Treatment Options for Sjögren’s

Artificial tears can relieve gritty, dry eyes and help prevent damage caused by dryness. If you can’t get relief from drugstore products, your doctor can prescribe stronger medications. 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.
Over-the-counter options include:

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

Prescription medications 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 help dry eyes. While they aren’t 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.

Artificial saliva products often provide relief from dry mouth. There are several over-the-counter products sold under various trade names. Toothpastes and mouth rinses developed specifically for dry mouth may help. If replacing moisture does not relieve dryness, your doctor may prescribe a medication to stimulate your salivary glands to produce more saliva. Two drugs, pilocarpine (Salagen) and cevimeline (Evoxac), are approved for dry mouth associated with Sjögren’s.
 
Artificial saliva products:

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

Dry mouth toothpastes and mouthwash include:

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

A lack of saliva, which neutralizes stomach acids, can cause heartburn. Many of the treatments are available over the counter, but it’s still a good idea to consult with your doctor.

Treatment options 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).

Vaginal lubricants and moisturizers can restore moisture and make intercourse easier. Avoid petroleum-based ointments such as petroleum jelly. There are many  vaginal lubricants available over the counter as gels, sprays and inserts. 

Lubricants to look for:

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

Treatment for mild joint inflammation typically consists of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (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 antirheumatic drug (DMARD) such as hydroxychloroquine (Plaquenil), methotrexate (Rheumatrex) or leflunomide (Arava) to inhibit the body’s immune response.

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. 
Prescription treatments 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

 
Therapeutic treatments include:

• 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.

Sjögren’s can cause inflammation in the kidneys and their structures. When necessary, treatment may consist of alkaline agents to maintain the balance of blood chemicals normally handled by the kidneys. It may also include prescription medication, such as corticosteroids and DMARDs, to control inflammation.

The body-wide inflammation of Sjögren’s can affect the nervous system in many ways. Doctors may prescribe corticosteroids to treat nerve inflammation and analgesics for pain relief. 

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 like econazole nitrate (Spectazole) or ciclopirox (Loprox) may be needed to clear the infection.