Doctors and researchers now believe that primary Sjogren’s disease and primary biliary cholangitis (PBC) are more closely connected than once thought, according to a review published recently in Frontiers in Immunology.
Both Sjogren’s disease and PBC are autoimmune diseases, and evidence shows they share many of the same genetic risk factors, immune system behaviors and even treatment targets. For patients, this means a diagnosis of one condition raises the chance of also developing the other, and understanding their overlap could lead to more effective care.
Genetic studies suggest that the same inherited traits can make people vulnerable to both illnesses. In fact, families affected by Sjogren’s disease or PBC often see several relatives develop one or the other, sometimes alongside additional autoimmune disorders. The conditions also involve similar immune system changes at the HLA gene region and beyond, influencing how T cells and B cells drive inflammation and tissue damage.
Blood tests help doctors detect and monitor both disorders. In Sjogren’s disease, anti-SSA and anti-SSB antibodies, along with antinuclear antibodies, are key signs. In PBC, anti-mitochondrial antibodies appear, along with changes in liver function tests such as elevated alkaline phosphatase. Importantly, some of these antibodies overlap, reflecting the shared immune activity fueling both conditions.
Read more about testing and diagnosis for PBC
The damage they cause also looks alike under the microscope. In Sjogren’s disease, salivary glands are infiltrated with immune cells that gradually destroy tissue, sometimes creating structures that raise the risk of developing lymphoma.
In PBC, bile ducts in the liver undergo similar immune attacks, leading to inflammation, scarring and, in advanced cases, cirrhosis. In both, the immune environment is dominated by overactive T and B cells, natural killer cells and inflammatory messengers such as interleukins.
Current treatments remain imperfect, but some overlap exists. Patients with Sjogren’s disease may receive steroids, immunosuppressants or drugs such as hydroxychloroquine to control symptoms. PBC is treated first with ursodeoxycholic acid, which improves bile flow and reduces liver damage, though not all patients respond.
“In the future, by delving into the pathogenesis of these two diseases, we may find more effective treatments to provide more effective and personalized therapies for treating patients and improving their quality of life,” stated this review’s authors.
For people living with Sjogren’s disease or PBC, this growing knowledge may lead to earlier diagnosis, closer monitoring and new treatment options. While both diseases can be serious and long-lasting, advances in understanding their common roots give reason for cautious optimism.
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