Sjogren's syndrome is one of the most common autoimmune conditions, affecting predominantly perimenopausal women. In the United States, 0.5 million to 3 million individuals are affected . Dry eyes and dry mouth are the main symptoms, but Sjogren's syndrome is a systemic condition that can produce serious complications including kidney failure, lymphoma, lung infection, and vasculitis. Sicca syndrome is another name for this condition, and the characteristic symptoms of dry mouth and dry eyes are often called sicca symptoms. These may accompany other autoimmune conditions, such as rheumatoid arthritis. When they occur in an otherwise healthy individual, the condition is called primary Sjogren's syndrome.
Dr. Manuel Ramos-Casals and collaborators reported that there are no therapeutic guidelines for treating Sjogren syndrome based on evidence from clinical trials. They presented a systematic review of the medical literature to help doctors evaluate treatment options.
The treatments with the best recommendations were:
1. Pilocarpine (brand name Salagen), a cholinergic agonist drug that increases saliva production when taken orally. Eye drops with this drug are also available.
2. Cevimeline (brand name Evoxac), another cholinergic agonist drug.
3. Cyclosporine eye drops.
In addition, many types of eye drops are helpful. Over the counter brands labeled “artificial tears” can relieve symptoms of dry eye. Preservative free varieties are recommended. Lubricating eye ointments can be used at night.
There is a very low level of evidence for the effectiveness of the majority of drugs used for Sjogren syndrome, according to Ramos-Casals. These include:
1. Tumor necrosis factor inhibitors. Clinical trials of infliximab (Remicade) and etanercept (Enbrel) found no significant differences from a placebo. Epratuzumab produced some improvement in a study of 16 patients.
2. Rituximab (Rituxin, MabThera), a monoclonal antibody used for rheumatoid arthritis, produced some positive results in small trials.
3. NSAID eyedrops. One trial showed a greater reduction in corneal sensitivity with diclofenac compared to indomethacin.
4. Glucocorticoid eyedrops. Fluorometholone produced better results than flurbiprofen. Loteprednol etabonate was not significantly better than placebo. Methylprednisolone improved ocular test scores.
5. Oral glucocorticoids. Results are mixed. One study showed oral prednisolone increased salivary slow rate, but another showed no effect.
6. Other immunomodulatory drugs. An earlier review by Dr. A. Thanou-Stavraki reported that traditional anti-rheumatic drugs are less effective for Sjogren's syndrome than for other autoimmune conditions.
Ramos-Casals recommended more research for patients who do not respond to the first-line therapies.
References:
1. Ramos-Casals M et al, “Treatment of primary Sjogren syndrome: A systematic review”, JAMA 2010 July 28; 304(4): 452.
2. Thanou-Stavraki A et al, “Primary Sjogren's syndrome: current and prospective therapies”, Semin Arthritis Rheum. 2008 Apr; 37(5): 273-92.
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.