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- So we do not have a curative treatment
for Sjogren's syndrome.
We have medications that can help improve symptoms
but really do not alter the course of the disease.
We rely on the patients to do a lot of the work
in terms of managing their Sjogren's syndrome
and what I mean by this is that they have to,
on a daily basis, attend to their dryness of the eyes,
dryness of the mouth, and provide proper care
so that complications do not arise.
So, for instance, for the eyes, it requires
that they administer artificial tears and medicated drops
on a regular basis throughout the day,
that they perform proper eyelid hygiene,
and that they see their eye doctor
on a regular basis to get proper care.
And for their mouth we really want them
to do very meticulous dental care
to prevent the development of cavities.
They may need to sip water frequently throughout the day.
They may use lozenges or other dry mouth products
to stimulate saliva flow and we want them
to see their dentist on a regular basis,
often four times a year, to get proper treatment.
They also should use fluoride to prevent
the development of cavities.
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Now, in addition to that meticulous self-care,
we as physicians can offer various medications.
So there are medications, for instance,
that can stimulate the production of saliva.
One of them is pilocarpine,
another one is cevimeline,
which can help in that regard.
There are also medications that can help
the joint pain and the fatigue.
The one that's most commonly used is hydroxychloroquine.
And when patients have more systemic manifestations,
such as arthritis
or they have internal organ manifestations,
we may use some of the same medications that are used
in patients with systemic lupus or rheumatoid arthritis,
including methotrexate and leflunomide
and mycophenolate and azathioprine,
all to try to bring this disease into better control.
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There are two medications available
that can help stimulate the flow of saliva
and, to less extent, the flow of tears
and can be helpful to patients with Sjogren's syndrome.
And these are called pilocarpine and cevimeline.
Patients can benefit, but at the same time, unfortunately,
these medications can have side effects.
It can cause sweating, it can cause urinary frequency,
it can cause some stomach upset.
Fortunately, in many patients,
if they continue the medication,
we'll notice that these side effects will diminish,
but the benefits will persist.
And so they can tolerate it.
But many patients actually choose
not to take these medications
and just rely on using artificial tears
and frequent sips of water to handle
the dryness of their eyes and mouth.
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Well, there are different types of products
that are available for dry eyes.
Many of them are available over the counter,
which are various artificial tears,
which have different consistencies,
which patients can choose and find the one
that best meets their needs.
But the eye doctor, the eye care professional,
may also provide medicated drops.
There are different ones now available,
one is called cyclosporine,
the other one is a illophitogras,
which are medicated, anti-inflammatory drops,
which can help the ocular inflammation
that ensues from the dryness.
The eye care professional can also offer
various other treatments that can help.
One of them is to actually occlude the tear ducts
that drain tears from the eyes.
And by occluding those tear ducts can leave
the tears in the eye and help relieve the dry eyes.
There are also other treatments that are available.
Sometimes, if patients have particularly severe dry eyes,
they can create an artificial tear from your own blood,
called serum tears, that can be
a very wonderful form of eye drop for patients
who have more severe dry eye disease.
And finally, there's something called
a scleral lens prosthesis, which is kind of
a very large contact lens that goes over,
not only the cornea, but the whites of the eye,
has a saline-filled well
that patients put in in the morning
and it can help relieve
the dry eye symptoms quite dramatically.
Some of my patients really find this
to be a miraculous treatment.
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One of the more troubling symptoms
that women who have Sjogren's syndrome may report,
is dryness of the vagina.
And this can lead to significant impairment
in their sexual satisfaction.
This is something that can be helped
by a gynecologist with lubricating gels,
sometimes with topical hormone treatments,
and other products that can help vaginal lubrication.
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So one of the reasons that Sjogren's syndrome
is hard to diagnose is that it really requires
the expertise of not only a rheumatologist,
but also an ophthalmologist or an eye care professional,
and sometimes an oral medicine specialist
to actually make the diagnosis.
So the eye care professional will do a special test
to see how much dryness there is of the eye.
The oral medicine specialist will examine,
looking for a deficiency of saliva,
and will often help in getting a lip biopsy.
And not only for diagnosis, but for management,
the ideal management of a patient with Sjogren's
really should involve these three professionals,
the rheumatologist, the oral medicine specialist,
and the eye care professional, because each of them knows
how to handle their particular area best
and can provide optimal care
for the patient with Sjogren's syndrome.
There are no curative treatments for Sjogren's syndrome,
but we have a variety of potential agents
that might work in Sjogren's syndrome.
And so there's now a considerable number
of clinical trials that are being conducted
to test various new agents,
some of which are brand new, others which have been used
to treat other rheumatic diseases
and to see if they will help
patients with Sjogren's syndrome.
So we at Hopkins and elsewhere
are actively recruiting patients for these clinical trials
in hope that one or more of these will provide
long-lasting treatment for Sjogren's patients.
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