The 2024 Nobel Prize in Physiology or Medicine, awarded for the discovery of microRNAs (miRNAs) as essential regulators of gene expression, has spotlighted their pivotal roles in disease processes, including autoimmune conditions such as Sjögren's disease (SD). SD is a chronic autoimmune disease marked by lymphocytic infiltration of exocrine glands, resulting in significant glandular dysfunction and diverse systemic effects. Recent research has revealed that miRNAs play crucial roles in SD pathogenesis, orchestrating immune cell activity, epithelial cell integrity, and the regulation of inflammatory pathways. Dysregulation of specific miRNAs is associated with exacerbated immune responses, glandular damage, epithelial cell dysfunction, and sustained inflammation, positioning these small RNA molecules as central players in disease progression. This review synthesizes current findings on the roles of miRNAs in SD, highlighting how certain miRNAs contribute to immune dysregulation, epithelial dysfunction, and disease chronicity. Additionally, we explore the potential of miRNAs as biomarkers for disease activity, reflecting both immune and epithelial health, and as novel therapeutic targets. By consolidating recent advancements, we aim to offer a comprehensive perspective on the involvement of miRNAs in SD and to underscore the potential for miRNA-based strategies to transform the diagnosis, management, and treatment of SD.