Sjogren's Syndrome
In 1933, Swedish physician Henrik Sjögren observed a large number of his female patients were experiencing dry eyes and mouths along with their arthritis symptoms. The condition became known as Sjögren’s syndrome.
These are the medications used to relieve the dryness caused by the autoimmune attack on the body’s moisture-producing glands.
Name: Cyclosporine ophthalmic emulsion
(Restasis)
Dosage: One drop in each eye, twice per day, approximately 12 hours apart
Special Instructions: Single-use vials must be used immediately upon opening, and then discarded.
Possible Side Effects*: Blurred vision; burning, pain, itchy or stinging feelings in eyes; discharge; foreign body sensation
Be Aware: Cyclosporine is an immunosuppressant. Do not use if you have an eye infection. Do not wear contact lenses while using this medication.
Name: Hydroxypropyl cellulose pellets
(Lacrisert)
Dosage: One pellet in lower lids, once or twice per day
Special Instructions: Place pellets in the lower eyelids. Adding artificial tears makes the pellets dissolve, creating and locking in moisture.
Possible Side Effects: Blurred vision; eye pain; irritation or redness of eyes; light sensitivity; matting or stickiness of eyelashes; swelling of eyelids; vision changes
Be Aware: Carefully follow directions for inserting. Improper placement could cause corneal abrasion. Be careful when driving or using machinery.
Name: Cevimeline
(Evoxac)
Dosage: 30 milligrams (mg), three times per day
Special Instructions: Start with a low dose, and take after meals to minimize side effects. Allow six to 12 weeks of uninterrupted treatment before improvement is noticed.
Possible Side Effects: Changes in heart rate (rare); diarrhea; excessive sweating; nausea; problems with night vision; rhinitis
Be Aware: Do not take if you have uncontrolled asthma, chronic bronchitis, chronic obstructive pulmonary disease, significant cardiovascular disease, acute iritis or narrow-angle glaucoma. Let your doctor know if you take beta-adrenergic antagonists (beta-blockers).
Name: Pilocarpine
(Salagen)
Dosage: 5 mg, four times per day, or as prescribed by your physician
Special Instructions: Allow at least six weeks of uninterrupted treatment before improvement in dry mouth symptoms is noticed.
Possible Side Effects: Change in blood pressure or heart rate; flushing; headache; sweating; urinary frequency
Be Aware: Do not take if you have known hypersensitivity to pilocarpine, uncontrolled asthma, acute iritis or narrow-angle glaucoma. Let your doctor know if you take beta-adrenergic antagonists (beta-blockers). Patients with controlled asthma, chronic bronchitis, chronic obstructive pulmonary disease or significant cardiovascular disease require close monitoring.
Sjögren’s syndrome is an arthritis-related disease that can affect several organs. Its most common effect is on the moisture-producing glands, including those of the eyes and mouth. It can cause extremely dry eyes (sometimes described as the feeling of sand in the eyes or a burning sensation), extremely dry mouth and throat, dental cavities from lack of saliva, enlarged glands near the jaw, vaginal dryness and fatigue, as well as joint pain, stiffness and swelling. Less common symptoms include rashes, numbness, and inflammation of the lungs, kidneys or liver.
What Causes It?
Sjögren’s syndrome is an autoimmune disease, a condition characterized by the body’s inability to distinguish healthy cells from foreign substances. In Sjögren’s, a type of white blood cell known as a lymphocyte attacks moisture-producing glands, such as tear and salivary glands, and in some cases the lungs, kidneys, liver, skin, nerves or joints.
Sjögren’s affects an estimated two to four million Americans. It is considered primary when it occurs alone. Primary Sjögren’s causes salivary gland swelling, lung, liver, nerve and skin involvement, as well as dry eyes and dry mouth. Most cases are secondary, meaning they occur along with other autoimmune diseases, such as rheumatoid arthritis or lupus.
Who Gets Sjögren’s?
A major risk factor for developing Sjögren’s is being a postmenopausal woman. It occurs less commonly in younger women, children and men of any age. Other risk factors include having an autoimmune disease, such as lupus, vasculitis, thyroid disease or scleroderma, or a family member with Sjögren’s.
How is Sjögren’s Diagnosed?
Sjögren’s syndrome cannot be solely diagnosed by the presence of dry eyes and dry mouth. Many other diseases, such as sarcoidosis, can cause signs that resemble Sjögren’s. Also, side effects of certain medications (tricyclic antidepressants, antihistamines and radiation treatments of the head and neck) can mimic the dry eyes and dry mouth symptoms of Sjögren’s syndrome. Diagnosis is based on a complete physical examination, medical history evaluation and the following tests:
Eyes
Slit-lamp test to detect damage to the surface of the eye from eye dryness by using a dye that exposes eroded areas of the conjunctiva (the membrane that covers the eye and lines the inside of the eyelids).
Schirmer test to reveal the degree of dryness in the eyes by placing a small strip of filter paper beneath the lower lid and measuring the amount of tears produced.
Mouth
Lip biopsy to show inflammation of the salivary glands.
Blood
Blood tests to detect antibodies, such as rheumatoid factor, ANA, anti-SSA or anti-SSB, which are associated with primary Sjögren’s syndrome.
How is Sjögren’s Treated?
There is no cure for Sjögren’s, but it can be treated effectively. Treatment typically involves medications and other measures that relieve the common symptoms of the condition. Exercise and proper nutrition may help with the fatigue often associated with Sjögren’s syndrome.
In addition, drinking water frequently, avoiding cigarette smoke, brushing with fluoride toothpaste after every meal and having frequent dental check-ups can keep symptoms under control.
Following are treatments for some of the specific symptoms of Sjögren’s syndrome:
- Two oral prescription medications – cevimeline (Evoxac) and pilocarpine (Salagen) – are approved for dry mouth associated with Sjögren’s syndrome.
- Water, sugar-free gum or candy and prescription or OTC mouth gels, tablets and sprays may relieve mouth dryness by stimulating salivary glands or moistening the mouth.
- Prescription or over-the-counter (OTC) artificial tears and eye drops help with the discomfort of dry eyes by lubricating the surface of the eyes.
- Hydroxypropyl cellulose pellets (Lacrisert), placed in the lower lids, dissolve and lock in moisture.
- Glucocorticoids (such as prednisone) may be prescribed if muscles, nerves or lungs are affected.
- Nonsteroidal anti-inflammatory drugs help reduce joint pain and stiffness and ease muscle aches.
- Hydroxychloroquine (Plaquenil) helps relieve joint pain, rashes and fatigue.
- Estrogen creams can ease vaginal dryness common to Sjögren’s and may relieve pain during intercourse.
AT experts answer your questions on Sjögren’s syndrome.
For more information on medications used to treat Sjögren’s syndrome check out the Arthritis Today Drug Guide.
