Lynn M. Petruzzi and Frederick B. Vivino
AORN Journal, Denver, Colorado (March, 2003)

Treatment for Sjögren's Syndrome (SS) is a two-pronged approach. Health care providers focus on treating the Sicca Symptoms as well as treating the underlying systemic disease.

The Sicca Symptoms of SS can be treated in a variety of ways. General measures to decrease dryness include reviewing the patient's medications to consider replacing one or more drying agents with medications that have fewer anticholinergic effects; avoiding environmental factors, such as wind, dust, smoke, and low humidity; and increasing fluid intake, especially water.

Measures to treat xerostomia include using artificial saliva and oral lubricants, such as topical vitamin E oil; avoiding alcohol and mouth washes containing alcohol, which can irritate and dry the mouth; using correct mouth breathing, which helps minimize oral symptoms; stimulating salivary production with the use of medications, such as pilocarpine tablets, which, if used regularly, produce subjective and objective improvement in salivary flow in most patients and also may stimulate other exocrine glands and provide relief from dry eyes, skin, nose, and vagina or cevimeline, which has U.S. Food and Drug Administration approval for use with SS xerostomia.

Other measures include using sugarless gum and candy and eating smaller, more frequent meals to stimulate salivary flow; and practicing good dental hygiene for caries prophylaxis through frequent brushing with a fluoride- containing toothpaste, regular flossing, frequent dental visits, and using topical fluoride. However, oral candidiasis should be identified and treated promptly.

Measures to treat xerophthalmia Include using preservative-free artificial tears and ocular lubricants and ointments; using lacrimal inserts (i.e., a small pellet that slowly dissolves producing a film over normal tears); undergoing punctal occlusion or closure of the tear duct to decrease drainage of tears and provide an increased tear volume; making frequent visits to an ophthalmologist for examination and evaluation of treatment.

Other measures include avoiding use of excessive eye makeup, particularly on the eyelid, because it can soften and enter the eye, creating more concentrated tears; and using moisture-chamber glasses specifically designed to protect the eye from irritants and hold sponges that increase the humidity surrounding the eye.

Extraglandular involvement is treated with two major groups of systemic medications--nonsteroidal anti-inflammatory drugs (NSAIDs) and immunomodulating medications. The choice of therapy is specific to the individual and has not been shown to affect the Sicca Symptoms of SS.

Arthralgias, myalgias, and polyarthritis commonly are treated with NSAIDs. Hydroxychloroquine can improve fatigue, musculoskeletal symptoms, lymphadenopathy, and parotid swelling and is the most commonly used immunosuppressive medication. Corticosteroids, either oral or IV, generally are reserved for patients with vasculitis or when the patient's nervous system or an internal organ (e.g., lung, kidney) is involved.

Patients with systemic symptoms usually are quite ill. Corticosteroids also can be injected locally to treat an area of specific inflammation, such as tendonitis or bursitis.

In the most serious cases, other immunomodulating agents may be prescribed with the intent of halting the inflammatory process, inducing remission, or preventing devastating complications.

These immunomodulating agents can be used alone or as concurrent therapy with NSAIDs and corticosteroids. They are very slow acting and may require weeks to months to produce results. Medications in this category include methotrexate, cyclophosphamide, and azathioprine.