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Treatment Options for Sjögren’s Syndrome

Over-the-counter treatments, prescription medications and medical procedures can help control Sjögren’s.

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Sjogren’s syndrome can affect all of moisture-producing glands and tissues in the body – not just the eyes and mouth –and cause a host of symptoms.

Below is head-to-toe a look at over-the-counter and prescription treatment options, as well as some medical procedures, for this common autoimmune condition that affects nine times as many women as men. (Read “Sjögren’s Syndrome and Your Body” for more about its effects on specific areas of the body and for tips on controlling symptoms.)

Mouth

Artificial saliva products often provide relief from dry mouth. There are a number of over-the-counter products sold under various trade names, including:

  • Glandosane
  • MoiStir
  • MouthKote
  • Oralube
  • Salivart
  • Xero-Lube

Also helpful are toothpastes and mouth rinses developed specifically for dry mouth. These include:

  • Biotene Dry Mouth Toothpaste and Biotene Mouthwash with Calcium
  • CloSYS Toothpaste and CloSYS Oral Rinse
  • Orajel Dry Mouth Moisturizing Toothpaste

If replacing moisture does not relieve dryness, your doctor may prescribe a medication to stimulate your own salivary glands to produce more saliva. Two such drugs, pilocarpine (Salagen) and cevimeline (Evoxac), are approved for dry mouth associated with Sjögren’s syndrome.

Eyes

Artificial tears can relieve gritty, dry eyes and help prevent damage caused by dryness. Over-the-counter options include:

  • Artificial Tears
  • Bion Tears
  • Gonak
  • Isopto Tears
  • Lacril
  • Nature’s Tears
  • Systane

If you can’t get relief from drugstore products, your doctor can prescribe stronger medications. These include:

  • The immunosuppressive drug cyclosporine in the form of an eye drop (Restasis) to be applied every 12 hours.
  • A cellulose pellet (Lacrisert) that is placed in the lower eyelid where it dissolves, adding moisture, when artificial tears are used.
  • Two drugs approved for dry mouth, pilocarpine (Salagen) and cevimeline (Evoxac), may also be useful for dry eyes. While they have not been approved for dry eyes, your doctor may prescribe them for that purpose. Also, if you take one of these drugs for dry mouth, it may help your eyes as well.

In severe cases, your doctor may consider an outpatient procedure called punctal occlusion, which involves cauterizing the puncta (small openings at the inner corners of the eyelids where tears drain from the eyes) to close them, keeping your eye’s natural tears on the surface longer. Another option is to temporarily close the puncta with a collagen plug.

Esophagus

A lack of saliva, which neutralizes stomach acids, can cause heartburn. Treatments include:

  • Sucralfate (Carafate) is an ulcer medication that coats and protects the esophagus and stomach.
  • H2 blockers, also called H2-receptor antagonists, reduce the production of gastric acid by blocking histamine 2. H2 blockers include cimetidine (Tagamet), famotidine (Pepcid) and ranitidine (Zantac).
  • Proton pump inhibitors are a group of medications that decrease the amount of acid in the stomach and intestines. They include omeprazole (Prilosec), esomeprazole (Nexium), rabeprazole (Aciphex), lansoprazole (Prevacid) and pantoprazole (Protonix).

Upper Respiratory System

Dry nasal passage can make sinus infections last longer and lead to complications such as pneumonia and bronchitis.

Treatment options for problems associated with dry nasal passages include:

  • Saline nasal sprays such as Ocean Saline Nasal Spray
  • Lavage of nasal passages with a saline solution
  • Decongestants including loratadine (Claritin) and desloratadine (Clarinex), fexofenadine (Allegra) and cetirizine (Zyrtec)
  • Antibiotics, including the sulfa-containing drug sulfamethoxazole/trimethoprim (Bactrim DS, Septra); the penicillin drug amoxicillin and clavulanate (Augmentin); the macrolide antibiotics azithromycin (Zithromax) and clarithromycin (Biaxin); the cephlasporins ceftibuten (Cedax) and cephalexin (Keflex); and the flouroquinolone (quinolones) antibiotics ciprofloxacin (Cipro), levofloxacin (Levoquin), and moxifloxacin (Avelox)
  • Steroid sprays, including Flonase, Beconase and Nasonex.
  • Expectorants such as alkalol (a saline solution that includes a mix of menthol, camphor, eucalyptol, thymol, and oils of wintergreen, spearmint, pine and cinnamon) and guaifenesin (Humabid-LA)

Skin

Treatment for dry skin typically consists of topical creams and lotions.

If the corners of your lips crack, it could be due to a yeast infection. Treatment with a prescription topical antifungal may be needed to clear the infection. These include:

  • Econazole nitrate (Spectazole)
  • Ciclopirox (Loprox)

Vagina

Vaginal lubricants and moisturizers can restore moisture and make intercourse easier. Avoid petroleum-based ointments such as petroleum jelly.

There are many different vaginal lubricants available over the counter as gels, sprays and inserts. Some to look for include:

  • Astroglide
  • KY Jelly
  • Lubrin
  • Maxilube
  • Replens
  • Surgilube

Joints

Treatment for joint inflammation typically consists of nonsteroidal anti-inflammatory drugs (NSAIDs) such as iburopfen (Motrin) or naproxen (Anaprox, Aleve).

For more severe inflammation, your doctor may prescribe:

  • A corticosteroid medication such as prednisone, which mimics natural substances that control immune response
  • A disease-modifying anti-rheumatic drug (DMARD) such as hydroxychloroquine (Plaquenil), methotrexate (Rheumatrex) or leflunomide (Arava) to inhibit the body’s immune response

Lungs

Sjögren’s can cause scarring of the lungs, which cannot be reversed, but medical treatment may help prevent it from progressing.

Treatment may consist of a combination of prescription medications and medical procedures. These include:

  • Corticosteroids
  • DMARDs such as azathioprine (Imuran) or cyclophosphamide (Cytoxan)
  • The mucus-thinning medication acetylcysteine
  • Anti-fibrotic (anti-scarring) medications such as bosentan (Tracleer) and pirfenidone
  • Oxygen therapy may make breathing less difficult
  • Pulmonary rehabilitation may help you live better by teaching you exercises to improve breathing and to breathe more efficiently.

Nervous System

The body-wide inflammation of Sjögren’s syndrome can affect the nervous system in many ways. Doctors may prescribe:

  • Corticosteroids to treat nerve inflammation
  • Analgesics for pain relief

Kidneys

Sjögren’s can cause inflammation in the kidneys and their structures. Unless these problems start to affect kidney function, your doctor may not propose treatment.

When necessary, treatment may consist of:

  • Alkaline agents to maintain the balance of blood chemicals normally handled by the kidneys
  • Corticosteroids and DMARDs to control inflammation

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