The treatment goals for Sjögren's Syndrome are to manage symptoms and prevent or limit organ damage. This may involve both palliative and systemic treatment, depending on the clinical features.
An initial strategy for treating Sjögren's syndrome should involve using simple topical agents to alleviate the main symptoms of dryness.
DRY EYES
Dry eye cannot be cured, but your eye's sensitivity can be lessened and measures taken so that your eyes remain healthy. The most frequent method of treatment is the use of artificial tears or tear substitutes. These agents can be limited by their short duration of action, and should therefore be used as often as necessary.
Preserved Drops
The majority of artificial tears contain a preservative which enables the drops to be used for one month after opening the container. The presence of the preservative inhibits the growth of any bacterial contaminants that could enter the opened bottle and cause an infection in the eye.
Preservative-Free Preparations
For individuals who experience sensitivity to preparations containing preservatives it may be worth considering the use of preservative-free drops. These can be made up specifically by the hospital pharmacy and can only be used for a limited period of time (usually a single dose) to prevent the risk of bacterial contamination.
Guidelines For Use
Artificial tears are available on prescription and over the counter depending on the chosen preparation. It is sometimes necessary for patients to try a variety of preparations to see which one they find the most effective and practical. Not all preserved drops for example, contain the same polymers or have the same formulation and so it is worth trying several preparations to find a formula that suits you.
Practical Tips: -
Avoid dry, air-conditioned environments.
- Use humidifiers and have plenty of plants with large leaves around the house to improve the humidity of your indoor environment.
- Moisture chamber glasses can be custom made and worn as a method of conserving tears. The side shields around the frame of the glasses, creates a humid environment around the eye and greatly reduces any evaporation.
DRY MOUTH
Saliva Substitutes
For individuals with no functional salivary tissue the use of saliva substitutes in the form of gels and mouth sprays, is the main line of treatment. Some of the products available in the market contain fluoride and are therefore recommended for individuals with their own dentition. Like artificial tear solutions, most formulations have a short duration of action and should be used as often as required.
Saliva replacement gels are often favoured by patients because of their longer duration of action. Specially formulated dry-mouth toothpastes and mouthwashes are available and many patients find these helpful and worth the additional cost [they are not prescribable].
Saliva Stimulants
In patients where glandular activity is still present, the chewing of (sugar-free) gum and the eating of foods which require vigorous chewing can help to increase salivary flow. Some individuals find sucking acidic sweets effective, although it is important to remember that these can be damaging to teeth.
Salagen ® (pilocarpine) is the only oral agent available in the UK with the ability to stimulate salivary and tear flow. It works by directly stimulating remaining glandular tissue. Clinical experience suggested that it has a fairly slow onset of action and you should persevere with the treatment, often for several months to obtain maximum benefit. Some patients experience side effects such as sweating, urinary frequency, change of bowel habit and flushing but clinical experience suggests that tolerance develops over time. It can therefore be helpful, to start with a low dose of 5mg once daily, and to wait until any such symptoms have subsided before increasing the dose. Many doctors will increase the dose at weekly, or longer intervals aiming to get three or four tablets daily for maximum benefit.
Sore Mouth And Ulcers
These can be treated with an antiseptic mouthwash, or more severe cases where pain is a particular problem an analgesic mouthwash or spray can be used instead. If ulcers or sores occur that do not respond to such simple treatment, further advice should be from your doctor or dentist.
Dental caries and oral hygiene
There are three simple precautions to take to help prevent the presence of dental caries:
Avoid any sugar-containing drinks or snacks between meals and particularly before bed.
- Brush your teeth at least twice daily with a fluoride containing toothpaste.
- Use a fluoride containing mouthwash.
- Regular visits to the dentist are also important.
Practical tips: -
- If dryness at night is a particular problem, it is helpful to have a glass of water available next to the bed if needed.
- Spreading a teaspoonful of salad oil around the mouth or breaking a vitamin E capsule into the mouth last thing at night can also improve lubrication and prevent the mouth from drying out while you sleep.
- Avoid tea, coffee, alcohol and other caffeinated drinks. These can be de-hydrating.
- Re-hydrate the mouth throughout the day by taking small sips of water. Sucking on ice cubes can have a similar effect.
