Sjögren's Syndrome and Gallstone Risk

Based on current medical evidence, there is no established direct association between Sjögren's syndrome and an increased risk of gallstones.

Sjögren's Syndrome: Systemic Manifestations

Sjögren's syndrome is a systemic autoimmune disorder characterized by:

Lymphocytic infiltration of the lacrimal and salivary glands with secondary compromise of gland function, leading to dry eyes and dry mouth 1
Female predominance with a female-to-male ratio of 20:1 1
Prevalence of approximately 0.4% in the general population 1
Systemic manifestations including arthralgia, myalgia, and fatigue 1
Potential for multiple organ involvement beyond exocrine glands 1

Sjögren's syndrome is associated with several comorbidities:

Primary biliary cholangitis occurs in 8% of cases of limited cutaneous systemic sclerosis (lcSSc), usually in those positive for anti-centromere antibodies 1
Thyroid dysfunction or autoimmune thyroiditis 1
Increased risk for lymphoproliferative disorders, with approximately 5% of patients developing lymphoma 2
Patients with decreased C4 levels at diagnosis have higher risk of developing lymphoma 1, 2
Renal manifestations including distal renal tubular acidosis 3
Pancreatic involvement with elevated pancreatic enzyme levels in up to 50% of patients 4

The established risk factors for gallstone disease include:

Female sex, older age, certain medications 5
Type 2 diabetes mellitus, nonalcoholic fatty liver disease, obesity, rapid weight loss, or hemolytic anemia 5
Approximately 10-15% of adults in the United States are affected by gallstones 5
Nearly 80% of gallstones are found incidentally and remain asymptomatic 5
Incidence rates show substantial geographical variation, with the lowest rates reported in African populations 6

While there is some evidence of pancreatic involvement in Sjögren's syndrome:

Mild pancreatic ductal changes have been observed in 27% of patients with Sjögren's syndrome 4
The concept of "autoimmune exocrinopathy" has been proposed in patients with Sjögren's syndrome, primary biliary cirrhosis, and chronic pancreatitis 4
However, no direct evidence links Sjögren's syndrome to an increased risk of gallstone formation 1, 2, 7

For patients with Sjögren's syndrome:

Co-management with a rheumatologist is essential due to potential systemic complications 1, 2
Regular monitoring for signs of lymphoma development is recommended 2
Screening for other autoimmune conditions may be warranted 1

For patients with gallstones:

Expectant management is recommended for asymptomatic gallstones due to their benign natural history 1
Treatment should be reserved for symptomatic disease 1, 8, 6
Laparoscopic cholecystectomy is the treatment of choice for most patients with biliary colic or acute cholecystitis 5

Avoid assuming that abdominal symptoms in Sjögren's syndrome patients are automatically related to their autoimmune condition; consider standard workup for common conditions like gallstones 5, 9
Dyspeptic symptoms (indigestion, belching, bloating) are common in persons with gallstones but may be unrelated to the stones themselves 9
Be aware that patients with Sjögren's syndrome may have multiple overlapping autoimmune conditions that could influence clinical presentation 1
Consider that 9-30% of patients with Sjögren's syndrome and/or primary biliary cirrhosis experience mild and intermittent abdominal pain, which could be confused with biliary symptoms 4