Sjögren’s disease (SjD) is a chronic autoimmune disease that primarily affects the moisture-producing glands, commonly causing dry eyes and dry mouth, but it can also affect many other parts of the body. Although SjD is far more common in female patients, researchers are still working to understand whether the disease presents differently between sexes. A new study published in Seminars in Arthritis and Rheumatism in 2026 examined sex differences in patient-reported symptoms, clinical findings, laboratory tests, and quality of life among patients with Sjögren’s disease receiving care at a multidisciplinary center in the Netherlands.
Study Design
Type of study: Cross-sectional cohort study using data from both a prospective cohort and retrospective diagnostic registry.
Location: University Medical Center Groningen (UMCG), Netherlands.
Participants: 405 patients with Sjögren’s disease who fulfilled the 2016 ACR/EULAR classification criteria. Of these participants, 360 (89%) were female and 45 (11%) were male.
What researchers examined:
- Patient-reported outcome measures assessing dryness, fatigue, pain, and quality of life
- Salivary and tear gland function testing
- Salivary gland ultrasound and biopsy findings
- Blood biomarkers
- Disease activity and disease-related damage
- Physical examination findings such as swollen joints and tender points
Statistical methods: Researchers compared outcomes between female and male participants using standard statistical analyses and performed regression analyses to explore which outcomes were independently associated with sex.
Key Findings
Female patients scored worse on multiple measures assessing oral and ocular dryness, including the ESSPRI dryness score, Xerostomia Inventory, and Ocular Surface Disease Index. They were also more likely to report needing liquids to swallow dry food and using tear substitutes frequently. Further, salivary testing showed significantly lower unstimulated and stimulated saliva production in female patients compared to male patients. Female patients also developed symptoms earlier in life and experienced a longer delay before diagnosis compared to male patients.
On the other hand, male patients were more likely to have pulmonary involvement and peripheral nervous system activity on the EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI), suggesting that some systemic manifestations may occur more frequently in males.
Despite differences in dryness symptoms, female and male patients reported similar levels of fatigue and pain across several questionnaires. Quality of life as measured by EQ-5D-5L and SF-36 scores were similar between female and male patients.
Clinical Significance
This study highlights that Sjögren’s disease may present differently in female and male patients. Females appeared to experience greater symptom burden related to dryness and reduced salivary gland function, whereas males demonstrated more systemic manifestations involving the lungs and peripheral nervous system. Importantly, these differences were not necessarily reflected in overall quality of life measures.
The findings reinforce the importance of individualized and patient-centered care in Sjögren’s disease. Clinicians may need to pay closer attention to severe sicca symptoms and diagnostic delay in female patients, while remaining vigilant for systemic complications in male patients. The study also emphasizes the value of combining patient-reported symptoms with objective testing when evaluating Sjögren’s disease.
Limitations and What This Means for Patients
The study was conducted at a tertiary referral center, meaning participants may have had more complex or severe disease than the general Sjögren’s population. In addition, the researchers only had information about biological sex and not gender, which may also influence symptom reporting. Finally, because this was a cross-sectional study, the researchers could not determine how symptoms or disease patterns change over time.
Future Directions
Future research should explore how both biological sex and gender-related factors influence Sjögren’s disease experiences, diagnosis, and long-term outcomes. Researchers also emphasized the importance of developing disease-specific quality-of-life measures that better capture the real-world impact of Sjögren’s disease on work, social participation, and daily living.
Reference:
Kokol, H., Rebel, D., de Wolff, L., Oei, E., van Deelen, E., Ausma, N., Olie, L., Alberga, J. M., van der Vegt, B., Kroese, F. G. M., Vissink, A., Delli, K., Verstappen, G. M., Bootsma, H., & Arends, S. (2026). Sex differences in patient-reported outcome measures and clinical parameters in patients with Sjögren’s disease. Seminars in Arthritis and Rheumatism, 78, 152960. https://doi.org/10.1016/j.semarthrit.2026.152960
