Balance Dysfunction in Sjogren’s Syndrome: Neurological and Clinical Perspectives

The neurological footprint of primary Sjögren’s syndrome may be broader than previously recognized. A new observational study has found that patients with this autoimmune condition exhibit measurable impairments in vestibular and balance function—symptoms that often escape clinical attention despite their potential impact on mobility, stability, and quality of life.

Primary Sjögren’s syndrome, classically associated with dry eyes and dry mouth due to lymphocytic infiltration of exocrine glands, is increasingly understood as a systemic disease. Its reach extends beyond mucosal surfaces, affecting joints, lungs, kidneys, and the nervous system. This latest research adds another dimension to its clinical profile: neurosensory disruption involving both central and peripheral vestibular pathways.

In this study, researchers assessed 24 individuals diagnosed with primary Sjögren’s syndrome and compared them to 26 age- and sex-matched healthy controls. Each participant underwent a detailed battery of vestibular and balance evaluations, including video head impulse testing (vHIT), sensory organization testing (SOT), and a suite of oculomotor assessments such as gaze stability, saccades, tracking, and optokinetic response. These tools allowed investigators to probe for signs of dysfunction in both the inner ear and the brain's integrative processing of balance-related input.

Findings revealed that the Sjögren’s cohort performed significantly worse on vHIT and SOT—two gold-standard tests for assessing the integrity of vestibular reflexes and multisensory balance integration. These impairments suggest deficits not only in the vestibulo-ocular reflex but also in how the central nervous system compensates for or processes disrupted sensory input. For patients, this may translate into symptoms like dizziness, lightheadedness, or postural instability—complaints that are easily misattributed to aging, medication side effects, or unrelated neurological conditions.

What makes these results particularly noteworthy is their clinical silence. Vestibular symptoms are not part of the conventional diagnostic criteria for Sjögren’s syndrome and are rarely documented in patient records unless severe. As a result, such deficits may be underdiagnosed or dismissed as incidental findings. Yet the consequences—falls, functional limitation, reduced confidence in mobility—are far from trivial, especially in a population primarily composed of middle-aged and older women.

This study reinforces the need for a broader clinical lens when evaluating patients with Sjögren’s. Routine vestibular screening could uncover meaningful deficits that are amenable to targeted interventions, such as vestibular rehabilitation therapy. Early identification might also preempt fall-related injuries and offer patients a clearer explanation for their symptoms.

While the study’s sample size was small and findings observational, they open important avenues for future research. Questions remain as to whether vestibular involvement in Sjögren’s stems from direct autoimmune attack on inner ear structures, secondary inflammatory processes, or central nervous system involvement. Longitudinal studies will be critical to determine whether these deficits progress over time and how they respond to therapy.

For now, the takeaway is clear: Sjögren’s syndrome may shake more than mucosal surfaces. Its reach extends to balance and orientation—domains that, when impaired, can undermine patients’ autonomy and confidence. Integrating vestibular assessments into routine care could be a small shift with significant impact, stabilizing not only posture but the overall care paradigm for a complex systemic disease.