From the Guidelines
Treatment for Sjögren's syndrome focuses on symptom management as there is no cure, and the first therapeutic approach to dryness should be symptomatic relief using topical therapies, as recommended by the EULAR guidelines 1.
Symptom Management
For dry eyes, artificial tears used several times daily and preservative-free options for frequent use are recommended, along with prescription medications like cyclosporine (Restasis) or lifitegrast (Xiidra) eye drops.
- Dry mouth can be managed with frequent water sipping, sugar-free gum or candies, and saliva substitutes;
- Prescription medications like pilocarpine (Salagen) 5-10mg three times daily or cevimeline (Evoxac) 30mg three times daily can stimulate saliva production.
Systemic Symptoms
For systemic symptoms, hydroxychloroquine (Plaquenil) 200-400mg daily may help with fatigue and joint pain, as suggested by the EULAR recommendations 1.
- More severe manifestations might require immunosuppressants like methotrexate (starting at 7.5-10mg weekly) or rituximab infusions.
- Nonsteroidal anti-inflammatory drugs can help with joint pain.
Lifestyle Modifications
Patients should maintain good oral hygiene with regular dental visits, avoid smoking, limit alcohol consumption, and use humidifiers in dry environments.
- This multifaceted approach targets the autoimmune inflammation that causes the exocrine gland dysfunction characteristic of Sjögren's syndrome.
Systemic Disease Treatment
Treatment of systemic disease should be tailored to organ-specific severity using the ESSDAI definitions, as recommended by the EULAR guidelines 1.
- Systemic therapies may be considered for most patients presenting with at least moderate activity in one clinical domain, or with a global moderate disease activity score.
- B-cell targeted therapies may be considered in patients with severe, refractory systemic disease, as suggested by the EULAR recommendations 1.
From the Research
Treatment Options for Sjögren's Syndrome
The treatment of Sjögren's syndrome is primarily focused on managing the symptoms of the disease, particularly the sicca features and systemic manifestations 2.
- Topical Therapies: Topical therapies, such as saliva substitutes and artificial tears, are used to treat sicca manifestations symptomatically 2, 3.
- Systemic Therapies: Systemic therapies, including antimalarials, glucocorticoids, immunosuppressive drugs, and biologic agents, may be used to manage extraglandular features and systemic symptoms 2, 4.
- Stimulation of Salivary Flow: Stimulation of salivary flow with a sialogogue, such as pilocarpine, is the therapy of choice for patients with residual salivary gland function 2, 5, 3.
- Immunomodulation: Immunomodulation, including the use of immunosuppressive drugs and biologic agents, may have a role in improving signs and symptoms and preventing progression of the disease 4.
Pharmacological Interventions
Several pharmacological interventions have been studied for the treatment of Sjögren's syndrome, including:
- Pilocarpine: Pilocarpine has been shown to be highly beneficial in reducing hyposalivation in patients with Sjögren's syndrome 5.
- Rituximab: Rituximab has been shown to be moderately effective in reducing hyposalivation in patients with Sjögren's syndrome 5.
- Interferon-alpha (IFN-α): IFN-α has been shown to be moderately effective in enhancing salivary flow and lacrimal secretion in patients with Sjögren's syndrome 5.
- Prednisone and Hydroxychloroquine: The combination of prednisone and hydroxychloroquine has been shown to be effective in reducing symptoms of Sjögren's syndrome, although the dose of prednisone should be tapered 5.
Other Therapies
Other therapies that have been studied for the treatment of Sjögren's syndrome include: