What are the treatment options for Sjögren’s syndrome?

The body’s immune system is a complex network of proteins, cells, and organs that defend the body against things that cause it harm. When an infectious bacteria, virus, fungus, parasite, or chemical makes its way into the body, the immune system goes into attack mode, identifying what doesn’t belong and removing it from the body.

Sometimes, some part of this complex process goes wrong, and the immune system begins to identify certain types of healthy cells, tissues, or other substances in the body as harmful. As a result, the immune system begins to attack the body. This type of health condition is called an autoimmune disease.

Sjögren’s syndrome is an autoimmune disease where the immune system primarily attacks the glands that produce tears and saliva, causing dry eye and dry mouth. Additionally, Sjögren’s syndrome can cause symptoms and complications in many other parts of the body. Symptoms like fatigue, joint pain, skin rash, anemia, and respiratory illness are common. In some cases, Sjögren’s syndrome can lead to neurological disorders, kidney disease, and a type of blood cancer called non-Hodgkin lymphoma.

Sjögren’s syndrome can occur on its own or occur alongside other autoimmune or immune-mediated disorders, such as rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis. This is referred to as secondary Sjögren or Sjögren-overlap syndrome.

Treatment options for Sjögren’s syndrome

As with most other autoimmune disorders, there is no cure for Sjögren’s syndrome. Treatment focuses on reducing and managing symptoms, as well as treating any complications, health concerns, or overlapping conditions. Because symptoms and the severity of symptoms vary from person to person, treatment plans will also vary from person to person.

Key therapies include:

• Dry eye therapies: artificial tear eye drops, prescription anti-inflammatory eye drops, specialty eyewear to protect the eyes and prevent tear evaporation, simple surgical procedures to block or seal tear ducts.
• Dry mouth therapies: supplements and/or prescriptions to increase saliva production, specialty mouthwash, and dental/oral care to address the impact that Sjögren’s-related dry mouth has on teeth and gums.
• Basic remedies: staying hydrated, frequently sipping liquids, chewing sugarless gum, saliva substitute mouthwashes, skin moisturizers, and lubricants can all help ease symptoms.
• Avoiding certain medications: decongestants, antidepressants, and antihistamines can all worsen dryness and should be avoided.

When Sjögren’s syndrome causes symptoms beyond dry eyes and dry mouth, other types of treatments may be needed. These can include:

• Non-steroidal anti-inflammatory drugs (NSAIDs), which may be recommended to manage joint pain
• Disease-modifying anti-rheumatic drugs (DMARDs), which regulate immune system activity and can help reduce autoimmune attacks.
• Corticosteroids, which reduce inflammation by suppressing the immune system, and may be used for short periods of time to treat flares of symptoms.

Some autoimmune or immune-mediated disorders are treated with medications called biologics or biologic therapies. These are another type of DMARD or disease-modifying therapy. A biologic may be prescribed to treat another autoimmune disorder that overlaps with Sjögren’s syndrome, such as rheumatoid arthritis. Some biologic therapies are also prescribed off label (outside their official indication) to treat severe Sjögren’s syndrome that involves multiple organs.

Biologic therapies are an important area of focus for medical researchers developing new therapies to treat Sjögren’s syndrome. Several biologic treatment options for Sjögren’s syndrome are likely to become available in the near future.