What Are The Latest Available Treatments For Sjögren’s?
Sjögren’s syndrome is an autoimmune disorder characterized classically by dry eyes (xerophthalmia) and dry mouth (xerostomia), secondary to white blood cell attack on the moisture producing glands and mucous membranes. Patients may also experience skin, nose and vaginal dryness as well, and sometimes suffer other symptoms in common with many autoimmune diseases, such as joint/muscle pain and chronic fatigue. There is no cure for Sjögren’s, which is treated symptomatically. Here we discuss some aspects of Sjögren’s therapy.
What are typical treatments for Sjögren’s syndrome?
When using over-the-counter eye drops or drinking water frequently doesn’t sufficiently help the Sjögren’s patient, there are several other available options that are commonly used. Two prescription medications, Salagen and Evoxac, may help someone with Sjögren’s produce more tears and saliva, and there are lubricants used for vaginal dryness, to stave off infections, which are more common under these conditions. There are also artificial tears available OTC, as well as “punctal plugs”, which are placed easily by an eye doctor and act to block the tear ducts that normally drain tears away from the eyes, leaving the surface more lubricated.
For other more general symptoms commonly seen in autoimmune disease, doctors may prescribe NSAIDs (anti-inflammatories) or more powerful prescription medications (such as immunosuppressants) for joint and muscle pain. And because a dry mouth and/or vagina create an ideal environment for infections, antibiotics or antifungals are used to treat any that emerge. Those patients with more serious complications, or greater involvement than normally seen, are treated according to the specific problem, such as with central nervous system or kidney issues. As is the case with most conditions, some therapeutic options tend to work better than others.
What are alternative treatments for Sjögren’s?
Besides the medications and measures listed above, there are certain lifestyle/alternative remedies that may be very helpful for some patients. As referenced above, there are several OTC products aimed at keeping eyes moist, particularly either artificial tears, eye lubricants or both, depending on the patient’s specific issues and tolerance.
Another measure that may work is to increase the humidity surrounding the eyes, whether via raising ambient humidity in the environment or through the use of goggles outside.
For dry mouth, one of the most important things a sufferer can do is continually drink water. Even if the mouth seems to dry again quickly, this will help maintain a certain level of moisture. Another option is artificial saliva, which contains a gel that keeps the mouth moist for a longer period than with just water. Those with Sjögren’s can also suck on hard candies or chew gum, which stimulates the salivary glands and may help with production (to a certain extent). And for patients experiencing dryness in their nose and nasal passages, OTC saline spray (NOT decongestant sprays, which increase nasal dryness) can be very useful.
Since Sjögren’s can promote dental problems such as cavities and possibly infections, following strict dental recommendations is a must. There are typically no special instructions other than brushing and flossing frequently, using a fluoride rinse, and scheduling regular dental checkups. Also, skin involvement can be treated with common skin moisturizers, and can be stemmed somewhat by not taking hot showers.
Some researchers have seen limited success with other therapeutic modalities, such as:
However, these therapeutic efforts are still in preliminary stages and not very widely used.
When is Sjögren’s considered to be in remission?
Interestingly, unlike rheumatoid arthritis, for which there is much interest in and literature and consensus about remission criteria, there doesn’t appear to be very well formulated similar criteria for Sjögren’s.
The closest thing to remission criteria was in this article in Oxford Journals which is concerned with assessing patient outcomes by various other measures, rather than with measures determining remission.
Another article from the NIH database, which doesn’t specify remission criteria, reports the unfortunate increased occurrence of a certain cancer in patients in long-term remission. And an additional study examined remission of kidney involvement in Sjögren’s, but not of the disease in its entirety, or in terms of its common symptomatology.
However, even without specific criteria, we can generally assume the disease is in remission when there is a prolonged decrease in or absence of most symptoms. The timeline is not specific in the literature as to how long symptoms must be reduced, and it isn’t clear exactly what clinicians consider “remission” in terms of signs and symptoms. Furthermore, unfortunately Sjögren’s only occasionally will go into full remission.
Are there any research studies I could enroll in for new treatments?
Thankfully, there is a considerable amount of interest in researching Sjögren’s, which means there are constantly trials being conducted or planned. More information about all aspects of Sjögren’s studies may be found at some/all of the following:
- Johns Hopkins Sjögren’s Syndrome centerNIH Sjögren’s Syndrome pages
- Sjögren’s Syndrome Foundation
- Oklahoma Medical Research Foundation
- University of Pennsylvania Rheumatology Department
- Massachusetts General Rheumatology Department
- Clinical Trials
- Any major academic medical center, which may have trials ongoing or may have more information
Questions for your doctor:
- Are there any other medications or lifestyle remedies we might try if my symptoms are not well controlled?
- What are your feelings about some of the alternative treatments mentioned in this article?
- Do you know of any current or future clinical studies that I might be a candidate for?
- For dry eyes, should I be using eye drops, artificial tears, eye gel lubricant, or a combination of these?
- What does the research front look like for Sjögren’s syndrome? Are there any new remedies that are currently in the pipeline or about to become available that might help me? If so, when can I try using them?
About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians. After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time. He may be reached at email@example.com.
This blog post was originally published by AutoimmuneMom.com, written by Dr. Rothbard, and first published on Jun 14, 2014.
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