Treatment

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There is no cure for Sjögren's syndrome, and no treatment has yet been found to restore physiological glandular secretions. This means that treatment primarily addresses the symptoms and is designed to relieve your discomfort and lessen the effects of dryness. Put another way, you can generally learn to manage your condition, but the root problems will remain. You may be referred to a rheumatologist for treatment.

Sjögren's syndrome can affect various parts of your body, so regular checkups can help detect and prevent future problems. And if you have secondary Sjögren's syndrome—that is, if the disorder is associated with another autoimmune condition—be sure to follow treatments for that condition.

Since Sjögren's syndrome affects everyone differently, your treatment plan will be based on your specific needs. But in general, moisture-replacement therapies may ease the symptoms of dryness. In some cases, your health care professional may recommend a simple procedure that blocks tear drainage from your eyes.

Dry eyes respond to the use of artificial tears applied every one to four hours or to pharmacological stimulation of tear production. Dry mouth can be relieved by drinking water, chewing sugar-free gum or using artificial saliva or saliva stimulants (such as pilocarpine and cevimeline). Wearing protective eyewear, such as goggles, or using a humidifier to keep moisture in the air can be helpful.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, may be used to treat musculoskeletal symptoms. If you have severe complications, your health care professional may prescribe corticosteroids or immunosuppressive drugs.

Here's an overview of some of the most commonly used medications:

• NSAIDs can suppress inflammation and reduce pain. Sjögren's patients are generally prescribed NSAIDs for joint pain, muscle ache, fever and fatigue. However, NSAIDs provide no improvement in the salivary or tear flow.

• Corticosteroids may be used if you have internal organ involvement—which is rare—or as a topical treatment for dry eyes. If you have secondary Sjögren's syndrome, you may already be on corticosteroids—especially if the primary condition is lupus or rheumatoid arthritis. The side effects can be significant, so you and your health care professional need to monitor both the efficacy and possible side effects of the medication.

• Immunomodulating agents are occasionally used in autoimmune diseases like Sjögren's. These medications act very slowly, so they don't bring about immediate relief. As with corticosteroids, these immunomodulating agents, with the exception of hydroxychloroquine, are generally used when there is internal organ involvement. These agents can include:

  • Hydroxychloroquine (Plaquenil), an antimalarial drug, is sometime used to relieve swelling, stiffness and pain. It may also have a limited effect on the glandular symptoms, the hallmark of the disease.

  • Methotrexate (Trexall) is a folic-acid inhibitor generally used to treat rheumatoid arthritis and may be prescribed for Sjögren's patients with internal organ involvement.

  • Cyclophosphamide (Cytoxan) is considerably more potent than methotrexate and is reserved for the most serious organ involvement. Other drugs used for severe organ involvement include mycophenolate (CellCept) and azathioprine (Azasan).

  • Antifungal drugs, such as nystatin (Bio-Statin, Nystop) may be used to treat oral candidiasis (a common fungal infection).

  • Pilocarpine (Salagen) and cevimeline (Evoxac) tablets may be use to increase salivary flow. Evoxac, however, should not be used for those with a number of other conditions, including asthma and acute angle glaucoma. Higher doses of both of these medications may have significant side effects including flushing, sweating, nausea, vomiting and diarrhea.

• Saliva substitutes can be used to replace oral secretions, but they have not been carefully studied, and they are only recommended when saliva secretions cannot be replaced by sips of water.

• Artificial tears or eye drops can help relieve the discomfort of dry eyes. You probably want to use preservative-free products, especially if you apply the drops frequently. These products include Tears Naturale Free and Bion Tears. (Note: Some over-the-counter eye drops contain vasoconstrictors and can cause further drying.)

• Cyclosporine A (Restasis) eye drops are immunosuppressive and are also used to increase tear production. Unlike artificial tears, these are available only by prescription.

As for the future, a variety of novel therapeutic approaches, using newer immunosuppressive agents, drops made from a person's own blood serum, and the injected medication rituximab (Rituxan) are being investigated but are not ready for widespread clinical application.