Treatments for Sjogren's Syndrome


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Treatment list for Sjogren's Syndrome: The list of treatments mentioned in various sources for Sjogren's Syndrome includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

  • Moisture replacement therapies
  • Dry eye treatments
    • Artificial tears
    • Eye ointment
    • Propyl methylcellulose (Lacriserts)
    • Punctal occlusion surgery (closing eye drainage ducts)
      • Collagen plugs - temporary because they gradually dissolve
      • Silicon plugs - permanent but can be removed.
      • Cauterization - permanent closing.
    • Avoid winds
    • Humidifier
    • Quit smoking
    • Avoid cigarette smoke
    • Care using mascara
  • Dry mouth treatments
    • Natural saliva stimulation - if you are still producing some saliva
    • Chewing gum
    • Sucking hard candy
    • Frequent sips of water
    • Saliva stimulants
    • Saliva substitute
    • Mouth lubricants
    • Lip balms - for dry or cracked lips
  • Oral hygiene - helps prevent mouth infectins.
    • Brushing teeth
    • Rinsing
    • Flossing
    • Regular dental checkups
    • Avoid sugar
    • Fluoride supplements
  • Dry skin treatments
  • Vaginal dryness treatments
    • Vaginal moisturizers
    • Vaginal lubricant - preferably a water-soluble lubricant rather than oil or petroleum based.
    • Skin creams - for outer vaginal areas.
  • Treatments for lung problems
  • Kidney treatments
  • Treatments for digestive, pancreas or liver problems
  • Avoid dryness-causing medications
    • Avoid antihistamines
    • Avoid decongestants
    • Avoid diuretics
    • Avoid some antidiarrhea drugs
    • Avoid some antipsychotic drugs
    • Avoid tranquilizers
    • Avoid some blood pressure medications
    • Avoid antidepressants
  • Treatments for immune or inflammation causes of Sjogren's and related disorders
  • Specialized planning and treatment of pregnancy for women with Sjogren's

Treatment of Sjogren's Syndrome: medical news summaries: The following medical news items are relevant to treatment of Sjogren's Syndrome:

Treatments of Sjogren's Syndrome discussion: There is no known cure for Sjogren's syndrome nor is there a specific treatment to restore gland secretion. Treatment is generally symptomatic and supportive. Moisture replacement therapies may ease the symptoms of dryness. Nonsteroidal anti-inflammatory drugs may be used to treat musculoskeletal symptoms. For individuals with severe complications, corticosteroids or immunosuppressive drugs may be prescribed. 1

Treatment is different for each person, depending on what parts of the body are affected. But in all cases, the doctor will help relieve your symptoms, especially dryness. For example, you can use artificial tears to help with dry eyes and saliva stimulants and mouth lubricants for dry mouth. Treatment for dryness is described in more detail below.

If you have extraglandular involvement, your doctor--or the appropriate specialist--will also treat those problems. Treatment may include nonsteroidal anti-inflammatory drugs for joint or muscle pain, saliva- and mucus-stimulating drugs for nose and throat dryness, and corticosteroids or drugs that suppress the immune system for lung, kidney, blood vessel, or nervous system problems. Hydroxychloroquine, methotrexate, and cyclophosphamide are examples of such immunosuppressants (drugs that suppress the immune system).

What Can I Do About Dry Eyes?

Artificial tears can help. They come in different thicknesses, so you may have to experiment to find the right one. Some drops contain preservatives that might irritate your eyes. Drops without preservatives don't usually bother the eyes. Nonpreserved tears typically come in single-dose packages to prevent contamination with bacteria.

At night, an eye ointment might provide more relief. Ointments are thicker than artificial tears and moisturize and protect the eye for several hours. They may blur your vision, which is why some people prefer to use them while they sleep.

Hydroxypropyl methylcellulose (Lacriserts*) is a chemical that lubricates the surface of the eye and slows the evaporation of natural tears. It comes in a small pellet that you put in your lower eyelid. When you add artificial tears, the pellet dissolves and forms a film over your own tears that traps the moisture.

Another alternative is surgery to close the tear ducts that drain tears from the eye. The surgery is called punctal occlusion. For a temporary closure, the doctor inserts collagen or silicone plugs into the ducts. Collagen plugs eventually dissolve, and silicone plugs are "permanent" until they are removed or fall out. For a longer lasting effect, the doctor can use a laser or cautery to seal the ducts.

* Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

General Tips for Eye Care

  • Don't use artificial tears that irritate your eyes--try another brand or preparation.

  • Nonpreserved drops may be more comfortable.

  • Blink several times a minute while reading or working on the computer.

  • Protect your eyes from drafts, breezes, and wind.

  • Put a humidifier in the rooms where you spend the most time, including the bedroom, or install a humidifier in your heating and air conditioning unit.

  • Don't smoke and stay out of smoky rooms.

  • Apply mascara only to the tips of your lashes so it doesn't get in your eyes. If you use eyeliner or eye shadow, put it only on the skin above your lashes, not on the sensitive skin under your lashes, close to your eyes.

  • Ask your doctor whether any of your medications contribute to dryness and, if so, how to reduce that effect.

What Can I Do About Dry Mouth?

If your salivary glands still produce some saliva, you can stimulate them to make more by chewing gum or sucking on hard candy. However, gum and candy must be sugar free because dry mouth makes you extremely prone to cavities. Take sips of water or another sugar free drink often throughout the day to wet your mouth, especially when you are eating or talking. Note that you should take sips of water--drinking large amounts of liquid throughout the day will not make your mouth any less dry. It will only make you urinate more often and may strip your mouth of mucus, causing even more dryness. You can soothe dry, cracked lips by using oil- or petroleum-based lip balm or lipstick. If your mouth hurts, the doctor may give you medicine in a mouth rinse, ointment, or gel to apply to the sore areas to control pain and inflammation.

If you produce very little saliva or none at all, your doctor might recommend a saliva substitute. These products mimic some of the properties of saliva, which means they make the mouth feel wet, and if they contain fluoride, they can help prevent cavities. Gel-based saliva substitutes tend to give the longest relief, but all saliva products are limited since you eventually swallow them.

At least two drugs that stimulate the salivary glands to produce saliva are available. These are pilocarpine and cevimeline. The effects last for a few hours, and you can take them three or four times a day. However, they are not suitable for everyone, so talk to your doctor about whether they might help you.

People with dry mouth can easily get mouth infections. Candidiasis, a fungal mouth infection, is one of the most commonly seen in people with Sjögren's. It most often shows up as white patches inside the mouth that you can scrape off, or as red, burning areas in the mouth. Candidiasis is treated with antifungal drugs. Various viruses and bacteria can also cause infections; they're treated with the appropriate antiviral or antibiotic medicines.

The Importance of Oral Hygiene

Natural saliva contains substances that rid the mouth of the bacteria that cause cavities and mouth infections, so good oral hygiene is extremely important when you have dry mouth. Here's what you can do to prevent cavities and infections:

  • Visit a dentist at least three times a year to have your teeth examined and cleaned.

  • Rinse your mouth with water several times a day. Don't use mouthwash that contains alcohol because alcohol is drying.

  • Use fluoride toothpaste to gently brush your teeth, gums, and tongue after each meal and before bedtime. Nonfoaming toothpaste is less drying.

  • Floss your teeth every day.

  • Avoid sugar. That means choosing sugar-free gum, candy, and soda. If you do eat or drink sugary foods, brush your teeth immediately afterward.

  • Look at your mouth every day to check for redness or sores. See a dentist right away if you notice anything unusual or have any mouth pain or bleeding.

  • Ask your dentist whether you need to take fluoride supplements, use a fluoride gel at night, or have a protective varnish put on your teeth to protect the enamel.

2

Treatment is different for each person, depending on what parts of the body are affected. But in all cases, the doctor will help relieve your symptoms, especially dryness. For example, you can use artificial tears to help with dry eyes and saliva stimulants and mouth lubricants for dry mouth. Treatment for dryness is described in more detail below.

If you have extraglandular involvement, your doctor--or the appropriate specialist--will also treat those problems. Treatment may include nonsteroidal anti-inflammatory drugs for joint or muscle pain, saliva- and mucus-stimulating drugs for nose and throat dryness, and corticosteroids or drugs that suppress the immune system for lung, kidney, blood vessel, or nervous system problems. Hydroxychloroquine, methotrexate, and cyclophosphamide are examples of such immunosuppressants (drugs that suppress the immune system).

What Can I Do About Dry Eyes?

Artificial tears can help. They come in different thicknesses, so you may have to experiment to find the right one. Some drops contain preservatives that might irritate your eyes. Drops without preservatives don't usually bother the eyes. Nonpreserved tears typically come in single-dose packages to prevent contamination with bacteria.

At night, an eye ointment might provide more relief. Ointments are thicker than artificial tears and moisturize and protect the eye for several hours. They may blur your vision, which is why some people prefer to use them while they sleep.

Hydroxypropyl methylcellulose (Lacriserts*) is a chemical that lubricates the surface of the eye and slows the evaporation of natural tears. It comes in a small pellet that you put in your lower eyelid. When you add artificial tears, the pellet dissolves and forms a film over your own tears that traps the moisture.

Another alternative is surgery to close the tear ducts that drain tears from the eye. The surgery is called punctal occlusion. For a temporary closure, the doctor inserts collagen or silicone plugs into the ducts. Collagen plugs eventually dissolve, and silicone plugs are "permanent" until they are removed or fall out. For a longer lasting effect, the doctor can use a laser or cautery to seal the ducts.

* Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

General Tips for Eye Care

  • Don't use artificial tears that irritate your eyes--try another brand or preparation.

  • Nonpreserved drops may be more comfortable.

  • Blink several times a minute while reading or working on the computer.

  • Protect your eyes from drafts, breezes, and wind.

  • Put a humidifier in the rooms where you spend the most time, including the bedroom, or install a humidifier in your heating and air conditioning unit.

  • Don't smoke and stay out of smoky rooms.

  • Apply mascara only to the tips of your lashes so it doesn't get in your eyes. If you use eyeliner or eye shadow, put it only on the skin above your lashes, not on the sensitive skin under your lashes, close to your eyes.

  • Ask your doctor whether any of your medications contribute to dryness and, if so, how to reduce that effect.

What Can I Do About Dry Mouth?

If your salivary glands still produce some saliva, you can stimulate them to make more by chewing gum or sucking on hard candy. However, gum and candy must be sugar free because dry mouth makes you extremely prone to cavities. Take sips of water or another sugar free drink often throughout the day to wet your mouth, especially when you are eating or talking. Note that you should take sips of water--drinking large amounts of liquid throughout the day will not make your mouth any less dry. It will only make you urinate more often and may strip your mouth of mucus, causing even more dryness. You can soothe dry, cracked lips by using oil- or petroleum-based lip balm or lipstick. If your mouth hurts, the doctor may give you medicine in a mouth rinse, ointment, or gel to apply to the sore areas to control pain and inflammation.

If you produce very little saliva or none at all, your doctor might recommend a saliva substitute. These products mimic some of the properties of saliva, which means they make the mouth feel wet, and if they contain fluoride, they can help prevent cavities. Gel-based saliva substitutes tend to give the longest relief, but all saliva products are limited since you eventually swallow them.

At least two drugs that stimulate the salivary glands to produce saliva are available. These are pilocarpine and cevimeline. The effects last for a few hours, and you can take them three or four times a day. However, they are not suitable for everyone, so talk to your doctor about whether they might help you.

People with dry mouth can easily get mouth infections. Candidiasis, a fungal mouth infection, is one of the most commonly seen in people with Sjögren's. It most often shows up as white patches inside the mouth that you can scrape off, or as red, burning areas in the mouth. Candidiasis is treated with antifungal drugs. Various viruses and bacteria can also cause infections; they're treated with the appropriate antiviral or antibiotic medicines.

The Importance of Oral Hygiene

Natural saliva contains substances that rid the mouth of the bacteria that cause cavities and mouth infections, so good oral hygiene is extremely important when you have dry mouth. Here's what you can do to prevent cavities and infections:

  • Visit a dentist at least three times a year to have your teeth examined and cleaned.

  • Rinse your mouth with water several times a day. Don't use mouthwash that contains alcohol because alcohol is drying.

  • Use fluoride toothpaste to gently brush your teeth, gums, and tongue after each meal and before bedtime. Nonfoaming toothpaste is less drying.

  • Floss your teeth every day.

  • Avoid sugar. That means choosing sugar-free gum, candy, and soda. If you do eat or drink sugary foods, brush your teeth immediately afterward.

  • Look at your mouth every day to check for redness or sores. See a dentist right away if you notice anything unusual or have any mouth pain or bleeding.

  • Ask your dentist whether you need to take fluoride supplements, use a fluoride gel at night, or have a protective varnish put on your teeth to protect the enamel.

3

Footnotes:
1. excerpt from NINDS Sjogren's Syndrome Information Page: NINDS
2. excerpt from Questions and Answers About Sjögren's Syndrome: NIAMS
3. excerpt from Questions and Answers About Sj”gren's Syndrome: NIAMS

Last revision: June 16, 2003

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