Treatments for Sjögren's Disease

Treatments, in addition to other measures like lifestyle changes, are a key aspect of managing Sjögren’s disease.

Some treatments aim to improve specific symptoms, while others work to help regulate the body’s immune system. Sjögren’s researchers are always striving to learn more about Sjögren’s disease and to work on developing new and better treatments for the disease.

Keep in mind that Sjögren’s affects each person differently, so treatments that work well for one person might not be well suited to another person. It’s important to work closely with your doctor to come up with a treatment plan that works well for you.

Before starting any treatment or making changes to your treatment, be sure to talk with your doctor. They can give you advice and make sure the treatments are safe and effective at treating your Sjögren’s. The information on this page is educational only, and not medical advice.

Systemic (Whole-Body) Treatments

Sjögren’s disease impacts the entire body. Systemic treatments or systemic therapies are treatments that work throughout your whole body, rather than targeting a specific area or part of the body. 

These treatments can help to reduce inflammation caused by Sjögren’s throughout the body, prevent Sjögren’s from damaging your healthy organs and tissues, and help improve your overall Sjögren’s symptoms. Examples of systemic therapies used to treat Sjögren’s include both prescription and over-the-counter medicines. They include: 

• Disease-modifying anti-rheumatic drugs (DMARDs), such as hydroxychloroquine or methotrexate. These are prescription medicines that help to regulate and control the body’s immune response.
• Non-steroidal anti-inflammatory drugs (NSAIDs), which include some over-the-counter options, such as ibuprofen and naproxen, as well as prescription options. These medicines may help reduce inflammation and pain. However, for some patients (such as those with kidney or liver complications) these drugs should be avoided. Always ask your doctor before taking an NSAID.
• Corticosteroids (also called steroids), such as prednisone. These medicines can help prevent Sjögren’s flares and improve severe Sjögren’s symptoms. These are generally only used for a short period of time. Long-term use of these drugs can cause many side effects, such as infections and steroid-induced osteoporosis, and cause organ damage, so they should be used under strict guidance by your doctor.
• Biologic drugs, such as Rituximab (Rituxan) and Benlysta (belimumab), are used for some patients who have a high disease activity or organ involvement.

It’s important to know that there are currently no U.S. Food and Drug Administration (FDA)-approved therapies that are specifically designed to treat Sjögren’s disease. But other FDA-approved medicines that are designed to treat systemic inflammation are used to treat Sjögren’s. 

Sjögren’s researchers are actively working to develop a systemic therapy that’s specifically for Sjögren’s disease. These medicines are being studied through clinical trials — a part of the research process that’s a key step for getting FDA approval.

• Find a clinical trial close to you
• Learn more about Sjögren’s Foundation Corporate Members that are sponsoring clinical trials
• Learn about clinical trials, what they are, and what to expect if you choose to participate

Treatments for Specific Organs and Body Systems

Some treatments for Sjögren’s treat a specific organ or body system that’s being impacted by Sjögren’s. For example, Sjögren’s may affect your:

• Lungs
• Kidneys
• Nervous system
• Gastrointestinal (digestive) system
• Genitals
• Skin, hair, or nails

Keep in mind that Sjögren’s can impact almost any organ or body system.

Treatments for a specific organ or body system generally aim to control inflammation throughout and prevent long-term damage to that organ or system.

The exact type of treatments you need depends on which organs or body systems are impacted and the symptoms you experience. They can include over-the-counter or prescription medicines or lifestyle changes. Examples include:

• Taking antacid tablets to help manage acid reflux
• Staying hydrated and using electrolyte formulas to help manage dizziness associated with dysautonomia (when Sjögren’s impacts the autonomic nervous system)
• Using inhaled corticosteroids to make breathing easier if Sjögren’s affects your lungs
• Biologic drugs, such as Rituximab (Rituxan) and Benlysta (belimumab), are used for some patients who have a high disease activity or organ involvement.
• Other prescription medications for specific organ needs.

Working With Specialists to Treat Specific Organs and Body Systems

Most people work with their primary care doctor or a rheumatologist (a doctor who treats rheumatic conditions like Sjögren’s) to manage their Sjögren’s care. But if Sjögren’s is impacting one of your organs or a body system, it’s important that you also work with a doctor who specializes in caring for that specific organ or body system (called a specialist). 

Healthcare specialists who may be a part of your Sjögren’s care may include:

• Ophthalmologists or optometrists — doctors who care for the eyes
• Dentists — doctors who care for the teeth and mouth
• Otorhinolaryngologists (ear, nose, and throat (ENT) specialists) — doctors who care for the ear, nose, and throat
• Pulmonologists — doctors who care for the lungs and respiratory system
• Nephrologists — doctors who care for the kidneys
• Neurologists — doctors who care for the nervous system, including the brain
• Cardiologists — doctors who care for the heart and blood vessels
• Gynecologists — doctors who care for women’s reproductive systems
• Dermatologists — doctors who care for the skin, hair, and nails
• Oncologists – doctors who care for blood conditions and lymphomas

The specialists caring for you can coordinate with your rheumatologist or primary care doctor and work together to make sure your Sjögren’s care is effective, safe, and addresses all of your symptoms.

Learn more about all the healthcare professionals who treat Sjögren's.

Treatments for Dry Eyes

Dry eye is one of the most common — and bothersome — Sjögren’s symptoms. Treatment options include over-the-counter and prescription medicines, procedures, and special lenses.

Over-the-Counter Products

Over-the-counter products like artificial tears, eye drops, gels, and ointments can add moisture back to the eye and help improve dry eye symptoms. 

When choosing and using these products, keep the following in mind:

• Look for products with no preservatives. This is especially important if you use artificial tears, eye drops, gels, or ointments multiple times a day.
• Avoid redness relief eye drops. These products can make dry eye and redness worse if you use them over a long period of time.
• Apply ointment at night. Ointments can blur the vision, so it’s important not to use them during the day.

Prescription Medicines and Products

Prescription medicines and products for treating dry eye include:

• Restasis® (cyclosporine ophthalmic emulsion 0.05%) — FDA-approved eye drops that help to control the inflammation that lowers tear production.
• CEQUA™ (cyclosporine A, ophthalmic solution 0.09%) — FDA-approved eye drops that help increase tear production. CEQUA works faster and may work better than Restasis.
• Vevye (cyclosporine ophthalmic solution 0.1%) — FDA-approved eye drops that help control inflammation and increase tear production. Vevye is better tolerated and more effective than CEQUA.
• Xiidra® (lifitegrast ophthalmic solution 5%) — FDA-approved eye drops that can help control inflammation and improve dry eye symptoms. It works in a different way on inflammation than cyclosporine drops, so it may help patients who fail cyclosporine drops.
• Tryptyr® (acoltremon) — FDA-approved eye drops that cause nerves in the eye to produce more tears.
• Corticosteroids (like prednisolone and loteprednol etabonate) — These are medicines (usually in the form of eye drops) that can help to treat flare-ups of dry eye symptoms. Using these medicines too often or for too long can raise your risk of other eye problems, including glaucoma, high intraocular pressure, and eye infections, so they’re typically prescribed to be used for only a short time.
• Cholinergics (like pilocarpine and cevimeline) — These are medicines that help to increase tear production. They may come as pills, eye drops, or gels.
• Tyrvaya® (varenicline) — Nasal spray that helps to increase tear production.
• Lacrisert® (hydroxypropyl cellulose) — This is an insert that works similarly to artificial tears. You place it between your eye and lower eyelid once per day, and it slowly dissolves to help lubricate the eye.

Eye drops made from your blood — Also called autologous blood serum drops, these are special eye drops that are made using a sample of your blood.

Procedures for Dry Eyes

Eye doctors can do a procedure called punctal occlusion (or punctal plugs) to treat dry eye. 

For punctal occlusion, small plugs are inserted into the punctal glands (puncta) of the eye. These glands typically drain tears away from the eye. By plugging these glands, tears sit on the surface of the eye for longer and help it retain moisture. Many people begin by placing a punctal plug in their lower glands.  For more severe dry eye, punctal plugs can be inserted to both lower and upper puncta.

Other procedures, such as IPL (intense pulsed light) treatments have also been used to support dry eyes, especially from Meibomian Gland Dysfunction (MGD), by using light pulses to clear blocked oil glands in eyelids, reduce inflammation, shrink abnormal blood vessels, and improve tear quality.

Scleral Lenses

Scleral lenses are similar to contact lenses, but they’re larger and cover more of the surface area of the eye. They help to hold in and retain moisture to help improve dry eye. Like contact lenses, you can get scleral lenses that help to correct your vision, too. 

Treatments for Dry Mouth

Dry mouth is another bothersome symptom that people with Sjögren’s commonly experience. Options for treating dry mouth include over-the-counter and prescription medicines and procedures.

Over-The-Counter Products

Over-the-counter products for dry mouth include saliva substitutes, hydrating mouthwashes or oral rinses, and sugar-free gum or lozenges:

• Saliva substitutes help to lubricate the mouth and help relieve some of the discomfort Sjögren’s patients may feel. These products can come in many different forms, including oral rinses, sprays, gels, and lozenges. Saliva substitutes are generally better to use than water (which rinses away lubricating fluids) to help dry mouth.
• Hydrating mouthwashes or oral rinses which help to add moisture back to the mouth. These are also generally more effective than using water for dry mouth.
• Sugar-free (made with xylitol) gum, lozenges, or candies can help stimulate saliva production.

When selecting these products, look for labels that say “dry mouth.” It’s also a good idea to avoid rinses or products that contain alcohol, as alcohol can make dry mouth worse.

Xylitol is used in many products as a sweetener but also as a protectant.  Xylitol has been shown to reduce tooth decay, which is a significant issue for Sjögren's patients.  However, in large doses, xylitol can produce GI issues for some people, so keep that in mind if you are sensitive to it. In small doses, such as in mints or gum, it generally is not disruptive.

You can also ask your doctor to recommend over-the-counter saliva substitutes.

Prescription Medicines and Products

Prescription medicines that doctors use to help treat dry mouth include:

• Salagen® (pilocarpine) and Evoxac® (cevimeline) — These are FDA-approved cholinergic therapies (mentioned above) that come as pills. They help increase saliva production. You’ll likely need to take them consistently for a few weeks to months before you notice an improvement.
• NeutraSal® (supersaturated calcium phosphate rinse) — This is a prescription oral rinse that helps to replace saliva. You can use this rinse up to 10 times a day.
• Numoisyn® (sorbitol) — These are lozenges that can help improve dry mouth symptoms. 

Dental Treatments

People with dry mouth caused by Sjögren’s are at a higher risk of certain dental problems, including cavities. To help prevent cavities from forming, your dentist may recommend certain treatments, such as fluoride treatments, to help protect the surface of your teeth. Brushing with a prescription fluoride toothpaste, made for dry mouth, is recommended.

Treating Dryness in Other Parts of the Body

These other treatments can help manage dryness in specific parts of the body.

Sinuses

Nasal saline sprays, gels, and rinses can help with dryness in the nose or sinuses.

Genitals

There are a few types of products that can help with dryness in the genital area:

Vaginal moisturizers can be applied regularly to the vagina and vulva and help to improve ongoing dryness by adding moisture back to the genital tissues.

Water-based lubricants provide immediate relief of dryness and can help to make sex more comfortable by reducing the friction caused by dryness. Lubricants can be used by both men and women.

Ears

To manage dryness in the ears, it’s important to practice good hygiene.

Clean the ears regularly with gentle, non-drying methods — Be careful not to clean them too frequently, which can remove oils and make dryness worse.

Over-the-counter lubricants (such as petrolatum, plant oils, vitamin E oil, and mineral oil-based) can help relieve dry, itchy ear canals. 

If you can, avoid using earbuds or hearing aids that are inserted into the ear, as these can dry the ear canals.

Skin, Hair, and Nails

Some ways to manage dryness of the skin, hair, and nails include:

• Choose fragrance-free moisturizers. Fragrance can worsen dryness.
• Use a barrier cream, which helps to trap moisture next to the skin. Examples include petroleum jelly (such as Aquaphor) or CeraVe Healing Ointment.
• Try products that include “humectants.” Humectants can help pull moisture into the skin. Some skin care products include humectants like urea, glycerin, hyaluronic acid, and lactic acid.
• Use a scalp oil or a medicated shampoo formulated for dryness. These can help moisturize the scalp and reduce dandruff. Look for shampoos with ingredients such as ketoconazole or selenium sulfide.
• Consider supplements. Certain supplements can support healthy skin, hair, and nails, but be sure to talk to your doctor before trying them. For example, biotin (a common supplement) can affect lab results, so you should avoid taking it for a few days before any lab testing. Note that many of these supplements have little to no medical evidence that they help. Ask your doctor.
• If you’re having trouble managing dryness in your skin, hair, or nails, see a dermatologist. They can evaluate your symptoms and provide guidance for treatment.

Complementary and Alternative Medicine (CAM) and Natural Treatments

Complementary and alternative medicine (CAM) are therapies and healing practices that people may use to treat conditions like Sjögren’s. 

Keep in mind that CAM and natural treatments are not part of conventional medicine (treatment that you get from medical doctors). But some patients find them helpful in managing their Sjögren’s symptoms. Some CAM and natural treatments are relatively low risk, while others can pose greater health risks.

Before starting any CAM or natural treatment, it’s important to talk to the doctor who helps you manage your Sjögren’s — they can help make sure the treatment is safe and won’t impact any other Sjögren’s treatments you take.

Examples of CAM and natural treatments that people with Sjögren’s may be familiar with include:

Acupuncture. Acupuncture is a traditional Chinese medicine practice that helps to treat pain and other health problems. It involves inserting thin needles into the skin. It may help people with Sjögren’s manage symptoms such as joint or muscle pain or stiffness.

Diet changes. Some research shows that eating an anti-inflammatory diet may help some people manage conditions like Sjögren’s. This type of diet involves eating more fruits and vegetables, fiber, and healthy fats (like those from fish or avocados) and fewer foods like red meat, refined oils (such as canola or corn oil), and artificial sweeteners and preservatives. Talk with your doctor about foods to include or limit in your diet if you’re interested in trying this. 

Herbal medicine. Herbal remedies are made from plants. Examples include turmeric, aloe vera, or green tea. Some herbal medicines are consumed (eaten and drank) while others may be applied to the skin. It’s important to talk with your provider before trying any herbal remedies, as they can interact with other medicines.

Other supplements. Other supplements, such as vitamin D3, omega-3 fatty acid supplements, and fish oil supplements may possibly help Sjögren’s patients. Ask your doctor and eye care specialist.

Avoid supplements that are promoted to “boost” the immune system, such as elderberry, ashwagandha, echinacea, spirulina, alfalfa, and chlorella. They can potentially worsen autoimmune disorders. 

Massage therapy. Massage can help with pain and stiffness and also relieve stress. Massage should always be done by a licensed massage therapist.