A Sjögren’s patient’s treatment path should be decided on a case-by-case basis after the potential benefits and side-effects are weighed by patients and their healthcare providers. Since Sjögren’s affects each patient differently, a personalized plan should be developed by you and your physician, dentist, eye care provider and other specialists about how to treat your various symptoms.
In some cases, lifestyle changes can help certain symptoms such as fatigue and gastro-intestinal reflux, and over-the-counter products can help alleviate symptoms such as dryness. Sjögren’s patients are often managed with a combination of management strategies, over-the-counter products and prescription drugs. Most patients will need prescription medications at some point in their disease course to help control their disease and reduce the potential for complications.
A number of different medications are available that can be used to manage symptoms. Currently, no single medication has been conclusively proven to slow the progression of Sjögren’s or treat all aspects of the disease.
Below are a few of the prescription treatments available, but by no means is this an exhaustive list. Talk to your physician for more information.
NSAIDs are often a first-line therapy used in Sjögren’s and reduce inflammation which is often high in Sjögren’s. NSAIDs reduce the production of prostaglandins that promote inflammation and pain. NSAIDs include common over-the-counter medications such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve), but many prescription NSAID drugs are available. The most common side effect of NSAIDs is stomach upset, and, rarely, NSAIDs might cause stomach or gastrointestinal bleeding or ulceration. One class of NSAIDs, cox-2 inhibitors, is less likely to cause stomach problems but may have different potential side effects that should be discussed with your doctor.
Corticosteroids, a class of drugs that includes prednisone, are fast-acting and may be highly successful in halting severe symptoms of Sjögren’s and/or a flare. Short-term use (up to one month) might be sufficient before tapering off completely, but sometimes long-term use (more than one month) is necessary. If a patient is prescribed corticosteroids for long-term use, the patient will start at a higher dose and taper down to a lower, maintenance dose. Corticosteroids have many potential side effects ranging from minor to more severe, so physicians may try to find a steroid-sparing drug that reduces a patient’s symptoms if a patient is on corticosteroids for a long period.
DMARDs modify the way the immune system functions, so instead of simply treating symptoms, DMARDs regulate abnormal immune responses. Unlike corticosteroids, these drugs do not produce an immediate effect but take time to have an impact on symptoms and before a patient feels a difference.
The most commonly prescribed DMARD is hydroxychloroquine (Plaquenil®). It is often prescribed as an initial and long-term therapy in Sjögren’s. While hydroxychloroquine is an old drug that has been used successfully in rheumatic diseases for many years and is generally considered very safe and effective, a rare side effect of this drug can be retinal damage, so the most appropriate dose for each individual should be considered carefully along with regular monitoring by an ocular specialist.
Methotrexate (examples include Trexall®, Rheumatrex®)
This drug might or might not be prescribed at the same time as hydroxychloroquine.
The following DMARDs might be tried in any potential order and is dependent on physician preference and the individual patient:
Mycophenolate (examples include Cellcept®, Myfortic®)
Cyclosporine (examples include Sandimmune®, Neoral®)
Please note that many biologics and small molecule therapies are currently under investigation for treating Sjögren’s. The Sjögren’s Foundation is working closely with these companies to ensure new therapies are developed.
To learn more about participating in a Biologics Clinical Trial, please visit our Clinical Trials page.
Salagen® (pilocarpine hydrochloride)
Restasis® (cyclosporine ophthalmic emulsion
Xiidra® (lifitegrast ophthalmic solution