-Ro antibodies, and the diagnosis can then rest on a lip biopsy and eye and saliva tests [7][4]; in the Vellore cohort, antibody-negative patients tended to have milder disease [6].

How is fatigue in Sjögren’s treated?

The 2025 British guideline recommends a holistic review of activity pacing, sleep and lifestyle, says exercise is safe and potentially beneficial, and suggests a trial of hydroxychloroquine when fatigue comes with systemic symptoms [4]; resistance exercise improved fatigue most in a 2025 meta-analysis [35].

Will Sjögren’s syndrome go away? Is it dangerous?

Sjögren’s is a long-term condition, but treatments help manage the symptoms, and most people live into old age with the same life expectancy as the general population, according to the NHS [1]. A recognised serious risk is lymphoma, which the NHS describes as rare; the 2025 British Society for Rheumatology guideline gives a lifetime risk of 5% to 10%, so regular review matters [1][4]. At Cure4Pain, Sjögren’s is lifelong management.

Is there an Ayurvedic treatment for Sjögren’s?

Our PubMed search in October 2026 found no controlled trial of Ayurvedic treatment for Sjögren’s. Cure4Pain does not use Ayurvedic medicines for Sjögren’s; please tell your doctor about any herbal products you take.

What is Sjögren’s syndrome called in Hindi and Marathi?

In Hindi and Marathi it is written शोग्रेन सिंड्रोम (pronounced “show-grin”); it is an autoimmune condition in which the eyes and mouth become dry (Hindi: एक ऑटोइम्यून रोग जिसमें आंखें और मुंह सूख जाते हैं; Marathi: डोळे आणि तोंड कोरडे पडणारा एक ऑटोइम्यून आजार).

Who is the best doctor for Sjögren’s in Mumbai?

Sjögren’s is best followed in rheumatology, with an eye specialist and a dentist, according to the 2025 British guideline [4]. At Cure4Pain in Malad West, Mumbai, and online worldwide, Dr Krushal Pabari (MD, PGCP Rheumatic & Musculoskeletal Diseases) prescribes and adjusts the guideline medicines and leads integrative care, with AT. Chintan Dalal, N.D.

What makes Sjögren’s worse?

Overdoing it and not resting enough can make Sjögren’s symptoms worse, according to the NHS, as can smoky, dusty, windy, air-conditioned or heated rooms, smoking, long periods at screens, and sugary, salty or acidic food and drink [1].

Is Sjögren’s hereditary?

Sjögren’s is not passed on in a simple way, but it may be linked to certain genes, together with hormones and possibly an infection as a trigger, according to the NHS [1].

Can low vitamin D cause dry mouth in Sjögren’s?

There is no evidence that it does: a 2023 genetic study found no evidence that vitamin D levels cause Sjögren’s [21], although vitamin D is lower on average in people with the condition [20].

Can I get Sjögren’s care online?

Yes. Cure4Pain sees people with Sjögren’s in Mumbai and online worldwide, led by Dr Krushal Pabari; blood tests are done at a laboratory near you every 6 to 8 weeks.

Do I have to stop my Sjögren’s medicines?

No. Never stop or change Sjögren’s medicines on your own. At Cure4Pain, Dr Krushal Pabari prescribes and adjusts them as per guidelines, under clinical guidance from Team Cure4Pain, and vitamin D therapy is added alongside them.

Can I have a baby if I have Sjögren’s?

Yes, with planning: anti-Ro antibodies can affect the baby’s heart rhythm, so the 2025 British guideline advises considering hydroxychloroquine in pregnancy for women with these antibodies [4][38]. At Cure4Pain, pregnancy care is led by your obstetrician and rheumatologist, with vitamin D at standard doses.

Do you treat children with Sjögren’s?

Yes. Dr Krushal Pabari sees children with Sjögren’s together with a children’s specialist.

Do you use acupuncture for Sjögren’s?

No. Cure4Pain does not use acupuncture or needling for Sjögren’s.

How much does Sjögren’s care cost at Cure4Pain?

The consultation fee is shown when you book on our patient portal. Blood tests are done at a laboratory near you; in India, the panel is available at a lower cost through the portal.

Who treats you

  • Dr Krushal PabariMD, PGCP - Rheumatic & Musculoskeletal Diseases. Assistant Professor, Cooper Hospital; Guest Professor, CMP Homoeopathic Medical College.
  • AT. Chintan Dalal, N.D.BNYS, R.AP. Functional nutrition and Coimbra Protocol practitioner.

Consultations look at the whole person: alongside the medical and nutritional plan, we bring a strong interest in behavioural science to counselling on stress, sleep and lasting lifestyle change.

How consultations work: Mumbai or online worldwide

Book through our patient portal. You can see us in person at our clinic in Malad West, Mumbai, or online from anywhere. Your first consultation reviews your history and tests; we then agree a plan together and set the monitoring schedule.

Book Appointment

Related conditions and articles

This page is for education and does not replace medical advice. Do not start, stop or change any medicine or supplement without medical guidance.

References

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2. Qin B, et al. Epidemiology of primary Sjögren’s syndrome: a systematic review and meta-analysis. Ann Rheum Dis 2015;74(11):1983-9. doi:10.1136/annrheumdis-2014-205375

3. Ramos-Casals M, et al. EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies. Ann Rheum Dis 2020;79(1):3-18. doi:10.1136/annrheumdis-2019-216114

4. Price EJ, et al. British Society for Rheumatology guideline on management of adult and juvenile onset Sjögren disease. Rheumatology (Oxford) 2025;64(2):409-439. doi:10.1093/rheumatology/keae152

5. Ramos-Casals M, et al. 2023 International Rome consensus for the nomenclature of Sjögren disease. Nat Rev Rheumatol 2025;21(7):426-437. doi:10.1038/s41584-025-01268-z

6. Sandhya P, et al. Clinical Characteristics and Outcome of Primary Sjogren’s Syndrome: A Large Asian Indian Cohort. Open Rheumatol J 2015;9:36-45. doi:10.2174/1874312901409010036

7. Shiboski CH, et al. 2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren’s Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts. Arthritis Rheumatol 2017;69(1):35-45. doi:10.1002/art.39859

8. Vivino FB, et al. Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with Sjögren syndrome: a randomized, placebo-controlled, fixed-dose, multicenter trial. P92-01 Study Group. Arch Intern Med 1999;159(2):174-81. doi:10.1001/archinte.159.2.174

9. Fife RS, et al. Cevimeline for the treatment of xerostomia in patients with Sjögren syndrome: a randomized trial. Arch Intern Med 2002;162(11):1293-300. doi:10.1001/archinte.162.11.1293

10. Rosenbaum JT, et al. American College of Rheumatology, American Academy of Dermatology, Rheumatologic Dermatology Society, and American Academy of Ophthalmology 2020 Joint Statement on Hydroxychloroquine Use With Respect to Retinal Toxicity. Arthritis Rheumatol 2021;73(6):908-911. doi:10.1002/art.41683

11. Marmor MF, et al. Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy (2016 Revision). Ophthalmology 2016;123(6):1386-94. doi:10.1016/j.ophtha.2016.01.058

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13. Devauchelle-Pensec V, et al. Treatment of primary Sjögren syndrome with rituximab: a randomized trial. Ann Intern Med 2014;160(4):233-42. doi:10.7326/M13-1085

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15. Noaiseh G, et al. Efficacy and safety of nipocalimab in patients with moderate-to-severe Sjögren’s disease (DAHLIAS): a randomised, phase 2, placebo-controlled, double-blind trial. Lancet 2025;406(10518):2435-2448. doi:10.1016/S0140-6736%2825%2901430-8

16. Mariette X, et al. Ianalumab for the Treatment of Patients with Sjögren’s Disease. N Engl J Med 2026;395(16):1585-1599. doi:10.1056/NEJMoa2601088

17. Patel V, et al. Clinical trials and new therapies in Sjögren’s disease. Curr Opin Immunol 2026;100:102743. doi:10.1016/j.coi.2026.102743

18. Vor Bio and RemeGen. Telitacicept receives NMPA approval for the treatment of Sjögren’s disease in China (press release, 8 June 2026). biospace.com/press-releases/telitacicept-receives-nmpa-approval-for-the-treatment-of-sjogrens-disease-in-china

19. Novartis. Novartis ianalumab receives FDA Breakthrough Therapy designation for Sjögren’s disease (media release, January 2026). novartis.com/news/media-releases/novartis-ianalumab-receives-fda-breakthrough-therapy-designation-sjogrens-disease

20. Radić M, et al. Vitamin D and Sjögren’s Disease: Revealing the Connections-A Systematic Review and Meta-Analysis. Nutrients 2023;15(3). doi:10.3390/nu15030497

21. Zhao M, et al. Serum vitamin D levels and Sjogren’s syndrome: bi-directional Mendelian randomization analysis. Arthritis Res Ther 2023;25(1):79. doi:10.1186/s13075-023-03062-2

22. Sandhya P, et al. Vitamin D Levels and Associations in Indian Patients with Primary Sjögren’s Syndrome. J Clin Diagn Res 2017;11(9):OC33-OC36. doi:10.7860/JCDR/2017/28493.10697

23. Agmon-Levin N, et al. Low levels of vitamin-D are associated with neuropathy and lymphoma among patients with Sjögren’s syndrome. J Autoimmun 2012;39(3):234-9. doi:10.1016/j.jaut.2012.05.018

24. Amon U, et al. Safety Data in Patients with Autoimmune Diseases during Treatment with High Doses of Vitamin D3 According to the “Coimbra Protocol”. Nutrients 2022;14(8). doi:10.3390/nu14081575

25. Office of Dietary Supplements, US National Institutes of Health. Vitamin D: Fact Sheet for Health Professionals. ods.od.nih.gov/factsheets/VitaminD-HealthProfessional

26. Dai Q, et al. Magnesium status and supplementation influence vitamin D status and metabolism: results from a randomized trial. Am J Clin Nutr 2018;108(6):1249-1258. doi:10.1093/ajcn/nqy274

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29. Office of Dietary Supplements, US National Institutes of Health. Vitamin B12: Fact Sheet for Health Professionals. ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional

30. Asbell PA, et al. n-3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease. N Engl J Med 2018;378(18):1681-1690. doi:10.1056/NEJMoa1709691

31. Wang WX, Ko ML. Efficacy of Omega-3 Intake in Managing Dry Eye Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2023;12(22). doi:10.3390/jcm12227026

32. Castro FLAL, et al. Nutritional Intervention for Sjögren Disease: A Systematic Review. Nutrients 2025;17(17). doi:10.3390/nu17172743

33. Machowicz A, et al. Mediterranean diet and risk of Sjögren’s syndrome. Clin Exp Rheumatol 2020;38 Suppl 126(4):216-221. pubmed.ncbi.nlm.nih.gov/33095150

34. Carubbi F, et al. Adherence to the Mediterranean diet and the impact on clinical features in primary Sjögren’s syndrome. Clin Exp Rheumatol 2021;39 Suppl 133(6):190-196. doi:10.55563/clinexprheumatol/5p5x5p

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36. Yang L, et al. Comprehensive Analysis of the Relationships Between the Gut Microbiota and Fecal Metabolome in Individuals With Primary Sjogren’s Syndrome by 16S rRNA Sequencing and LC-MS-Based Metabolomics. Front Immunol 2022;13:874021. doi:10.3389/fimmu.2022.874021

37. NHS. Symptoms of non-Hodgkin lymphoma. nhs.uk/conditions/non-hodgkin-lymphoma/symptoms

38. Brito-Zerón P, et al. Autoimmune congenital heart block and primary Sjögren’s syndrome: characterisation and outcomes of 49 cases. Clin Exp Rheumatol 2020;38 Suppl 126(4):95-102. pubmed.ncbi.nlm.nih.gov/33025893

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