TREATMENT
There is no cure for
Sjogren's syndrome, and no treatment has yet been found to restore physiological
glandular secretions. This means that treatment primarily addresses the
symptoms, and is designed to relieve your discomfort and lessen the effects of
dryness. Put another way, you can generally learn to manage your condition, but
the root problems will remain. (For strategies on managing Sjogren's syndrome,
see the Prevention section at this Web site.) You may be referred to a
rheumatologist for treatment.
Sjogren's syndrome can affect various parts of your body, so regular checkups
can help detect and prevent future problems. And if you have secondary Sjogren's
syndrome--that is, if the disorder is associated with another autoimmune
condition, be sure to follow specific treatment for that condition.
Since Sjogren's syndrome affects everyone differently, your treatment plan will
be based on your specific needs. But in general, moisture-replacement therapies
may ease the symptoms of dryness. In some cases, your health care professional
may recommend a simple procedure that blocks tear drainage from your eye.
Dry eyes respond to the use of artificial tears applied
every one to three hours, or of pharmacological stimulation of
tear production. Dry mouth can be relieved by drinking water,
sugar-free chewing gum, using artificial saliva or using saliva
stimulants (such as pilocarpine and cevimeline). Wearing
protective eye wear, such as goggles, or using a humidifier to
keep moisture in the air can be helpful.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and
ibuprofen, may be used to treat musculoskeletal symptoms. If you
have severe complications, your health care professional may
prescribe corticosteroids or immunosuppressive drugs.
Here's an overview of some of the most commonly used medications:
* NSAIDs can suppress inflammation and reduce pain. Sjogren's
patients are generally prescribed NSAIDs for joint pain, muscle
ache, fever and fatigue. However, NSAIDs provide no improvement in
the salivary or tear flow.
* Corticosteroids may be used if you have internal organ
involvement--which is rare. If you have secondary Sjogren's
syndrome, you may already be on corticosteroids --especially if
the primary condition is lupus or rheumatoid arthritis. The side
effects can be significant, so you and your health care
professional need to monitor both the efficacy and possible side
effects of the medication.
* Immunomodulating agents are occasionally used in autoimmune
diseases like Sjogren's. These medications act very slowly, so
they don't bring about immediate relief. As with corticosteroids,
these immunomodulating agents, with the exception of
hydroxychloroquine, are generally used when there is internal
organ involvement. These agents can include:
* Hydroxychloroquine, an antimalarial drug, is sometime used to
relieve swelling, stiffness and pain. It may also have a limited
effect on the glandular symptoms, the hallmark of the disease.
* Methotrexate is a folic-acid inhibitor generally used to treat
rheumatoid arthritis, and may be prescribed for Sjogren's patients
with internal organ involvement.
* Cyclophosphamide is considerably more potent than methotrexate,
and is reserved for the most serious organ involvement.
* Antifungal drugs, such as nystatin and clotrimazole, may be used
to treat oral candidiasis (a common fungal infection).
* Pilocarpine (Salagen) and cevimeline (Evoxac) tablets may be use
to increase salivary flow. These drugs should not be used for
those with a number of other conditions, including asthma and
acute angle glaucoma. Higher doses of these medications may have
significant side effects including flushing, sweating, nausea,
vomiting and diarrhea.
* Saliva substitutes are most useful perioperatively when patients
are unable to drink.
* Artificial tears or eye drops can help relieve the discomfort of
dry eyes. You probably want to use preservative-free products,
especially if you apply the drops frequently. These products
include Cellufresh, Tears Naturale Free or Bion Hypotears PF.
(Note: Some over-the-counter eye drops contain vasoconstrictors
and can cause further drying.)
* Cyclosporine A (Restasis) eye drops are immunosuppressive and
are also used to increase tear production. Unlike artificial
tears, these are available only by prescription.
As for the future, a variety of novel therapeutic approaches,
using newer immunosuppressive agents, gene transfer, and tissue
transplantation techniques are also being investigated, but are
not yet ready for widespread clinical application.
