Sjogren’s Syndrome; Treatment

Sjogren’s Syndrome; 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.

References

“Sjogren’s Syndrome.” Sjogren’s World. Copyright 2005. http://www.sjogrensworld.org. Accessed June 7, 2005.

“Sjogren’s Syndrome.” Arthritis Foundation. Copyright 2004. http://www.arthritis.org. Accessed June 7, 2005.

“Sjogren’s Syndrome Information Page.” The National Institute of Neurological Disorders and Stroke. Updated February 9, 2005. http://www.ninds.nih.gov. Accessed June 7, 2005.

“About Sjogren’s Syndrome: What is Sjogren’s Syndrome?”; “FAQs About Sjogren’s Syndrome”: “Diagnosis”: “Treatment”: “Additional Resources.” Sjogren’s Syndrome Foundation, Inc. http://www.sjogrens.org/syndrome. Accessed June 7, 2005.

Carsons, Harris, ed. The New Sjogren’s Syndrome Handbook. London: Oxford University Press. 1998.

Keywords: Atherosclerosis,Latrogenic,Uric acid,Rebound,Relapse,Sertraline,Sperm,Type

COPYRIGHT 2005 National Women’s Health Resource Center

COPYRIGHT 2007 Gale Group