From the Guidelines
Hydroxychloroquine (Plaquenil) is not strongly recommended for the treatment of dry eye symptoms in Sjögren's syndrome or Sicca syndrome, as the literature does not demonstrate strong evidence for its efficacy in this regard. Sjögren's syndrome is an autoimmune disorder where the immune system attacks moisture-producing glands, particularly those in the eyes and mouth, causing dryness and inflammation. Sicca syndrome refers to the collection of dryness symptoms (dry eyes, dry mouth) that can occur either as part of Sjögren's or independently. According to the most recent study 1, the efficacy of oral secretagogues was greater in the treatment of oral dryness than ocular dryness, and topical lubricants, topical anti-inflammatory therapy, and tear-conserving strategies seemed effective for dry eye syndrome.
The European League Against Rheumatism (EULAR) recommendations for the management of Sjögren's syndrome with topical and systemic therapies 1 suggest that the first therapeutic approach to dryness should be symptomatic relief using topical therapies, and systemic therapies may be considered for the treatment of active systemic disease. However, the use of hydroxychloroquine is not strongly recommended for the treatment of dry eye symptoms, as the literature does not demonstrate strong evidence for its efficacy in this regard 1.
Instead, other treatments such as oral muscarinic agonists (pilocarpine and cevimeline) may be considered for the treatment of dry mouth and dry eye symptoms 1. These medications bind to muscarinic receptors, which stimulate secretion of the salivary and sweat glands, and they also appear to improve tear production. Patients treated with pilocarpine or cevimeline may experience improvement in dry mouth and dry eye symptoms, although the most common side effect is excessive sweating.
In summary, while hydroxychloroquine may be used to alleviate fatigue and arthralgias in patients with Sjögren's syndrome, its use is not strongly recommended for the treatment of dry eye symptoms, and other treatments such as oral muscarinic agonists and topical therapies may be more effective. Regular eye exams and monitoring for potential side effects are necessary for patients with Sjögren's syndrome or Sicca syndrome, regardless of the treatment approach.
From the Research
Sjögren's Syndrome and Sicca Syndrome
- Sjögren's syndrome is a systemic autoimmune disease characterized by mouth and eye dryness, pain, and fatigue 2.
- Sicca syndrome is another term used to describe the dryness symptoms associated with Sjögren's syndrome, including dry eyes and dry mouth 3.
- Primary Sjögren's syndrome (pSS) is a subtype of Sjögren's syndrome that is not associated with any other autoimmune disease 4.
Hydroxychloroquine (Plaquenil) Treatment
- Hydroxychloroquine is an immunosuppressant commonly prescribed for Sjögren's syndrome, although its efficacy is still a topic of debate 2, 5.
- Some studies suggest that hydroxychloroquine may improve symptoms of Sjögren's syndrome, such as pain and fatigue, but not dryness symptoms 2, 6.
- A systematic review and meta-analysis found that hydroxychloroquine was not effective in treating dry mouth and dry eyes in pSS, but may be effective in reducing pain and erythrocyte sedimentation rate 6.
- Another study found that hydroxychloroquine therapy was associated with a lower incidence of extraglandular manifestations (EGM) in pSS patients, including arthritis, fatigue, and purpura 4.
Efficacy and Safety of Hydroxychloroquine
- The efficacy of hydroxychloroquine in treating Sjögren's syndrome is still uncertain, and more studies are needed to confirm its benefits 2, 5, 6.
- Hydroxychloroquine is generally well-tolerated, but common adverse effects include gastrointestinal symptoms 6.
- Further studies are needed to evaluate the long-term outcomes and safety of hydroxychloroquine treatment in Sjögren's syndrome patients 2, 5.