Dry mouth, severe COVID linked

Dear Dr. Roach: I don’t know what to think; perhaps you can help. As an 83-year-old previously healthy, very active female, I was recently diagnosed first with bronchitis and then with COVID, all in one month. Ten weeks later, I am struggling with dry mouth, gums and lips that no doctor can explain.

Is this one of the long COVID symptoms? I’ve tested negative for the A and B versions of Sjogren’s disease.

Can a virus cause an autoimmune disease in a previously healthy person?

And is this just something that I have to learn to live with, as it is quite challenging?

C.R.

Answer: Sjogren’s disease is an autoimmune disease involving many secretory glands, especially those in the mouth and eye.

Dry eye and mouth are cardinal symptoms of the disease, but fatigue, muscle aches and sometimes mild cognitive impairment (“brain fog”) are other common symptoms. Although the antiRo and anti-La autoantibodies are usually found with Sjogren’s disease, they are not necessary to make the diagnosis and can be found in healthy people without Sjogren’s disease.

There is a clear connection between Sjogren’s and COVID infections, particularly with severe COVID. Several authors have reported cases where the person who developed symptoms was found to have antibodies and proven to have Sjogren’s disease by biopsy during their hospitalization for COVID. A study in lab animals also showed that a COVID infection can induce the Sjogren’s autoantibodies and reduce saliva and eye secretions.

There is not yet longterm data on the prognosis of Sjogren’s disease following COVID. It is possible that the dry mouth will get better over the months, like with other persistent COVID symptoms. However, it is more likely that COVID triggered Sjogren’s disease, and it may be permanent.

Rheumatologists tend to be the experts for Sjogren’s disease, and there are many treatments available beyond symptomatic treatment of dry eyes and mouth.