From the Guidelines
Sjogren's syndrome does not directly affect iron absorption, but patients with the condition may experience reduced iron absorption due to secondary effects such as reduced saliva production and potential autoimmune gastritis. The primary reason for potential iron absorption issues in Sjogren's patients is the reduced saliva production, which can lead to dry mouth (xerostomia) and make it more difficult to swallow foods, potentially leading to reduced intake of iron-rich foods [ 1 ]. Additionally, some Sjogren's patients may develop autoimmune gastritis, which can impair stomach acid production and further reduce iron absorption.
To improve iron absorption in Sjogren's patients:
- Ensure adequate hydration to combat dry mouth
- Consider taking iron supplements with vitamin C to enhance absorption, as a recent iron isotope study showed that taking iron with 80 mg ascorbic acid on an empty stomach improves iron absorption [ 1 ]
- Consume iron-rich foods like lean meats, leafy greens, and fortified cereals
- If prescribed, take iron supplements on an empty stomach or between meals for better absorption, as taking iron with food or using enteric-coated formulations may improve tolerability but decrease absorption [ 1 ]
It is essential to note that patients with impaired absorption due to prior gastric surgery, inflammatory bowel disease, or chronic kidney disease may require intravenous iron supplementation [ 1 ]. Patients should consult their healthcare provider for personalized advice, as iron supplementation may not be necessary for all Sjogren's patients and should be based on individual iron levels and symptoms. According to the most recent study [ 1 ], there is no strong evidence that any of the available oral formulations is more effective or better tolerated than the others, and the ferrous iron salts are a reasonable choice to start with due to their low cost.
From the Research
Sjögren's Syndrome and Iron Absorption
- Sjögren's syndrome is an autoimmune disorder that can lead to various systemic complications, including anemia 2.
- Anemia in Sjögren's syndrome can be caused by iron deficiency, anemia of chronic disease, autoimmune hemolytic anemia, and other factors 2.
- Iron deficiency anemia is a common cause of anemia in Sjögren's syndrome, and it can be treated with iron supplementation 3, 2.
- However, the absorption of iron in patients with Sjögren's syndrome may be impaired due to various factors, including gastrointestinal disease and malabsorption 4, 5.
Malabsorption and Iron Deficiency
- Malabsorption is a disorder of the gastrointestinal tract that can lead to defective digestion, absorption, and transport of nutrients, including iron 5.
- Premucosal, mucosal, and postmucosal malabsorption can all contribute to iron deficiency anemia 5.
- In patients with Sjögren's syndrome, malabsorption can be caused by gastrointestinal disease, such as celiac disease, tropical sprue, and Crohn's disease 5.
- Iron supplementation can be effective in treating iron deficiency anemia in patients with Sjögren's syndrome, but the optimal dosing regimen is still unclear 6.
Treatment of Iron Deficiency Anemia
- Oral iron supplementation is a common treatment for iron deficiency anemia in patients with Sjögren's syndrome 3, 6.
- The optimal dosing regimen for oral iron supplementation is still unclear, but recent studies suggest that alternate-day dosing may be more effective than daily dosing 6.
- Parenteral iron supplementation may be necessary in some cases, especially if oral iron supplementation is not effective 3.