From the Guidelines
Sjögren's syndrome is an autoimmune disorder that requires a comprehensive treatment approach, focusing on symptom management and quality of life, with the primary goal of alleviating dry eyes and dry mouth, as well as addressing systemic symptoms and potential complications, as recommended by the European League Against Rheumatism (EULAR) 1.
Treatment Approach
The treatment of Sjögren's syndrome involves a multi-faceted approach, including:
- Topical therapies for dry eyes, such as artificial tears and lubricating ointments, with prescription options like cyclosporine eye drops (Restasis) or lifitegrast (Xiidra) to reduce inflammation 1.
- Stimulation of saliva production for dry mouth, through frequent sipping of water, use of sugar-free gum or lozenges, and consideration of prescription medications like pilocarpine (Salagen) or cevimeline (Evoxac) 1.
- Management of systemic symptoms, such as joint pain and fatigue, with hydroxychloroquine (Plaquenil) or methotrexate, and other immunosuppressants for more severe manifestations 1.
- Good oral hygiene practices, including regular dental visits, fluoride treatments, and avoidance of sugary foods 1.
Systemic Involvement
For patients with systemic involvement, such as interstitial lung disease (ILD), the use of immunosuppressive agents like mycophenolate mofetil (MMF) or azathioprine may be considered, with caution and close monitoring due to potential side effects 1.
Pulmonary Disease
In the management of pulmonary disease in Sjögren's syndrome, antifibrotic drugs like nintedanib may be used as second-line therapy for progressive fibrotic ILD, and cyclophosphamide or rituximab may be considered for rapidly progressive or exacerbating ILD 1.
Quality of Life
The overall goal of treatment is to improve the quality of life for patients with Sjögren's syndrome, by alleviating symptoms, preventing complications, and enhancing functional capacity, as emphasized by the EULAR recommendations 1.
From the Research
Schogren Disease Overview
- Schogren disease, also known as Sjögren syndrome, is a systemic autoimmune disease characterized by dry eyes and dry mouth 2.
- The disease is classified as primary or secondary, with primary disease being a solitary process and secondary disease accompanying another autoimmune disease, often rheumatoid arthritis 2.
Symptoms and Treatment
- Patients with Sjögren syndrome experience slowly progressive infiltration of lacrimal and salivary glands by mononuclear cells, leading to diminished secretions and resultant symptoms of xerostomia and xerophthalmia 3.
- Pilocarpine tablets have been shown to be effective in treating dry mouth and dry eyes in patients with Sjögren syndrome, with significant improvement in global assessments of dry mouth, dry eyes, and other symptoms of dryness [(3,4,5,6)].
- Cevimeline has also been found to be associated with improvement in dry mouth and dry eye symptoms 4.
- Topical ocular 0.05% cyclosporine has been shown to improve Schirmer and corneal staining scores, blurred vision, and artificial tear use in patients with Sjögren syndrome 4.
Treatment Efficacy
- A double-blind randomized controlled trial found that pilocarpine was more effective than artificial saliva in enhancing salivary and lacrimal secretion in patients with Sjögren syndrome 5.
- A 12-week controlled study found that oral pilocarpine had a beneficial effect on subjective eye symptoms and objective improvement in rose bengal staining, but did not increase tear production as measured by the Schirmer-I test 6.
- A systematic review of randomized controlled trials found that pilocarpine and cevimeline were associated with improvements in dry mouth and dry eye symptoms, while anti-tumor necrosis factor agents did not show clinical efficacy 4.