Treatment for Sjögren Syndrome

Despite extensive work and research, no cure has yet been found for Sjögren Syndrome, and palliative measures are the central treatment focus. There are many saliva substitutes and artificial tears that help to reduce and alleviate the symptoms of a dry mouth and eyes. This type of local palliative treatment focuses specifically on dryness symptoms (dry eyes and mouth). Preservative-free gels and mouthwashes to combat a dry mouth and artificial tears, in single doses, under the supervision of an ophthalmologist, are very helpful.

The treatment must be carried out by a multidisciplinary medical team coordinated by a specialist in internal medicine (or rheumatologist), but which also includes other specialists in dryness (ophthalmologists, dentists, otolaryngologists, and gynaecologists) and experts on the possible effects on internal organs (pulmonologists, dermatologists, nephrologists, neurologists, haematologists, etc.). It is equally important that the primary care physician is involved in the care process, especially for patients with no systemic or internal effects, and that patients are educated about their disease so that they can help manage their own treatment.

Monitoring the symptoms at least every six months, by the specialist, helps prevent or limit organ damage and improves the patient's quality of life. If the disease progresses favourably, these controls can be up to one year apart.

The treatment, which varies from patient to patient, also depends on the symptoms the patient is experiencing at any given time. If the effects are severe, more continuous monitoring may be required and hospital admission may even become necessary.

Because dryness symptoms are the most characteristic of Sjögren Syndrome, it is important for patients to avoid treatments that worsen symptoms by decreasing the function of the salivary glands. Drugs that may accentuate these symptoms include diuretics, antihypertensive drugs (to control high blood pressure), antidepressants, and antihistamines, among others. However, some patients prefer to use them because of their benefits, despite any adverse effects they may have.

• It should be administered with caution in patients who have cholelithiasis or biliary tract disease, a peptic ulcer, cognitive or psychiatric disorders, renal failure, nephrolithiasis, or narrow-angle glaucoma.

Most of the adverse effects observed during treatment with pilocarpine are a consequence of increased parasympathetic stimulation. These adverse effects are dose-dependent and generally mild and self-limiting. However, serious adverse effects may occasionally occur, and the patient should therefore be carefully monitored.

Adverse effects classified as very frequent or frequent are: headache; dizziness; watering eyes; blurred vision; abnormal vision; conjunctivitis; eye pain; flushing (vasodilatation); high blood pressure; palpitations; rhinitis, dyspepsia; diarrhoea; abdominal pain; nausea; vomiting; constipation; sweating; allergic reactions, rash; itching; and increased urinary frequency.

They can also cause intestinal problems, insomnia, and stomach ulcers. Calcium can also be lost from the bones (osteoporosis is the most common side effect of long-term corticosteroid treatments). They increase body hair and acne. The skin becomes thinner and stretch marks or spider veins appear. They raise blood sugar and cholesterol. Corticosteroids cause the liver to make more glucose and, through other internal mechanisms, they also cause the body to make worse use of that glucose. There is, therefore, a greater risk of hyperglycaemia, and people with diabetes may not be able to control their disease.

All these complications are typical in people treated with very high doses and for long periods of time. However, corticosteroids are a life-saving medication that prevents significant autoimmune damage to major organs, which is why they are the first line of treatment in the most serious conditions. However, it is currently recommended that large doses are administered intravenously (over 3-5 days) at the most serious point. Treatment then continues with doses lower than 30 mg a day, going down slowly, but progressively, until the drugs are completely stopped, if the clinical situation permits.

In order to control possible alterations, periodic analyses are made every 3-6 months (at the beginning of treatment, this may be every month).

As these drugs interfere with the immune system, people who take them have a greater risk of infection. The immune system protects against infections, so when a drug cancels out or decreases the work of the immune system, there is a greater likelihood that the patient will be affected by an infection.