Sjögren's Syndrome - Treatment Overview

Treatment Overview

There is no cure for Sjögren's syndrome. But treatment can help control your symptoms. Treatment options include medications to supplement tears and saliva, as well as measures you can take at home to prevent eye damage and dental problems.

Initial treatment

You can control your symptoms of Sjögren's syndrome, which are often distressing but are rarely disabling.¹ Your health professional may suggest home treatment to:

• Provide moisture to your eyes and mouth, by using artificial teardrops and saliva.
• Prevent eye damage, by protecting your eyes from wind, smoke, and other irritants.
• Prevent dental problems, by brushing and flossing your teeth.
• Prevent fatigue, by balancing rest and exercise.
• Relieve respiratory and skin problems, by humidifying your home and office and using moisturizing creams.
• Take antacids, such as ranitidine (Zantac), cimetidine (Tagamet), or omeprazole (Prilosec), to relieve acid reflux.
• Replenish vaginal moisture.
• Control pain with gentle exercise and acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs).

Ongoing treatment

Progression of Sjögren's syndrome varies by individual. Most people with this disease have chronic dryness of the eyes and mouth that lasts throughout their lives. Your health professional may suggest home treatment to:

• Provide moisture to your eyes and mouth, by using artificial teardrops and saliva.
• Prevent eye damage, by protecting your eyes from wind, smoke, and other irritants.
• Prevent dental problems, by brushing and flossing your teeth.
• Prevent fatigue, by balancing rest and exercise.
• Relieve respiratory and skin problems, by humidifying your home and office and using moisturizing creams.
• Take antacids, such as ranitidine (Zantac), cimetidine (Tagamet), or omeprazole (Prilosec), to relieve acid reflux.
• Replenish vaginal moisture.
• Control pain with gentle exercise and acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs).

If your symptoms fail to improve or get worse even with home treatment, your health professional may want to prescribe medications or use other treatments.

• For dry eyes: Your health professional may prescribe:
  • Cevimeline (Evoxac) capsules or pilocarpine (Salagen) tablets to stimulate tear production. These medications are usually prescribed for dry mouth, but recent studies report that they may be effective in relieving dry eyes as well.^{4, 5}
  • Topical or oral antibiotics if you develop redness, swelling, and pain of the eyelids (blepharitis).²
• For dry mouth: Your health professional may:
  • Recommend that you use artificial saliva products, which coat the mouth, and/or place lemon drops under the tongue to stimulate saliva production.
  • Prescribe antifungal medications if a yeast infection such as thrush develops in your mouth. For more information, see the topic Thrush.
  • Recommend a fluoride rinse or brush-on topical fluoride varnish, such as Colgate Duraphat or Prevident Prophylaxis Paste, to help prevent cavities caused by rapid tooth decay.³
  • Prescribe a saliva stimulant, such as pilocarpine tablets or cevimeline capsules.
  • Recommend that you avoid antihistamine medications, which can make dry mouth worse.
• For vaginal dryness: Your health professional may prescribe the hormone estrogen in either topical creams or oral doses if nonprescription vaginal moisturizers and lubricants have not relieved dryness and painful intercourse.⁶

Treatment if the condition gets worse

Progression of Sjögren's syndrome varies by individual. Most people with this disease have chronic dryness of the eyes and mouth that lasts throughout their lives. If your symptoms are not relieved by home treatment and medications and your disease begins to affect other parts of the body, your health professional may prescribe stronger medication or recommend surgery.

If extremely dry eyes are not helped by tear substitutes, topical cyclosporine ophthalmic eyedrops (Restasis) may provide relief.⁷

If neither tear substitutes nor cyclosporine eyedrops ease your dry eyes, your health professional may perform a surgical procedure called punctal occlusion, in which he or she places temporary or permanent plugs in your tear ducts (lacrimal ducts) to help keep moisture in your eyes. These plugs keep your tears from draining away from the eyes and leaving them dry.

For joint pain, chronic inflammation in saliva and tear glands, or other serious symptoms, treatment may include:

• Corticosteroids (such as prednisone), which are used to relieve muscle and joint inflammation but can have serious side effects, including osteoporosis, glaucoma, and diabetes.²
• Disease-modifying antirheumatic drugs (DMARDs), also known as slow-acting antirheumatic drugs (SAARDs). These medications may be prescribed by themselves or in combination to manage the symptoms of joint and muscle pain and dry skin from Sjögren's syndrome.² DMARDs that may be prescribed include hydroxychloroquine sulfate (Plaquenil) or methotrexate.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may provide relief from inflammation, but people with Sjögren's syndrome may be more susceptible to developing gastroesophageal reflux disease (GERD) after taking NSAIDs.

What to think about

Research to develop new medications to treat the symptoms of Sjögren's syndrome is ongoing.

• Interferon alfa (IFN-alfa) may help increase your production of saliva.¹ Experts are uncertain about the benefit of this treatment.
• Bromhexine cough syrup may stimulate the production of tears.⁶
• Medications that modify immune system function are under study to see whether they can reduce glandular inflammation in Sjögren's syndrome. Studies have not proven that Infliximab helps dry mouth, dry eyes, and fatigue symptoms.⁸