Sjögren's Syndrome - Treatment Overview

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Sjögren's Syndrome - Treatment Overview

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There is no cure for Sjögren's syndrome. But treatment can help control your symptoms. Treatment options include not only medicines you can take to supplement tears and saliva but also things you can do 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. Your doctor may suggest home treatment to:

Provide moisture to your eyes and mouth, by using artificial teardrops and artificial 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.
Relieve acid reflux by taking antacids, such as ranitidine (Zantac), cimetidine (Tagamet), or omeprazole (Prilosec).
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 doctor may suggest home treatment to:

Provide moisture to your eyes and mouth, by using artificial teardrops and artificial 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.
Relieve acid reflux by taking antacids, such as ranitidine (Zantac), cimetidine (Tagamet), or omeprazole (Prilosec).
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 doctor may want to prescribe medicines or use other treatments.

For dry eyes: Your doctor may prescribe:
Cevimeline (Evoxac) capsules or pilocarpine (Salagen) tablets to stimulate tear production. These medicines are usually prescribed for dry mouth, but recent studies report that they may be effective in relieving dry eyes also.
Topical antibiotics if you develop redness, swelling, and pain of the eyelids (blepharitis).
For dry mouth: Your doctor may:
Recommend that you use artificial saliva products to coat the mouth, and/or place sugarless lozenges under the tongue to stimulate saliva production.
Prescribe antifungal medicines 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 medicines, which can make dry mouth worse.
For vaginal dryness: Your doctor may prescribe the hormone estrogen in either topical creams doses if nonprescription vaginal moisturizers and lubricants have not relieved dryness and painful intercourse.

Progression of Sjögren's syndrome is different for everyone. 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 medicines and your disease begins to affect other parts of the body, your doctor may prescribe stronger medicine or recommend surgery.

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

If neither tear substitutes nor cyclosporine eyedrops ease your dry eyes, your doctor 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:

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.
Corticosteroids (such as prednisone), which are used to relieve muscle and joint inflammation but can have serious side effects, including osteoporosis, glaucoma, and diabetes.
Disease-modifying antirheumatic drugs (DMARDs), also known as slow-acting antirheumatic drugs (SAARDs). These medicines may be prescribed alone or in combination to manage the symptoms of joint and muscle pain and dry skin from Sjögren's syndrome. DMARDs that may be prescribed include hydroxychloroquine sulfate (Plaquenil) or methotrexate.
What to think about
Research to develop new medicines 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.
Medicines that modify immune system function, such as infliximab, are being studied to see whether they can reduce glandular inflammation in Sjögren's syndrome.

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