What is Sjögren's (Sjögren syndrome) syndrome?

From the Guidelines

The management of Sjögren's syndrome should focus on symptom relief, with the use of topical and systemic therapies, as recommended by the 2020 EULAR guidelines 1. The therapeutic approach to Sjögren's syndrome (SjS) has remained largely unchanged in recent decades, with treatment decisions often challenging in clinical practice.

• The primary goal of treatment is to relieve symptoms, with a focus on managing the central triplet of symptoms: dryness, fatigue, and pain.
• Topical therapies, such as artificial tear drops, topical non-steroidal anti-inflammatory drugs, and topical corticosteroids, can be effective in managing dry eyes and other symptoms.
• Oral muscarinic agonists, such as pilocarpine and cevimeline, can stimulate saliva production and help manage dry mouth.
• Hydroxychloroquine may be used to help manage fatigue and joint pain, while immunosuppressants like methotrexate or rituximab may be necessary for more severe cases.
• Patients should also maintain good oral hygiene, avoid smoking, limit alcohol and caffeine, and use a humidifier to help manage their symptoms. The 2020 EULAR guidelines provide a comprehensive approach to the management of SjS, with 12 specific recommendations that form a logical sequence, starting with the management of the central triplet of symptoms followed by the management of systemic disease 1.
• These guidelines are based on evidence collected from studies including primary SjS patients and provide a rational therapeutic approach to SjS patients useful for healthcare professionals.
• The guidelines also address the use of biological therapies, such as rituximab, abatacept, and belimumab, which may be effective in managing certain symptoms of SjS. Overall, the management of Sjögren's syndrome requires a comprehensive approach that takes into account the individual patient's symptoms and needs, with a focus on relieving symptoms and improving quality of life 1.

From the Research

Symptoms and Treatment of Sjögren Syndrome

• Sjögren syndrome is a systemic autoimmune disease characterized by dry eyes and dry mouth, with other organ systems affected in many patients 2.
• The main symptoms of Sjögren syndrome include xerostomia (dry mouth) and xerophthalmia (dry eyes) 3, 4.
• Treatment options for Sjögren syndrome include topical and systemic drugs, such as pilocarpine and cevimeline, which can help relieve dry eyes and dry mouth 5, 2.

Efficacy of Pilocarpine in Treating Sjögren Syndrome

• Pilocarpine has been shown to stimulate the secretion of saliva and improve lacrimal flow in patients with Sjögren syndrome 3, 4.
• Studies have found that pilocarpine is more effective than artificial saliva in enhancing salivary and lacrimal secretion in patients with Sjögren syndrome 3.
• Pilocarpine has also been found to improve subjective global assessment of dry eyes and objective assessment of dry eyes, as measured by the rose bengal test 4.

Management and Diagnosis of Sjögren Syndrome

• Diagnosis of Sjögren syndrome requires coordination with a team of specialists, including dentists, otolaryngologists, rheumatologists, and ophthalmologists 2.
• The American/European consensus criteria are used to make an accurate diagnosis of Sjögren syndrome 6.
• Management of Sjögren syndrome involves local therapy for sicca symptoms, hydroxychloroquine for milder systemic symptoms, and steroids and immunosuppressive drugs for more severe extraglandular disease 6.