From the Guidelines
The primary treatment for Sjögren's syndrome focuses on symptom management, with the first therapeutic approach being symptomatic relief using topical therapies, as recommended by the EULAR guidelines 1.
Symptom Management
The treatment typically begins with artificial tears and saliva substitutes to address the hallmark symptoms of dry eyes and dry mouth.
- For more severe dryness, prescription medications like pilocarpine (Salagen) or cevimeline (Evoxac) at doses of 5-10 mg three times daily may be used to stimulate moisture production.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800 mg three times daily) can help manage joint pain and inflammation.
Systemic Manifestations
For more severe systemic manifestations, immunosuppressive medications including hydroxychloroquine (200-400 mg daily), methotrexate (7.5-20 mg weekly), or corticosteroids may be prescribed, with the treatment tailored to organ-specific severity using the ESSDAI definitions 1.
- The use of systemic therapies should be restricted to patients with active systemic disease, with a global moderate disease activity score (score >5) 1.
Lifestyle Modifications
Patients should maintain good oral hygiene, stay hydrated, avoid smoking, and limit alcohol and caffeine consumption which can worsen dryness.
- Regular follow-up with rheumatologists and ophthalmologists is essential as Sjögren's can affect multiple organ systems and may increase risk for certain lymphomas.
Treatment Individualization
Treatment is individualized based on which symptoms are most problematic and how severely the disease affects quality of life, with a multidisciplinary approach involving various health professionals being essential 1.
From the FDA Drug Label
Pilocarpine hydrochloride tablets are indicated for ... the treatment of symptoms of dry mouth in patients with Sjogren’s Syndrome. The recommended dose of pilocarpine hydrochloride tablets is one tablet (5 mg) taken four times a day. Efficacy was established by 6 weeks of use.
The primary treatment for Sjogren's syndrome is pilocarpine. The recommended dosage is 5 mg taken four times a day 2 2.
From the Research
Treatment Overview
The primary treatment for Sjogren's syndrome is focused on managing its symptoms, as there is currently no cure for the disease 3, 4, 5.
Symptomatic Treatment
- Treatment of sicca manifestations is symptomatic and based on the administration of topical therapies, such as saliva substitutes and preservative-free artificial tears 3.
- For patients with residual salivary gland function, stimulation of salivary flow with a sialogogue (pilocarpine or cevimeline) is the treatment of choice 3, 6, 7.
- Pilocarpine has been shown to be effective in improving salivary flow, lacrimal flow, and subjective global assessment in patients with Sjogren's syndrome 6, 7.
Systemic Involvement
- The management of extraglandular features must be tailored to the specific organ(s) involved 3.
- Hydroxychloroquine may be appropriate for patients with fatigue, arthralgia, and myalgia, while glucocorticoids and immunosuppressive agents should be reserved for severe systemic involvement 3.
- Disease-modifying therapy is reserved for patients with systemic involvement, but there is limited evidence for its efficacy 5.
Interdisciplinary Care
- The main considerations in the interdisciplinary care of patients with Sjogren's disease are measures to improve quality of life, pharmacological and non-pharmacological treatments to keep disease activity in check, and management of the risk of lymphoma 5.
- Patients with Sjogren's syndrome often require care from multiple healthcare practitioners, including dentists, ophthalmologists, and rheumatologists 4.