Management of Sjogren's syndrome

Seek specialist advice

The dry eyes can be treated by diathermy obliteration of the lacrimal punctum and instillation of artificial tears consisting of hydroxyethylcellulose drops.

Meticulous oral hygiene with toothpaste, dental floss and a special 1% chlorhexidine gluconate preparation helps to control the dental caries and periodontal disease.

Artificial saliva may help to keep the mouth moist.

First approach to extra-glandular (systemic) major organ-system disease is oral/parenteral corticosteroids

• corticosteroids are not recommended for the routine treatment of pSS (primary Sjogren's syndrome) although intermittent short courses of oral or intramuscular steroid are effective for systemic flares of disease and steroids may be used for significant organ manifestations with or without additional immunosuppressive treatment (1)

Various DMARDs (methotrexate, azathioprine) have been successfully employed as steroid-sparing agents although none is specifically approved for Sjogren.

Hydroxychloroquine may be used to treat inflammatory polyarthritis

• recommended for patients with pSS especially those with skin and joint disease and fatigue (1)

B cell depletion may have a role in certain severe extra-glandular manifestations (vasculitis)

• rituximab is recommended for specialist use in patients with significant systemic manifestations refractory to treatment with steroids and other immunosuppressive (1)

TNF-alpha inhibitors have not proved effective for Sjogren

Reference:

• Price EJ, Rauz S, Tappuni AR, Sutcliffe N, Hackett KL, Barone F, Granata G, Ng WF, Fisher BA, Bombardieri M, Astorri E, Empson B, Larkin G, Crampton B, Bowman SJ., British Society for Rheumatology Standards, Guideline and Audit Working Group. The British Society for Rheumatology guideline for the management of adults with primary Sjogren's Syndrome. Rheumatology (Oxford). 2017 Oct 01;56(10):e24-e48