From the Guidelines
The first therapeutic approach for patients with Sjögren's syndrome should be symptomatic relief using topical therapies, such as artificial tears and ocular gels/ointments for ocular dryness, and non-pharmacological stimulation, pharmacological stimulation, or saliva substitution for oral dryness, depending on the severity of salivary gland dysfunction. According to the EULAR recommendations for the management of Sjögren's syndrome 1, a multidisciplinary approach involving various health professionals is essential for managing patients with Sjögren's syndrome. The treatment of systemic disease should be tailored to organ-specific severity using the ESSDAI definitions, and glucocorticoids should be used at the minimum dose and length of time necessary to control active systemic disease 1. Some key points to consider in the management of Sjögren's syndrome include:
- Baseline evaluation of salivary gland function is recommended before starting treatment for oral dryness 1
- The preferred first therapeutic approach for oral dryness may be non-pharmacological stimulation for mild dysfunction, pharmacological stimulation for moderate dysfunction, and saliva substitution for severe dysfunction 1
- Refractory or severe ocular dryness may be managed using topical immunosuppressive-containing drops and autologous serum eye drops 1
- Concomitant diseases should be evaluated in patients presenting with fatigue or pain, and treatment should be tailored to the individual patient's needs 1. Overall, the goal of treatment is to manage symptoms, prevent complications, and improve quality of life for patients with Sjögren's syndrome, and a multidisciplinary approach, with a focus on symptomatic relief using topical therapies, is the most effective way to achieve this goal.
From the Research
Sjögren's Syndrome Symptoms and Treatment
- Sjögren's syndrome is characterized by the presence of xerostomia (dry mouth) and/or xerophthalmia (dry eyes) 2, 3, 4, 5.
- Pilocarpine, a muscarinic cholinergic agonist, has been proven to be efficacious in treating radiation-induced xerostomia and symptoms of dry mouth in Sjögren's patients 2, 3, 4.
- Studies have shown that pilocarpine can significantly increase salivary flow and improve symptoms of dry mouth and dry eyes in patients with Sjögren's syndrome 2, 3, 4.
Pilocarpine Dosage and Efficacy
- A dose-adjusted study found that oral pilocarpine (20 mg to 30 mg daily) was effective in relieving Sjögren's-related dry mouth and dry eye symptoms 2.
- A fixed-dose study found that 5-mg pilocarpine tablets four times daily (20 mg/d) was well tolerated and produced significant improvement in symptoms of dry mouth and dry eyes 3.
- A double-blind randomized controlled trial found that pilocarpine was more effective than artificial saliva for enhancing salivary and lacrimal secretion in patients with Sjögren's syndrome 4.
Current Therapy and Future Directions
- Current treatment options for Sjögren's syndrome have limitations, and future therapies must be designed to improve symptoms of dry eyes and dry mouth, extraglandular disease, and fatigue and cognitive deficits 6.
- Innovative directions involving interactions with neuroscientists and neuropsychiatrists together or combined with new immune targeting may hold promise for better treating Sjögren's syndrome 6.