Sjogren's syndrome - Treating Sjögren's syndrome

There's no cure for Sjögren's syndrome, but treatments help relieve symptoms such as eye and mouth dryness.

Sjögren's syndrome affects everyone in different ways, so your treatment plan will be tailored to suit you.

Eye care

Artificial tears

Mild to moderate cases of dry eye can usually be successfully treated with eye drops containing "artificial tears" – a liquid that mimics tears. These eye drops are available from a pharmacist, without a prescription.

There are many different types of eye drops, so you can try different brands to find the one that works best for you. If you're using eye drops regularly (more than three times a day), you should use one that doesn't contain preservatives. This is because there's evidence that over-exposure to preservatives can damage the surface of the eye.

A short-term dose of eye drops containing corticosteroids may be recommended if your eyes become irritated. However, long-term corticosteroid use isn't recommended because they can cause serious side effects.

To minimise the chance of experiencing side effects from corticosteroids, you'll be prescribed the lowest effective dose for the shortest possible time.

Moisture chamber spectacles

Wearing glasses reduces tear evaporation by up to 30%, and this effect can be maximised by wearing specially-made glasses called moisture chamber spectacles. These wrap around your eyes like goggles and help retain moisture and protect the eyes from irritants.

Some people used to be embarrassed to wear them, but modern designs look like sports glasses.

Punctal plugs

Punctual occlusion is a widely-used technique that seals the tear ducts (into which the tears drain) with small plugs. This should help keep the eye better protected by tears.

Temporary plugs made of silicone are usually used first to see if they help. If it does, more permanent plugs can be used.

Mouth care

Looking after your mouth

A number of techniques can be used to keep your mouth lubricated, including:

maintaining good oral hygiene to prevent tooth decay and gum disease
increasing your fluid intake
using sugar-free chewing gum to stimulate saliva production
sucking ice cubes to help lubricate your mouth and reduce dryness
regularly using mouth rinses to soothe your mouth and protect it against infection

If you smoke, you should try to quit. Smoking irritates the mouth and increases the rate at which saliva evaporates.

Saliva substitutes

There are a number of saliva substitute products that can help lubricate your mouth. However, they don't replicate the role of saliva in preventing infection, so you'll still need to maintain excellent oral hygiene.

Saliva substitutes are available as a spray, lozenge (medicated sweet), gel, or gum. Your GP or pharmacist can tell you which product is most suitable for you.

Medication for Sjögren's syndrome

Pilocarpine

The medicine pilocarpine is often used to treat the symptoms of dry eyes and dry mouth. Pilocarpine stimulates the glands to produce more saliva and tears.

Side effects of pilocarpine include:

hyperhidrosis (excessive sweating)
nausea
diarrhoea
heartburn
abdominal (stomach) pain
an increased need to go to the toilet

For some people, the side effects of pilocarpine are mild. Others find that the side effects outweigh the benefits.

Don't take pilocarpine if you have asthma or chronic obstructive pulmonary disease (COPD), or if you're pregnant or breastfeeding.

Hydroxychloroquine

Hydroxychloroquine has been shown to slow down the immune system's attack on the tear and saliva glands. It can also help reduce any associated symptoms of muscle pain, joint pain and stiffness.

You'll need to take hydroxychloroquine for several weeks before you notice any improvements, and it could be six months before you experience the full benefit of the treatment.

Side effects are uncommon and usually mild. They include:

nausea
skin rash
loss of appetite
stomach cramps
vomiting

In very rare cases, hydroxychloroquine can damage the retina, affecting vision. You'll probably be asked to attend an eye examination so that your retina can be checked before you start treatment. Regular eye examinations (usually at least once a year) are also recommended after you begin treatment.

Hydroxychloroquine shouldn't be used by breastfeeding women.

Treating other symptoms of Sjögren's syndrome

Dry skin

Several soaps and creams are specifically designed for people with dry skin. Your pharmacist or GP can advise you.

Vaginal dryness

The symptoms of vaginal dryness can be treated using a lubricant. Some women also use oestrogen creams or hormone replacement therapy (HRT).

Muscle and joint pains

Muscle and joint pains can be treated with an over-the-counter non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen. If this doesn't work, see your GP, as stronger NSAIDs are available on prescription.

NSAIDs can increase your risk of developing stomach ulcers and internal bleeding, particularly if they're taken on a long-term basis.

If you find swallowing NSAIDs difficult because of your dry mouth, you can try an NSAID cream that's rubbed into affected joints.

NSAIDs aren't recommended for pregnant or breastfeeding women, or for people with pre-existing risk factors for cardiovascular or kidney conditions.

General advice

These simple tips can help prevent many of the problems associated with Sjögren's syndrome:

have a dental check-up every six months
practise good dental hygiene – brushing, flossing and using mouthwash regularly
avoid eating too many sweet foods
avoid strong and perfumed soaps – use special creams and soaps from your pharmacist
avoid dry environments, such as air-conditioned offices, whenever possible
avoid drinking too much alcohol
get information about self-help groups through the British Sjögren’s Syndrome Association (BSSA)