How PBC and Sjögren’s Can Overlap

People with PBC or Sjögren’s may have overlapping risk factors and symptoms, and these conditions can sometimes occur together. This may be because both conditions have a similar disease process. PBC and Sjögren’s disease are both autoimmune conditions, meaning the immune system mistakenly attacks the body’s own cells, causing inflammation and damage.

In the United States, about a third of people with autoimmune conditions are diagnosed with more than one autoimmune disease.

What’s more, research suggests there’s a relationship between PBC and Sjögren’s disease. One study estimates that about 35 percent of people with PBC also have Sjögren’s. This could affect how the two conditions are evaluated and managed.

Risk Factors for PBC and Sjögren’s

Many autoimmune diseases have some genetic and environmental factors that affect whether a person develops each disease. Though the causes of PBC and Sjögren’s are still being studied, there are some overlaps in the risk factors that can lead to these autoimmune conditions.

These include the following factors:

• Female sex — Women are more likely than men to develop PBC or Sjögren’s.
• Age — Sjögren’s disease and PBC are more likely to be diagnosed in people over 40.
• Genetic factors — People with a family history of PBC or Sjögren’s may be more likely to develop these conditions.
• Other autoimmune diseases — People with autoimmune conditions like rheumatoid arthritis may be more likely to develop PBC or Sjögren’s, and vice versa.
• Viral or bacterial infections — Certain infections may trigger autoimmune conditions including PBC and Sjögren’s.

Symptoms That May Point to Both Conditions

Many people with PBC may not feel any symptoms, but those who do may have some overlap with symptoms of Sjögren’s disease.

One member shared, “Sjögren’s? I’ve had dry mouth for a while. Even when I’m drinking, my mouth is dry. I find this very weird. Yesterday, my eyes got so dry.”

Some symptoms can occur with either condition, while others are more closely linked to PBC or Sjögren’s disease. Symptoms may include:

• Dry eyes
• Dry mouth
• Dry skin
• Tiredness
• Joint pain
• Swelling

“Fatigue is the most common early complaint in both, which is why these conditions often get written off for years,” Dr. Harsha Moole, MD, internal medicine physician in Topeka, Kansas, shared with myPBCteam. “Dry eyes and dry mouth are the classic Sjögren’s signs, but PBC can carry its own dryness too, so the two overlap more than people expect,” he said.

For some people, symptoms can get very intense, requiring medical attention. “The itching, burning, and stinging can get out of control. I’ve tried over-the-counter drops, and nothing seems to help,” shared one myPBCteam member about their dry eye symptoms.

Contact your healthcare provider for further evaluation if you have severe joint pain or swelling, intense itching, or dryness in the mouth, eyes, or skin causing pain. Sometimes these symptoms may point to a condition outside of PBC, such as Sjögren’s. Comprehensive testing and evaluation can help your health team find the most appropriate treatments for you.

Managing PBC and Sjögren’s Together

How healthcare providers manage PBC and Sjögren’s has some overlap. However, there are some differences to keep in mind when managing them together.

Supportive Treatment

“Autoimmune care is individualized by organ, severity, and what the patient can tolerate,” said Dr. Moole. Your treatment options can depend on your symptoms. This is called symptomatic or supportive treatment.

For example, people with dry eyes may be advised to use artificial tears or prescription eye drops. For dry mouth, drinking water or chewing sugar-free gum may help. Prescription medications can also help the body make more saliva.

Differences in PBC and Sjögren’s Treatment

Your doctor’s evaluation will determine how to manage Sjögren’s and PBC. The first-line treatment for PBC is usually ursodeoxycholic acid (UDCA, also called Ursodiol). It’s recommended when liver function tests are abnormal. Other medications are recommended when UDCA doesn’t work well or isn’t tolerated.

On top of supportive treatment, people with Sjögren’s may be recommended medications that affect the immune system. Depending on a person’s symptoms and which parts of the body are affected, doctors may use medications such as hydroxychloroquine, corticosteroids, or methotrexate to help control inflammation and immune-system activity.

Keep in touch with your care team if you’re managing both PBC and Sjögren’s together. “When the picture is mixed, a rheumatologist and a hepatologist often work together to sort it out. Sometimes it takes both specialties,” advised Dr. Moole.

Interactions to Consider

Some medications may interact with each other, and others may have specific dosage instructions. For example, if someone takes an aluminum-based antacid for their Sjögren’s-related acid reflux symptoms, it can block the absorption of Ursodiol needed for PBC.

Always share your full medication list, including your over-the-counter and prescription medications, with your healthcare team.