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Sjogren’s syndrome is an autoimmune disorder that causes dry mouth and eyes. It can affect people of any age but is seen to be more common in older women.
The treatment for Sjogren’s syndrome aims at alleviating the associated symptoms and also preventing any long-term complications, including dental problems or infection.
Treatment for Sjogren’s Syndrome
Sjogren’s syndrome can be very difficult to treat because no single therapeutic approach can address the disease as a whole. Rather, treatments are provided according to each system that is affected.
As a chronic condition without “cure,” patients with Sjogren’s syndrome are advised to learn as much as they can about their condition and to focus on pharmacologic and non-pharmacologic treatments that can help.
The Sjogren’s Foundation (1) and the Arthritis Foundation (2) are excellent resources for patients. Moreover, several interactive support groups on Facebook and other social media platforms can prove helpful for those suffering from this very difficult syndrome.
Dryness of the eyes and mouth, while very uncomfortable, can also lead to damage to the eyes and a number of dental problems, including caries, periodontal disease, thrush, and loss of teeth. An important goal of treatment is to address and prevent these problems.
As such, it is important to work with a team familiar with the management of Sjogren’s syndrome. Usually, this involves a rheumatologist for overall guidance, an ophthalmologist, and a dentist.
For the dry eyes, the treatment includes the following:
- Lacrisert, a slow-release product that is the size of a small pellet, is placed just inside the lower eyelid. It can provide several hours of tear support, although some patients find this product difficult to tolerate.
- When the dryness is more severe, prescription drops may be used, such as Restasis (cyclosporine) or Xiidra (lifitegrast), which are immunomodulatory agents that actually treat the tear gland inflammation.
In addition to the use of antirheumatic agents to attempt to control Sjogren’s syndrome overall, specific treatments focused on particular systems involved are often required as well. As such, the additional help of specialists is necessary.
Home Remedies for Managing Sjogren’s Syndrome
Various at-home remedies can help improve the symptoms of Sjogren’s syndrome.
For eye inflammation caused by Sjogren’s syndrome:
- Apply hot compresses and use eyelid cleansers. (3)
- Gently massage the eyelids to clear blockage from the oil glands.
- Use wraparound goggles that protect the eyes from air, wind, and airborne particles to help prevent tear evaporation.
For dry mouth and related symptoms caused by Sjogren’s syndrome:
- Use fluoride-containing toothpaste to prevent cavities. (4)
- Chew sugarless gum and candy to stimulate saliva production. (5)
- Consume ample amounts of liquid throughout the day. (5)
- Refrain from having alcohol or caffeinated beverages since they promote dehydration.
- Do not eat spicy or acidic foods that can irritate your mouth.
- Brush and floss your teeth after every meal.
For other symptoms related to Sjogren’s syndrome:
- Apply petroleum jelly or lip balm on dry lips.
- Use saline sprays to relieve a blockage in the nose since breathing through the mouth can leave it parched. (6)
- Apply moisturizers to the skin, especially after baths or showers.
- Some women might have vaginal dryness, especially after menopause. This can be improved with the help of estrogen cream, vaginal moisturizers, vaginal lubricants, and hyaluronic acid suppositories. (7)
Self-Care Recommended for Sjogren’s Syndrome
Several self-care and over-the-counter measures can be done to address dryness in the eyes.
Artificial tear drops and moisturizers can be helpful in many cases. Products that contain sodium hyaluronate or hydroxypropyl methylcellulose are superior to simple saline drops. (8)
Some products contain preservatives, which can be irritating in some patients, so it is important to read labels.
Examples of useful products include:
- Tears Naturale II
- Liquifilm Tears
- Isoptotears
- Bion Tears
- Viscotears
- HypoTears PF
- Refresh
- Systane
- Moisture Eyes
- TheraTears
- Tear-Free
These drops must be used frequently, 4–6 times per day. It is also important to consider the environment as pollutants and lack of adequate humidity can aggravate eye irritation. Glasses can often be protective, but contact lenses should be avoided.
Treating Dry Mouth Caused by Sjogren’s Syndrome
For dry mouth, a number of saliva substitutes are available, but many patients find these ineffective. The best way is to take frequent sips of water. Other ways to increase natural salivary flow include:
- Sugar-free sour lemon or cherry drops and sugarless gum, especially products containing Xylitol sweetener
- Tart flavors
Avoid beverages with high acidity, such as cola drinks and many herbal teas and coffee, since they can worsen the condition.
Skin Care Tips for Sjogren’s Syndrome Patients
Dry skin and itchiness are common problems in patients with Sjogren’s syndrome and can be best addressed with the use of moisturizing agents. Lac-Hydrin (ammonium lactate) is a prescription moisturizing lotion that is often useful.
When topical therapies are insufficient, oral secretagogues, such as pilocarpine and cevimeline, may be used to stimulate glandular secretions and can be effective.
Managing Other Symptoms of Sjogren’s Syndrome
To address extraglandular symptoms, such as fatigue, joint pains, skin rashes, and other organ system involvement, Sjogren’s syndrome is treated much like lupus or rheumatoid arthritis. (9)
Even though no specific antirheumatic agents are indicated for Sjogren’s syndrome, certain medications may be used with some success. These include:
- Prednisone
- Antimalarials (i.e., hydroxychloroquine)
- Methotrexate
- Leflunomide
- Other disease-modifying antirheumatic drugs (DMARDs)
In more severe cases, other medications have been employed, such as:
- Systemic cyclosporine
- Mycophenolate
- Biologic agents such as rituximab
TNF-inhibitors, such as etanercept and infliximab, have proven disappointing. (10)
Effects of Sjogren’s Syndrome on the Nervous System
Sjogren’s syndrome has many neurologic manifestations, such as peripheral, sensory, and motor, and cranial neuropathies.
Central nervous system involvement may include:
- Memory and cognitive problems
- Optic neuritis
- Myelitis
Again, the management of these cases depends upon the specific nature of the involvement and requires the expertise of a neurologist.
Final Word
Sjogren’s syndrome may occur alone, but it may also be accompanied by other autoimmune disorders, including lupus, rheumatoid arthritis, and scleroderma.
It is necessary for patients to regularly contact their dentists and physicians to discuss the progression of the disease and possible treatment options.
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