From the Guidelines
Sjögren's syndrome treatment should prioritize symptomatic relief using topical therapies, with a focus on managing dry eyes and dry mouth, as well as addressing systemic symptoms such as fatigue and joint pain. For dry eyes, artificial tears like Systane or Refresh are used frequently throughout the day, with preservative-free options preferred for frequent use, as recommended by the 2020 EULAR guidelines 1. Prescription medications such as cyclosporine eye drops (Restasis) or lifitegrast (Xiidra) can reduce inflammation and increase tear production, with a study published in 2024 highlighting the benefits of autologous serum and autologous plasma rich in growth factors drops in improving ocular irritation symptoms and conjunctival and corneal dye staining in patients with Sjögren’s syndrome 1. For dry mouth, patients should sip water frequently, use sugar-free gum or lozenges, and consider saliva substitutes like Biotene, with pilocarpine (5-10mg three times daily) or cevimeline (30mg three times daily) prescribed to stimulate saliva production, as supported by the 2020 EULAR recommendations 1. Some key points to consider in the management of Sjögren's syndrome include:
- The use of topical therapies as the first-line approach for dryness, with a focus on symptomatic relief 1
- The importance of addressing systemic symptoms such as fatigue and joint pain, with hydroxychloroquine (200-400mg daily) often used to manage these symptoms 1
- The potential benefits of immunosuppressants like methotrexate (starting at 7.5-10mg weekly) or rituximab for resistant cases, with B-cell targeted therapies like rituximab considered in patients with severe, refractory systemic disease 1
- The need for patients to maintain good oral hygiene with regular dental visits, avoid smoking, limit alcohol and caffeine consumption, and use humidifiers in dry environments, as part of a multifaceted approach to managing the disease and improving quality of life.
From the Research
Treatment Options for Sjögren's Syndrome
- The treatment of primary Sjögren's syndrome is based on managing sicca features and systemic manifestations 2.
- Sicca manifestations are treated symptomatically with topical therapies, such as saliva substitutes and artificial tears 2, 3.
- In patients with residual salivary gland function, stimulation of salivary flow with a sialogogue is the therapy of choice 2.
- The management of extraglandular features must be tailored to the specific organ or organs involved, and may include antimalarials, glucocorticoids, immunosuppressive drugs, and biologic agents 2, 3.
Biologic Treatment
- Biologic agents targeting B cells, such as rituximab, epratuzumab, and belimumab, have shown promising results in treating Sjögren's syndrome 4.
- T cell stimulation inhibition is another potentially effective target for SS treatment, with early-phase studies showing positive results with abatacept and alefacept 4.
- Modulation or inhibition of other targets, such as IFN, IL-6, and Toll-like receptor, are also being investigated as potential therapies for SS 4.
Symptomatic Relief
- Saliva substitutes can provide relief for patients with xerostomia, but the optimal properties of a saliva substitute may vary depending on individual salivary flow rates 5.
- Artificial tears can improve contrast sensitivity in patients with Sjögren's syndrome, particularly those with mucoadhesive properties 6.
- The effects of artificial tears on contrast sensitivity are limited, but may be more pronounced at medium spatial frequencies 6.