From the Guidelines
The primary treatment for Sjögren's syndrome focuses on symptom management, with artificial tears and saliva substitutes being the first line of treatment for dry eyes and dry mouth, as recommended by the EULAR guidelines 1.
Symptom Management
- Artificial tears and saliva substitutes are used to address dry eyes and dry mouth.
- Prescription medications such as pilocarpine (Salagen) or cevimeline (Evoxac) may be used to stimulate saliva production at doses of 5-10 mg three times daily.
- Topical cyclosporine eye drops (Restasis) can reduce eye inflammation.
Systemic Manifestations
- Hydroxychloroquine (200-400 mg daily) may help with fatigue and joint pain, as suggested by the study by Fauchais et al 1.
- In cases with significant organ involvement, immunosuppressants like methotrexate (10-25 mg weekly) or rituximab may be prescribed, with the treatment tailored to organ-specific severity using the ESSDAI definitions 1.
Lifestyle Modifications
- Frequent water sipping, using humidifiers, avoiding drying medications, and practicing good oral hygiene are important lifestyle modifications.
- Treatment is individualized based on symptom severity and organ involvement, targeting the underlying immune dysregulation that causes exocrine gland dysfunction and systemic inflammation. The EULAR guidelines recommend a multidisciplinary approach involving various health professionals, with a central role for specialists in autoimmune diseases 1. The guidelines also emphasize the importance of symptomatic relief using topical therapies for dryness, and the use of systemic therapies for active systemic disease 1.
From the FDA Drug Label
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. Pilocarpine hydrochloride tablets are indicated for ... the treatment of symptoms of dry mouth in patients with Sjogren’s Syndrome.
The primary treatment for Sjogren's syndrome is pilocarpine. The recommended dosage is 5 mg taken four times a day 2. This treatment is indicated for the treatment of symptoms of dry mouth in patients with Sjogren’s Syndrome 2.
From the Research
Treatment Overview
The primary treatment for Sjogren's syndrome is focused on managing its symptoms, particularly the sicca features (dry eyes and dry mouth) and systemic manifestations.
- 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, 4, 5.
Management of Extraglandular Features
The management of extraglandular features must be tailored to the specific organ(s) involved.
- Hydroxychloroquine may be appropriate for patients with fatigue, arthralgia, and myalgia 3.
- Glucocorticoids and immunosuppressive agents should be reserved for severe systemic involvement, although no controlled trials in primary SS guide their use 3.
- B-cell depleting agents have shown promising results in clinical trials 3.
Specific Treatment Options
Specific treatment options for Sjogren's syndrome include:
- Pilocarpine, which has been shown to stimulate the secretion of saliva and improve symptoms of dry mouth and dry eyes 4, 5.
- Artificial saliva, which may be used to manage dry mouth symptoms, although it is less effective than pilocarpine 4.
- Topical cyclosporine A, which may be used in severe cases of keratoconjunctivitis sicca 3.
Interdisciplinary Care
Due to the complexity of Sjogren's syndrome, interdisciplinary care is often necessary to manage the disease and its symptoms.
- Measures to improve quality of life, such as pharmacological and non-pharmacological treatments, are important considerations in the care of patients with Sjogren's disease 6.
- Management of the risk of lymphoma is also a key consideration, as patients with Sjogren's syndrome are at increased risk of developing non-Hodgkin lymphoma 6.