Materiały źródłowe

• #1 Sjogren’s syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sjogrens-syndrome/diagnosis-treatment/drc-20353221

  Treatment for Sjogren’s syndrome depends on the parts of the body affected. Many people manage the dry eye and dry mouth of Sjogren’s syndrome by using over-the-counter eyedrops and sipping water more frequently. But some people need prescription medications, or even surgical procedures. […] Depending on your symptoms, your doctor might suggest medications that: […] Prescription eyedrops such as cyclosporine (Restasis) or lifitegrast (Xiidra) may be recommended by your eye doctor if you have moderate to severe dry eyes. […] Drugs such as pilocarpine (Salagen) and cevimeline (Evoxac) can increase the production of saliva, and sometimes tears. […] If you develop arthritis symptoms, you might benefit from nonsteroidal anti-inflammatory drugs (NSAIDs) or other arthritis medications. […] Hydroxychloroquine (Plaquenil), a drug designed to treat malaria, is often helpful in treating Sjogren’s syndrome. […] A minor procedure to seal the tear ducts that drain tears from your eyes (punctal occlusion) might help relieve your dry eyes.

• #2 Sjögren’s Syndrome: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/4929-sjogrens-syndrome

  Your provider will suggest treatments to manage your symptoms. Theres no cure for Sjgrens syndrome, but your provider will help you find a treatment plan that reduces its impact on your daily routine and quality of life. […] Some common treatments for dryness in your eyes, mouth or vagina include: […] Artificial tears: Your eye care specialist might suggest over-the-counter (OTC) eye drops, prescription drops or lubricants to keep your eyes moist. […] Dry eye surgery (punctal plugs): An ophthalmologist (eye surgeon) can surgically close some or all of your tear ducts to keep your natural tears in your eyes for longer. […] Saliva producers: Your dentist may suggest over-the-counter saliva (spit) supplements or prescriptions to help your body make more saliva. […] Special mouthwash or dental care products: People with Sjgrens syndrome have a higher risk of dental health issues, so you may need more frequent cleanings, special fluoride treatments or prescription toothpaste and mouthwash.

• #3 Treatment | Sjögren’s Foundation

  https://sjogrens.org/understanding-sjogrens/treatment

  A number of different medications are available that can be used to manage symptoms. […] A Sjgrens patients 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 Sjgrens 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. Sjgrens 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.

• #4 Sjögren’s Syndrome: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/4929-sjogrens-syndrome

  Your provider will suggest treatments to manage your symptoms. Theres no cure for Sjgrens syndrome, but your provider will help you find a treatment plan that reduces its impact on your daily routine and quality of life. […] Some common treatments for dryness in your eyes, mouth or vagina include: […] Artificial tears: Your eye care specialist might suggest over-the-counter (OTC) eye drops, prescription drops or lubricants to keep your eyes moist. […] Dry eye surgery (punctal plugs): An ophthalmologist (eye surgeon) can surgically close some or all of your tear ducts to keep your natural tears in your eyes for longer. […] Saliva producers: Your dentist may suggest over-the-counter saliva (spit) supplements or prescriptions to help your body make more saliva. […] Special mouthwash or dental care products: People with Sjgrens syndrome have a higher risk of dental health issues, so you may need more frequent cleanings, special fluoride treatments or prescription toothpaste and mouthwash.

• #5 Sjogren’s syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sjogrens-syndrome/diagnosis-treatment/drc-20353221

  Treatment for Sjogren’s syndrome depends on the parts of the body affected. Many people manage the dry eye and dry mouth of Sjogren’s syndrome by using over-the-counter eyedrops and sipping water more frequently. But some people need prescription medications, or even surgical procedures. […] Depending on your symptoms, your doctor might suggest medications that: […] Prescription eyedrops such as cyclosporine (Restasis) or lifitegrast (Xiidra) may be recommended by your eye doctor if you have moderate to severe dry eyes. […] Drugs such as pilocarpine (Salagen) and cevimeline (Evoxac) can increase the production of saliva, and sometimes tears. […] If you develop arthritis symptoms, you might benefit from nonsteroidal anti-inflammatory drugs (NSAIDs) or other arthritis medications. […] Hydroxychloroquine (Plaquenil), a drug designed to treat malaria, is often helpful in treating Sjogren’s syndrome. […] A minor procedure to seal the tear ducts that drain tears from your eyes (punctal occlusion) might help relieve your dry eyes.

• #6 Treatment | Sjögren’s Foundation

  https://sjogrens.org/understanding-sjogrens/treatment

  Currently, no single medication has been conclusively proven to slow the progression of Sjgrens 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 Sjgrens and reduce inflammation which is often high in Sjgrens. […] Corticosteroids, a class of drugs that includes prednisone, are fast-acting and may be highly successful in halting severe symptoms of Sjgrens and/or a flare. […] DMARDs modify the way the immune system functions, so instead of simply treating symptoms, DMARDs regulate abnormal immune responses. […] The most commonly prescribed DMARD is hydroxychloroquine (Plaquenil). […] Please note that many biologics and small molecule therapies are currently under investigation for treating Sjgrens. […] Evoxac (cevimeline) […] Salagen (pilocarpine hydrochloride) […] Restasis cyclosporine ophthalmic emulsion […] Xiidra lifitegrast ophthalmic solution […] CEQUA Cyclosporine Ophthalmic Solution […] TYRVAYA Varenicline Solution.

• #7 Sjogren’s Syndrome: Causes, Symptoms, and Treatment Options

  https://www.webmd.com/a-to-z-guides/sjogrens-syndrome

  You’ll need to take medicines throughout your life to help you manage your symptoms. You can buy some kinds in a drugstore without a prescription, while your doctor may need to prescribe stronger ones if those don’t work well enough. […] Drops called „artificial tears” can keep your eyes from drying out. You’ll need to use them regularly throughout the day. There are also gels and ointments that you put on your eyes at night. The advantage of these thicker treatments is that they stick to your eye’s surface, so you won’t need to apply them as often as the drops. But because ointments they affect your vision, you use them while you sleep. […] If artificial tears aren’t helping, your doctor may prescribe drugs for your dry eyes, including: Cequa, Lacrisert, Restasis. […] Another treatment option for dry eyes is a procedure called punctal occlusion. This is when your doctor puts tiny plugs into your tear ducts to block them up. This keeps tears from draining away too fast, meaning they stay on your eyes longer and help your eyes stay moist.

• #8 Sjogren’s syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sjogrens-syndrome/diagnosis-treatment/drc-20353221

  Treatment for Sjogren’s syndrome depends on the parts of the body affected. Many people manage the dry eye and dry mouth of Sjogren’s syndrome by using over-the-counter eyedrops and sipping water more frequently. But some people need prescription medications, or even surgical procedures. […] Depending on your symptoms, your doctor might suggest medications that: […] Prescription eyedrops such as cyclosporine (Restasis) or lifitegrast (Xiidra) may be recommended by your eye doctor if you have moderate to severe dry eyes. […] Drugs such as pilocarpine (Salagen) and cevimeline (Evoxac) can increase the production of saliva, and sometimes tears. […] If you develop arthritis symptoms, you might benefit from nonsteroidal anti-inflammatory drugs (NSAIDs) or other arthritis medications. […] Hydroxychloroquine (Plaquenil), a drug designed to treat malaria, is often helpful in treating Sjogren’s syndrome. […] A minor procedure to seal the tear ducts that drain tears from your eyes (punctal occlusion) might help relieve your dry eyes.

• #9 Sjögren’s Syndrome: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/4929-sjogrens-syndrome

  Your provider will suggest treatments to manage your symptoms. Theres no cure for Sjgrens syndrome, but your provider will help you find a treatment plan that reduces its impact on your daily routine and quality of life. […] Some common treatments for dryness in your eyes, mouth or vagina include: […] Artificial tears: Your eye care specialist might suggest over-the-counter (OTC) eye drops, prescription drops or lubricants to keep your eyes moist. […] Dry eye surgery (punctal plugs): An ophthalmologist (eye surgeon) can surgically close some or all of your tear ducts to keep your natural tears in your eyes for longer. […] Saliva producers: Your dentist may suggest over-the-counter saliva (spit) supplements or prescriptions to help your body make more saliva. […] Special mouthwash or dental care products: People with Sjgrens syndrome have a higher risk of dental health issues, so you may need more frequent cleanings, special fluoride treatments or prescription toothpaste and mouthwash.

• #10 Sjogren’s syndrome: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/233747

  Antifungal medication: If oral thrush occurs, medication may be prescribed to combat the fungus. […] Vaginal lubricants: For vaginal dryness, water-based vaginal lubricants can provide a solution, especially during sexual intercourse. […] Punctual occlusion: When all conservative treatment options have been exhausted, this surgical option seals the tear ducts with small plugs to reduce the drainage of tears from the eye. This keeps the eye moist for longer. Temporary silicone plugs are likely to be used until the procedure is confirmed successful. […] Autologous eye serum: In severe cases of eye dryness, eye drops can be made from the persons blood serum. […] Here are some easy ways to keep the mouth lubricated: […] consuming more liquids. […] rinsing the mouth regularly to prevent infection and soothe the area

• #11 Treatment | Sjögren’s Foundation

  https://sjogrens.org/understanding-sjogrens/treatment

  Currently, no single medication has been conclusively proven to slow the progression of Sjgrens 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 Sjgrens and reduce inflammation which is often high in Sjgrens. […] Corticosteroids, a class of drugs that includes prednisone, are fast-acting and may be highly successful in halting severe symptoms of Sjgrens and/or a flare. […] DMARDs modify the way the immune system functions, so instead of simply treating symptoms, DMARDs regulate abnormal immune responses. […] The most commonly prescribed DMARD is hydroxychloroquine (Plaquenil). […] Please note that many biologics and small molecule therapies are currently under investigation for treating Sjgrens. […] Evoxac (cevimeline) […] Salagen (pilocarpine hydrochloride) […] Restasis cyclosporine ophthalmic emulsion […] Xiidra lifitegrast ophthalmic solution […] CEQUA Cyclosporine Ophthalmic Solution […] TYRVAYA Varenicline Solution.

• #12 Sjögren Syndrome: A three-part DED treatment plan and insights from a unique case

  https://www.ophthalmologytimes.com/view/sj-gren-syndrome-a-three-part-ded-treatment-plan-and-insights-from-a-unique-case

  These efforts are very important because patients with Sjgren syndrome need a long-term, comprehensive plan and therapeutic management to help them reach the best possible visual outcomes. […] To effectively manage DED, we need to know the details of each patient’s disease, Sjgren treatments, and past DED therapies. […] Treatment goals are to stimulate aqueous production, support the ocular surface, and alleviate other contributing conditions. […] To encourage atrophied lacrimal glands to produce more aqueous, we turn to therapies that stimulate the nasal nerve, which in turn stimulates the lacrimal functional unit (lacrimal gland, accessory glands, meibomian glands, and mucin-producing goblet cells). […] Sjgren patients should use artificial tears at least 4 times per day (breakfast, lunch, dinner, and bedtime), which makes it essential to use a preservative-free formulation.

• #13 Treatment Options for Sjogren’s | Arthritis Foundation

  https://www.arthritis.org/diseases/more-about/treatment-options-for-sjogren-syndrome

  Prescription medications include: […] The immunosuppressive drug cyclosporine in the form of an eye drop (Restasis) to be applied every 12 hours. […] A cellulose pellet (Lacrisert) that is placed in the lower eyelid where it dissolves, adding moisture, when artificial tears are used. […] Two drugs approved for dry mouth, pilocarpine (Salagen) and cevimeline (Evoxac), may help dry eyes. While they arent approved for dry eyes, your doctor may prescribe them for that purpose. Also, if you take one of these drugs for dry mouth, it may help your eyes. […] Artificial saliva products often provide relief from dry mouth. There are several over-the-counter products sold under various trade names. Toothpastes and mouth rinses developed specifically for dry mouth may help. If replacing moisture does not relieve dryness, your doctor may prescribe a medication to stimulate your salivary glands to produce more saliva. Two drugs, pilocarpine (Salagen) and cevimeline (Evoxac), are approved for dry mouth associated with Sjgrens.

• #14 Sjögren’s Syndrome: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/4929-sjogrens-syndrome

  Your provider will suggest treatments to manage your symptoms. Theres no cure for Sjgrens syndrome, but your provider will help you find a treatment plan that reduces its impact on your daily routine and quality of life. […] Some common treatments for dryness in your eyes, mouth or vagina include: […] Artificial tears: Your eye care specialist might suggest over-the-counter (OTC) eye drops, prescription drops or lubricants to keep your eyes moist. […] Dry eye surgery (punctal plugs): An ophthalmologist (eye surgeon) can surgically close some or all of your tear ducts to keep your natural tears in your eyes for longer. […] Saliva producers: Your dentist may suggest over-the-counter saliva (spit) supplements or prescriptions to help your body make more saliva. […] Special mouthwash or dental care products: People with Sjgrens syndrome have a higher risk of dental health issues, so you may need more frequent cleanings, special fluoride treatments or prescription toothpaste and mouthwash.

• #15 Sjogren’s syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sjogrens-syndrome/diagnosis-treatment/drc-20353221

  Treatment for Sjogren’s syndrome depends on the parts of the body affected. Many people manage the dry eye and dry mouth of Sjogren’s syndrome by using over-the-counter eyedrops and sipping water more frequently. But some people need prescription medications, or even surgical procedures. […] Depending on your symptoms, your doctor might suggest medications that: […] Prescription eyedrops such as cyclosporine (Restasis) or lifitegrast (Xiidra) may be recommended by your eye doctor if you have moderate to severe dry eyes. […] Drugs such as pilocarpine (Salagen) and cevimeline (Evoxac) can increase the production of saliva, and sometimes tears. […] If you develop arthritis symptoms, you might benefit from nonsteroidal anti-inflammatory drugs (NSAIDs) or other arthritis medications. […] Hydroxychloroquine (Plaquenil), a drug designed to treat malaria, is often helpful in treating Sjogren’s syndrome. […] A minor procedure to seal the tear ducts that drain tears from your eyes (punctal occlusion) might help relieve your dry eyes.

• #16 Diagnosis and Management of Sjögren Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0315/p465.html

  Pilocarpine and cevimeline can help relieve dry eyes and dry mouth. […] The muscarinic agonists pilocarpine (Salagen) and cevimeline (Evoxac) can be used to relieve xerophthalmia in patients with Sjgren syndrome. Muscarinic agonists improve subjective and objective signs and symptoms of xerostomia in patients with Sjgren syndrome. […] Treatment for xerostomia consists of good oral hygiene, salivary stimulation, use of saliva substitutes, and recognition of complications. […] Daily topical fluoride use and antimicrobial mouth rinses can help prevent caries in patients with reduced salivary flow. […] Several over-the-counter salivary substitutes are available as lozenges, rinses, sprays, and swabs. […] Muscarinic agonists also may be used. An RCT of 44 patients showed that pilocarpine at a dosage of 5 mg four times daily is superior to placebo in improving subjective xerostomia.

• #17 Sjögren’s Syndrome: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/4929-sjogrens-syndrome

  Your provider will suggest treatments to manage your symptoms. Theres no cure for Sjgrens syndrome, but your provider will help you find a treatment plan that reduces its impact on your daily routine and quality of life. […] Some common treatments for dryness in your eyes, mouth or vagina include: […] Artificial tears: Your eye care specialist might suggest over-the-counter (OTC) eye drops, prescription drops or lubricants to keep your eyes moist. […] Dry eye surgery (punctal plugs): An ophthalmologist (eye surgeon) can surgically close some or all of your tear ducts to keep your natural tears in your eyes for longer. […] Saliva producers: Your dentist may suggest over-the-counter saliva (spit) supplements or prescriptions to help your body make more saliva. […] Special mouthwash or dental care products: People with Sjgrens syndrome have a higher risk of dental health issues, so you may need more frequent cleanings, special fluoride treatments or prescription toothpaste and mouthwash.

• #18 Sjögren’s disease – Wikipedia

  https://en.wikipedia.org/wiki/Sj%C3%B6gren%27s_disease

  For systemic symptoms, including fatigue, joint pain, myositis, and neuropathy, biologic immunosuppressant drugs such as rituximab and belimumab that work via B-cell pathology are often used and have less toxic profiles than traditional immunosuppressive regimens. […] Preventive dental treatment is also necessary (and often overlooked by the patient), as the lack of saliva associated with xerostomia creates an ideal environment for the proliferation of bacteria that cause cavities. Treatments include at-home topical fluoride application to strengthen tooth enamel and frequent teeth cleanings by a dental hygienist. Existing cavities must also be treated, as cavities that extend into the tooth cannot be effectively treated by teeth cleaning alone, and are at a high risk of spreading into the pulp of the tooth, leading to the loss of vitality and need for extraction or root canal therapy. This treatment regimen is the same as for all xerostomia patients, such as for those undergoing head and neck radiation therapy, which often damages the salivary glands; these glands are more susceptible to radiation than other body tissues. […] Fatigue, depression, and aerobic capacity all showed a significant difference after a 12-week exercise program compared with controls, in favor of the exercise intervention. A small study showed possible efficacy of vagus nerve stimulation for Sjogren’s fatigue reduction.

• #19 Treatment Options for Sjogren’s | Arthritis Foundation

  https://www.arthritis.org/diseases/more-about/treatment-options-for-sjogren-syndrome

  Vaginal lubricants and moisturizers can restore moisture and make intercourse easier. Avoid petroleum-based ointments such as petroleum jelly. There are many vaginal lubricants available over the counter as gels, sprays and inserts. […] Treatment for mild joint inflammation typically consists of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) or naproxen (Anaprox, Aleve). For more severe inflammation, your doctor may prescribe: […] A corticosteroid medication such as prednisone, which mimics natural substances that control immune response, […] A disease-modifying antirheumatic drug (DMARD) such as hydroxychloroquine (Plaquenil), methotrexate (Rheumatrex) or leflunomide (Arava) to inhibit the bodys immune response. […] Sjgrens can cause scarring of the lungs, which cannot be reversed, but medical treatment may help prevent it from progressing. Treatment may consist of a combination of prescription medications and medical procedures.

• #20 Sjögren’s Syndrome: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/4929-sjogrens-syndrome

  Vaginal moisturizers or lubricants: Your provider will suggest over-the-counter or prescription lubricants to add moisture to your vagina every day or during sexual intercourse. […] Hormone therapy: Some people need hormone therapy (like supplemental estrogen) to treat vaginal dryness caused by a hormonal imbalance. […] Treatments for pain and other symptoms can include: […] Over-the-counter pain relievers: Over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) or acetaminophen can relieve pain and reduce swelling. […] Corticosteroids: Prescription anti-inflammatory medications your provider will give you as pills or injections. […] Immunosuppressants: Prescription medications that calm your immune system and reduce how active it is. Your provider might recommend disease-modifying antirheumatic drugs (DMARDs).

• #21 Sjogren’s syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sjogrens-syndrome/diagnosis-treatment/drc-20353221

  Treatment for Sjogren’s syndrome depends on the parts of the body affected. Many people manage the dry eye and dry mouth of Sjogren’s syndrome by using over-the-counter eyedrops and sipping water more frequently. But some people need prescription medications, or even surgical procedures. […] Depending on your symptoms, your doctor might suggest medications that: […] Prescription eyedrops such as cyclosporine (Restasis) or lifitegrast (Xiidra) may be recommended by your eye doctor if you have moderate to severe dry eyes. […] Drugs such as pilocarpine (Salagen) and cevimeline (Evoxac) can increase the production of saliva, and sometimes tears. […] If you develop arthritis symptoms, you might benefit from nonsteroidal anti-inflammatory drugs (NSAIDs) or other arthritis medications. […] Hydroxychloroquine (Plaquenil), a drug designed to treat malaria, is often helpful in treating Sjogren’s syndrome. […] A minor procedure to seal the tear ducts that drain tears from your eyes (punctal occlusion) might help relieve your dry eyes.

• #22 Diagnosis and Management of Sjögren Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/0315/p465.html

  Another small RCT showed that cevimeline at a dosage of 30 mg three times daily improves xerostomia symptoms and salivary flow. […] Systemic and biologic agents are being investigated for use in Sjgren syndrome. A study on interferon alfa, an immunomodulator, showed an improvement in subjective oral and ocular dryness and an increase in nonstimulated whole saliva flow. […] Antimalarial medications and corticosteroids are being re-evaluated in the treatment of Sjgren syndrome. […] Hydroxychloroquine (Plaquenil) may be useful for treating the arthralgias and fatigue associated with Sjgren syndrome. […] Rituximab (Rituxan), an anti-CD20 monoclonal antibody that depletes B lymphocytes, holds promise as a therapy for severe inflammatory manifestations of Sjgren syndrome.

• #23 Sjogren’s Syndrome Treatment Options – Ortho Illinois

  https://www.orthoillinois.com/rheumatology/sjogrens-syndrome-treatment-options/

  Patients often find it helpful to drink more water to increase moisture in their mouth. In addition, sugarless candy and chewing sugar free gum can help boost saliva production. An artificial saliva product may also help. Medications such as pilocarpine (Salagen) and cevimeline (Evoxac) can increase the production of saliva, and sometimes help boost tears. […] If you develop arthritis symptoms along with Sjogrens syndrome, which can sometimes happen, your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) or medications specifically targeted to arthritis. Low-dose steroids such as prednisone can reduce joint pain. […] To broadly treat the symptoms associated with Sjogrens, your rheumatologist might suggest hydroxychloroquine (Plaquenil). A drug that was designed to treat malaria, hydroxychloroquine can be effective in treating Sjogrens syndrome. Immunosuppressant drugs such as methotrexate (Trexall) may also be discussed with you by your rheumatologist.

• #24 Sjogren’s Syndrome – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/ddi/sjogrens-syndrome/

  Nonbiologic therapies employed in the treatment of Sjgrens syndrome include pilocarpine or cevimeline, hydroxychloroquine, NSAIDs, steroids, immunosuppressants, azathioprine, cyclophosphamide, mycophenolate and methotrexate. Biologic therapies that can be used to treat Sjgrens syndrome include infliximab, rituximab, belimumab, abatacept, and tocilizumab. […] Pilocarpine and cevimeline can relieve symptoms of oral and ocular dryness. Ocular inflammation can also be treated with topical corticosteroids or cyclosporine. […] The first-line treatment for musculoskeletal discomfort and mild inflammatory arthritis associated with Sjgrens syndrome is hydroxychloroquine. There is some weak evidence that it reduces fatigue. If hydroxychloroquine fails to work, methotrexate given either alone or in combination with hydroxychloroquine should be used.

• #25 Sjogren Syndrome Treatment & Management: Approach Considerations, Surgical Therapy, Consultations

  https://emedicine.medscape.com/article/332125-treatment

  Of the TNF inhibitors, both etanercept and infliximab have failed to demonstrate significant benefit in Sjgren syndrome. […] Combination therapy with leflunomide and hydroxychloroquine resulted in a significant decrease in ESSDAI scores and caused no serious adverse events, in a small phase 2a randomized clinical trial from the Netherlands. At 24 weeks, the mean difference in ESSDAI score in the leflunomide-hydroxychloroquine group (n=21), compared with the placebo group (n=7), was 4.35 points after adjustment for baseline values. […] The overall paucity of evidence in therapeutic studies in primary Sjgren syndrome suggests that much larger trials of the most promising therapies are necessary. The investigators concluded that further evaluation of leflunomide-hydroxychloroquine combination therapy in larger clinical trials is warranted.

• #26 Sjögren’s Syndrome: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/4929-sjogrens-syndrome

  Vaginal moisturizers or lubricants: Your provider will suggest over-the-counter or prescription lubricants to add moisture to your vagina every day or during sexual intercourse. […] Hormone therapy: Some people need hormone therapy (like supplemental estrogen) to treat vaginal dryness caused by a hormonal imbalance. […] Treatments for pain and other symptoms can include: […] Over-the-counter pain relievers: Over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) or acetaminophen can relieve pain and reduce swelling. […] Corticosteroids: Prescription anti-inflammatory medications your provider will give you as pills or injections. […] Immunosuppressants: Prescription medications that calm your immune system and reduce how active it is. Your provider might recommend disease-modifying antirheumatic drugs (DMARDs).

• #27 Sjögren’s disease – Wikipedia

  https://en.wikipedia.org/wiki/Sj%C3%B6gren%27s_disease

  In women with Sjgren’s disease, vaginal dryness, vulvodynia and dyspareunia (painful sexual intercourse) are often reported; personal lubricants are recommended to help lessen irritation or pain that may result from dryness in the vaginal and vulval areas. […] Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to treat musculoskeletal symptoms. For individuals with severe complications, corticosteroids or immunosuppressive drugs may be prescribed, and sometimes intravenous immunoglobulins. Also, disease-modifying antirheumatic drugs such as methotrexate may be helpful. Hydroxychloroquine (Plaquenil) is another option and is generally considered safer than methotrexate. However, these prescribed drugs have a range of side effects such as nausea, loss of appetite, dizziness, hair loss, stomach aches/cramps, headache, liver toxicity and increased risk of infections.

• #28 Sjögren’s Disease: Diagnosis, Treatment, and Steps to Take

  https://www.niams.nih.gov/health-topics/sjogrens-disease/diagnosis-treatment-and-steps-to-take

  Over-the-counter or prescribed pain relievers. These medicines alleviate joint and muscle pain, and discomfort from swollen glands. […] Disease-modifying anti-rheumatic drugs (DMARDs) and anti-malarial drugs are often prescribed in people with joint pain, rashes, and other serious effects of the disease. While these medicines have not specifically been approved for Sjgrens disease, they may be helpful in some people with the disorder. […] Corticosteroids. These medications help control inflammation and pain. Because they are potent drugs, your doctor will prescribe the lowest dose possible to achieve the desired benefit. They are usually reserved for people with rare, serious effects of the disorder.

• #29 Sjogren Syndrome Treatment & Management: Approach Considerations, Surgical Therapy, Consultations

  https://emedicine.medscape.com/article/332125-treatment

  No curative agents for Sjgren syndrome exist. The treatment of the disorder is essentially symptomatic. […] Patients should use skin creams, such as Eucerin, or skin lotions, such as Lubriderm, to help with dry skin. Vaginal lubricants, such as Replens, can be used for vaginal dryness. Vaginal estrogen creams can be considered in postmenopausal women. Watch for and treat vaginal yeast infections. […] Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can be taken for arthralgias. Consider hydroxychloroquine if NSAIDs are not sufficient for the synovitis occasionally associated with primary Sjgren syndrome. However, hydroxychloroquine does not relieve sicca symptoms. Patients with RA associated with Sjgren syndrome likely require other disease-modifying agents. […] In patients with major organ involvement, such as lymphocytic interstitial lung disease, consider therapy with steroids and immunosuppressive agents, such as cyclophosphamide.

• #30 Sjogren’s Syndrome – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/ddi/sjogrens-syndrome/

  Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat general Sjgrens syndrome symptoms, including muscular pain and joint discomfort. […] Prednisone is used to treat Sjgrens syndrome because of its success in treating other autoimmune illnesses. Low-dose prednisone is used to treat arthritis in Sjgrens syndrome as well as cutaneous symptoms of the disease. In uncontrolled studies, high doses of prednisone were found to be effective for treatment of renal, lung, and central nervous system symptoms associated with Sjgrens syndrome. […] For severe forms of visceral damage such as pulmonary, cutaneous, renal, neurological and musculoskeletal seen in Sjgrens syndrome, glucocorticoids or immunosuppressive therapy may be used. Patients with primary Sjgrens syndrome and significant liver or renal impairment should not use methotrexate.

• #31 Medications for Sjogren’s Syndrome | NYU Langone Health

  https://nyulangone.org/conditions/sjogrens-syndrome/treatments/medications-for-sjogren-s-syndrome

  If you have fibromyalgia in addition to Sjogrens syndrome, your doctor may treat the chronic, widespread pain with an anticonvulsant, such as pregabalin, sold as Lyrica. […] For moderate joint pain, your doctor may prescribe an immunosuppressant. […] Your doctor may prescribe a mild medication first, such as hydroxychloroquine, sold as Plaquenil. […] If joint pain is severe and does not respond to hydroxychloroquine, your doctor may prescribe methotrexate. […] If severe Sjogrens syndrome affects other major organs, such as the lungs, brain, or kidneys, doctors may prescribe more powerful medications that suppress the immune response, including cyclophosphamide, rituximab, and azathioprine. […] Corticosteroid medications, commonly known as steroids, decrease inflammation by suppressing the immune response.

• #32 Sjogren’s Syndrome – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/ddi/sjogrens-syndrome/

  Increased use of biologic therapies in Sjgrens syndrome is based on an improved understanding of the mechanism of Sjgrens syndrome and the establishment of therapeutic targets for these agents in patients with other autoimmune disorders. In addition, resistance to therapy in primary Sjgrens syndrome with documented organ damage is an indication for initiation of biologic therapy. […] Rituximab is a chimeric anti-CD20 monoclonal antibody that depletes B cells by causing a direct toxic effect on these cells over a period of 4 to 12 months. Rituximab treatment has been found to be effective for patients with primary Sjgrens syndrome. […] The monoclonal anti-BAFF antibody belimumab was shown to be effective in the treatment of Sjgrens syndrome in a prospective 1-year open-label bicentric study involving 30 patients.

• #33 Sjogren Syndrome Treatment & Management: Approach Considerations, Surgical Therapy, Consultations

  https://emedicine.medscape.com/article/332125-treatment

  Reports on the use of rituximab in patients with primary Sjgren syndrome have emerged in the literature. […] In a double-blind, randomized, placebo-controlled trial, Meijer et al found that rituximab significantly improved saliva flow rate, lacrimal gland function, and other variables in patients with primary Sjgren syndrome. […] In an open-label clinical trial, modest improvements were noted in patient-reported symptoms of fatigue and oral dryness. However, no significant improvement in the objective measures of lacrimal and salivary gland function was noted, despite effective depletion of blood B cells. […] In a randomized, placebo-controlled, parallel-group study of 120 patients with primary Sjgren syndrome, treatment with rituximab did not alleviate disease activity or symptoms at week 24, although it did alleviate some symptoms at weeks 6 and 16.

• #34 Sjogren Syndrome Treatment & Management: Approach Considerations, Surgical Therapy, Consultations

  https://emedicine.medscape.com/article/332125-treatment

  Rituximab appears promising in the treatment of vasculitis and intravenous immunoglobulin (IVIG)dependent ataxic neuropathy. […] Results from the AIR registry (French) indicated that rituximab appears to be effective in cryoglobulinemia or vasculitis-related peripheral nervous system involvement in primary Sjgren syndrome. […] In a prospective study of 78 patients with primary Sjgren syndrome treated with rituximab, significant improvement in extraglandular manifestations was reported, as measured by EULAR [European League Against Rheumatism] Sjgren Syndrome Disease Activity Index (ESSDAI) (disease activity score) and overall good tolerance reported. […] Several smaller studies of rituximab revealed improvement of arthralgias, regression of parotid gland swelling, and improvement of immune-related thrombocytopenia.

• #35 Sjogren Syndrome Medication: Gastrointestinal Agents, Other, Ophthalmic Lubricants, Antimalarials, Antineoplastics, Alkylating, Immunomodulators, Corticosteroids, Antineoplastics, Monoclonal Antibody

  https://emedicine.medscape.com/article/332125-medication

  Rituximab has a promising effect in the treatment of patients with severe extraglandular manifestations of Sjgren syndrome. […] Although some data support its efficacy for glandular involvement, it is not currently used for the treatment of sicca symptoms alone. […] Rituximab is a monoclonal antibody directed against the CD20 antigen on maturing B-lymphocytes, leading to the depletion of mature circulating B-cells, which are believed to play an important role in the pathophysiology of primary Sjgren syndrome. […] Treatment of primary Sjgren syndrome with rituximab: a randomized trial. […] Efficacy of rituximab in primary Sjgren’s syndrome with peripheral nervous system involvement: results from the AIR registry. […] Efficacy of rituximab in systemic manifestations of primary Sjgren’s syndrome: results in 78 patients of the AutoImmune and Rituximab registry.

• #36 New Treatment Guidelines for Sjögren’s Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5812283/

  The only strongly recommended treatment of fatigue in SD was exercise, which provides the same benefit for SD patients that is seen in patients with RA, SLE, or multiple sclerosis. […] CPGs for use of biologics in SD are summarized in Box 4. The CEP recommended against the use of TNF- inhibitors in SD, based on findings from 2 earlier studies, but emphasized this recommendation does not preclude the use of these agents in SD patients if needed for other indications (eg, overlapping manifestations with RA). […] Rituximab may be considered as a therapeutic option for KCS in patients with primary SD and for whom conventional therapies, including topical moisturizers, secretagogues, anti-inflammatories, immunomodulators, and punctual occlusion, have proven insufficient. […] Guidelines will be revised as new information becomes available.

• #37 Sjogren’s Syndrome – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/ddi/sjogrens-syndrome/

  Increased use of biologic therapies in Sjgrens syndrome is based on an improved understanding of the mechanism of Sjgrens syndrome and the establishment of therapeutic targets for these agents in patients with other autoimmune disorders. In addition, resistance to therapy in primary Sjgrens syndrome with documented organ damage is an indication for initiation of biologic therapy. […] Rituximab is a chimeric anti-CD20 monoclonal antibody that depletes B cells by causing a direct toxic effect on these cells over a period of 4 to 12 months. Rituximab treatment has been found to be effective for patients with primary Sjgrens syndrome. […] The monoclonal anti-BAFF antibody belimumab was shown to be effective in the treatment of Sjgrens syndrome in a prospective 1-year open-label bicentric study involving 30 patients.

• #38 Sjogren’s Syndrome – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/ddi/sjogrens-syndrome/

  Abatacept, a T-cell-targeted therapy, has been demonstrated in several studies to increase saliva production and decrease systemic symptoms of the condition as well as glandular inflammation. […] Infliximab is a TNF- antagonist that is used to treat certain types of arthritis, bowel disease, and skin disease. Further research is needed to evaluate the efficacy of topical infliximab in patients with Sjgrens syndrome. […] Tocilizumab is an IL-6 receptor antagonist and has been linked to multiple autoimmune disorders. IL-6 levels are higher in the tears, saliva, and blood of patients with Sjgrens syndrome. Clinical trials of tocilizumab in this setting are ongoing. […] Treatment Recommendations for Specific Systemic Manifestations: Parotid swelling: NSAIDS and short term oral corticosteroids with dosages less than 20 mg/day for a maximum of 1 month. Antibiotics can be utilized as needed. Arthritis: hydroxychloroquine with annual ophthalmological follow-ups NSAIDs and short-term oral or intra-articular corticosteroids. Second-line DMARDs such as methotrexate can also be considered. Interstitial pneumopathy: oral or intravenous corticosteroids, cyclophosphamide in active alveolitis, pirfenidone, or nintedanib. Tubulointerstitial nephritis: potassium and bicarbonate replacement. Peripheral neuropathy: antidepressants, gabapentin, oral or intravenous corticosteroids, or intravenous IG. Cryoglobulinemic vasculitis with organ involvement: methylprednisolone, plasmapheresis, or rituximab.

• #39 Sjogren’s Syndrome – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/ddi/sjogrens-syndrome/

  Abatacept, a T-cell-targeted therapy, has been demonstrated in several studies to increase saliva production and decrease systemic symptoms of the condition as well as glandular inflammation. […] Infliximab is a TNF- antagonist that is used to treat certain types of arthritis, bowel disease, and skin disease. Further research is needed to evaluate the efficacy of topical infliximab in patients with Sjgrens syndrome. […] Tocilizumab is an IL-6 receptor antagonist and has been linked to multiple autoimmune disorders. IL-6 levels are higher in the tears, saliva, and blood of patients with Sjgrens syndrome. Clinical trials of tocilizumab in this setting are ongoing. […] Treatment Recommendations for Specific Systemic Manifestations: Parotid swelling: NSAIDS and short term oral corticosteroids with dosages less than 20 mg/day for a maximum of 1 month. Antibiotics can be utilized as needed. Arthritis: hydroxychloroquine with annual ophthalmological follow-ups NSAIDs and short-term oral or intra-articular corticosteroids. Second-line DMARDs such as methotrexate can also be considered. Interstitial pneumopathy: oral or intravenous corticosteroids, cyclophosphamide in active alveolitis, pirfenidone, or nintedanib. Tubulointerstitial nephritis: potassium and bicarbonate replacement. Peripheral neuropathy: antidepressants, gabapentin, oral or intravenous corticosteroids, or intravenous IG. Cryoglobulinemic vasculitis with organ involvement: methylprednisolone, plasmapheresis, or rituximab.

• #40 Manifestations and management of Sjögren’s disease | Arthritis Research & Therapy | Full Text

  https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-024-03262-4

  Recently, a randomized placebo-controlled trial showed that the combination of rituximab and belimumab (anti-B cell-activating factor antibody) was well tolerated (primary outcome) and improved ESSDAI score in patients with Sjgrens disease. […] The prognostic implications of serious systemic complications make it paramount that these are identified and treated in a timely manner. […] Treatment should be tailored to the type and severity of organ involvement. […] For patients with ILD, the treatment approach should be based on the severity of symptoms, level of physiologic impairment, and extent of radiographic disease. […] There is no evidence from controlled trials to support the use of glucocorticoids or immunosuppressants to treat ILD associated with Sjgrens disease, but prednisone is considered an initial treatment option, with a steroid-sparing agent such as azathioprine or mycophenolate added if an initial response is seen.

• #41 Manifestations and management of Sjögren’s disease | Arthritis Research & Therapy | Full Text

  https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-024-03262-4

  In 2021, the Sjgrens Foundation published clinical practice guidelines for the evaluation and management of pulmonary involvement. […] These recommended that therapeutic decisions for patients with pulmonary manifestations should ideally be based on multidisciplinary discussion and should be individualized based on the type of pulmonary involvement, PFTs, and findings on HRCT. […] Recommendations for the management of ILD were based on the severity according to the pulmonary domain of the ESSDAI, which is based on symptoms defined using the New York Heart Association (NYHA) Functional Classification, imaging, and PFTs. […] It was recommended that patients with ILD who have no or minimal respiratory symptoms and mild impairment on PFTs/HRCT can be closely monitored without treatment, while those with rapid deterioration may require pharmacological therapy or, if refractory to treatment, referral for lung transplant.

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• #44 Sjogren syndrome: Symptoms, Causes, and Treatment – DermNet

  https://dermnetnz.org/topics/sjoegren-syndrome

• #45 Sjogren Syndrome Treatment & Management: Approach Considerations, Surgical Therapy, Consultations

  https://emedicine.medscape.com/article/332125-treatment

  Of the TNF inhibitors, both etanercept and infliximab have failed to demonstrate significant benefit in Sjgren syndrome. […] Combination therapy with leflunomide and hydroxychloroquine resulted in a significant decrease in ESSDAI scores and caused no serious adverse events, in a small phase 2a randomized clinical trial from the Netherlands. At 24 weeks, the mean difference in ESSDAI score in the leflunomide-hydroxychloroquine group (n=21), compared with the placebo group (n=7), was 4.35 points after adjustment for baseline values. […] The overall paucity of evidence in therapeutic studies in primary Sjgren syndrome suggests that much larger trials of the most promising therapies are necessary. The investigators concluded that further evaluation of leflunomide-hydroxychloroquine combination therapy in larger clinical trials is warranted.

• #46 Congress of Clinical Rheumatology Annual Meeting

  https://www.healio.com/news/rheumatology/20210918/promising-treatments-for-sjgrens-syndrome-may-enter-clinical-use-in-35-years

  It is likely that one or more promising treatments currently being investigated for Sjgrens syndrome will come into use within the next 3 to 5 years, according to a presenter at the 2021 Congress of Clinical Rheumatology-West. […] Those treatments, all the subjects of studies published in either 2019 or 2020, include combination therapy with hydroxychloroquine and leflunomide, combination therapy with rituximab (Rituxan; Genentech, Biogen) and belimumab (Benlysta, GlaxoSmithKline), the anti-CD40 antibody iscalimab (Novartis) and the BAFF receptor inhibitor and B-cell depletion agent ianalumab (Novartis). […] These are the ones that have made it through phase 2 trials and have shown positive results, Vivino said. One would predict that one or more of these treatment strategies will likely come into use sometime within the next 3 to 5 years.

• #47 Manifestations and management of Sjögren’s disease | Arthritis Research & Therapy | Full Text

  https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-024-03262-4

  The lack of robust evidence to support the efficacy of treatments in Sjgrens disease means that management is generally based on extrapolation of observations from other autoimmune diseases. […] To date, the only therapies to have met their primary outcome of improvement in ESSDAI score in randomized placebo-controlled trials in patients with Sjgrens disease are leflunomide in combination with hydroxychloroquine, iscalimab (anti-CD40 monoclonal antibody), ianalumab (anti-B cell-activating factor receptor antibody) and low-dose interleukin 2. […] Treatment guidelines for rheumatologic manifestations of Sjgrens disease issued by the Sjgrens Syndrome Foundation in 2017 provided a moderately strong recommendation for the use of rituximab (anti-CD20 antibody) in patients with vasculitis, cryoglobulinemia associated with vasculitis, severe parotid swelling, inflammatory arthritis, pulmonary disease, and/or peripheral neuropathy, based on data from non-randomized studies.

• #48 Congress of Clinical Rheumatology Annual Meeting

  https://www.healio.com/news/rheumatology/20210918/promising-treatments-for-sjgrens-syndrome-may-enter-clinical-use-in-35-years

  It is likely that one or more promising treatments currently being investigated for Sjgrens syndrome will come into use within the next 3 to 5 years, according to a presenter at the 2021 Congress of Clinical Rheumatology-West. […] Those treatments, all the subjects of studies published in either 2019 or 2020, include combination therapy with hydroxychloroquine and leflunomide, combination therapy with rituximab (Rituxan; Genentech, Biogen) and belimumab (Benlysta, GlaxoSmithKline), the anti-CD40 antibody iscalimab (Novartis) and the BAFF receptor inhibitor and B-cell depletion agent ianalumab (Novartis). […] These are the ones that have made it through phase 2 trials and have shown positive results, Vivino said. One would predict that one or more of these treatment strategies will likely come into use sometime within the next 3 to 5 years.

• #49 Congress of Clinical Rheumatology Annual Meeting

  https://www.healio.com/news/rheumatology/20210918/promising-treatments-for-sjgrens-syndrome-may-enter-clinical-use-in-35-years

  It is likely that one or more promising treatments currently being investigated for Sjgrens syndrome will come into use within the next 3 to 5 years, according to a presenter at the 2021 Congress of Clinical Rheumatology-West. […] Those treatments, all the subjects of studies published in either 2019 or 2020, include combination therapy with hydroxychloroquine and leflunomide, combination therapy with rituximab (Rituxan; Genentech, Biogen) and belimumab (Benlysta, GlaxoSmithKline), the anti-CD40 antibody iscalimab (Novartis) and the BAFF receptor inhibitor and B-cell depletion agent ianalumab (Novartis). […] These are the ones that have made it through phase 2 trials and have shown positive results, Vivino said. One would predict that one or more of these treatment strategies will likely come into use sometime within the next 3 to 5 years.

• #50 Congress of Clinical Rheumatology Annual Meeting

  https://www.healio.com/news/rheumatology/20210918/promising-treatments-for-sjgrens-syndrome-may-enter-clinical-use-in-35-years

  It is likely that one or more promising treatments currently being investigated for Sjgrens syndrome will come into use within the next 3 to 5 years, according to a presenter at the 2021 Congress of Clinical Rheumatology-West. […] Those treatments, all the subjects of studies published in either 2019 or 2020, include combination therapy with hydroxychloroquine and leflunomide, combination therapy with rituximab (Rituxan; Genentech, Biogen) and belimumab (Benlysta, GlaxoSmithKline), the anti-CD40 antibody iscalimab (Novartis) and the BAFF receptor inhibitor and B-cell depletion agent ianalumab (Novartis). […] These are the ones that have made it through phase 2 trials and have shown positive results, Vivino said. One would predict that one or more of these treatment strategies will likely come into use sometime within the next 3 to 5 years.

• #51 Manifestations and management of Sjögren’s disease | Arthritis Research & Therapy | Full Text

  https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-024-03262-4

  The lack of robust evidence to support the efficacy of treatments in Sjgrens disease means that management is generally based on extrapolation of observations from other autoimmune diseases. […] To date, the only therapies to have met their primary outcome of improvement in ESSDAI score in randomized placebo-controlled trials in patients with Sjgrens disease are leflunomide in combination with hydroxychloroquine, iscalimab (anti-CD40 monoclonal antibody), ianalumab (anti-B cell-activating factor receptor antibody) and low-dose interleukin 2. […] Treatment guidelines for rheumatologic manifestations of Sjgrens disease issued by the Sjgrens Syndrome Foundation in 2017 provided a moderately strong recommendation for the use of rituximab (anti-CD20 antibody) in patients with vasculitis, cryoglobulinemia associated with vasculitis, severe parotid swelling, inflammatory arthritis, pulmonary disease, and/or peripheral neuropathy, based on data from non-randomized studies.

• #52 Targeted Therapy for Severe Sjogren’s Syndrome: A Focus on Mesenchymal Stem Cells

  https://www.mdpi.com/1422-0067/25/24/13712

  Results obtained in a large number of recently published experimental studies and pilot clinical trials have demonstrated the therapeutic efficacy of MSCs in the treatment of severe pSS. […] Accordingly, in this review article, we summarized current knowledge about the molecular mechanisms that are responsible for the therapeutic potential of MSCs in the suppression of immune cell-driven destruction of salivary and lacrimal glands and for the attenuation of systemic inflammatory response, opening new avenues for the targeted therapy of severe pSS. […] The therapeutic potential of MSCs mainly relies on their immunosuppressive and regenerative properties. […] MSCs, in juxtacrine and paracrine manners, suppressed the DC-dependent generation of inflammatory Th1 and Th17 lymphocytes, induced the expansion and promoted the immunosuppressive properties of Tregs and MDSCs, impaired the cross-talk between autoreactive T and B cells, and prevented the synthesis and secretion of autoantibodies.

• #53 Targeted Therapy for Severe Sjogren’s Syndrome: A Focus on Mesenchymal Stem Cells

  https://www.mdpi.com/1422-0067/25/24/13712

  Additionally, MSC-derived growth and trophic factors promoted survival and prevented apoptosis of injured cells in inflamed lacrimal and salivary glands, enhancing their repair and regeneration. […] Despite these encouraging results, it should be noted that all of these findings were obtained either in animal studies or in pilot clinical trials with a small number of recruited patients. Therefore, upcoming large-scale double-blinded randomized clinical trials need to validate these findings before MSCs can be widely offered as new therapeutic agents for the treatment of severe pSS.

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• #56 Experimental cell therapy trial treats first Sjögren’s disease patient – School of Medicine and Public Health

  https://www.med.wisc.edu/news/trial-treats-sjogrens-disease-patient/

  In 2022, McCoy partnered with the UW Program for Advanced Cell Therapy, or PACT, a joint venture between the UW School of Medicine and Public Health and UW Health. The program develops novel immunotherapy treatments using cells, like white blood cells or types of stem cells, from a patient or a sibling, activating them in the PACT cell manufacturing lab and then injecting them into the patient. […] McCoy wondered if the use of a patient’s own enhanced stem cells could be used to improve salivary gland function in Sjögren’s disease patients and began working with PACT to start a clinical trial. She received FDA approval to initiate the trial in 2023. The approach extracts cells from the patient’s own bone marrow, activates them and injects them into salivary glands. […] The current standard of care is not addressing the root cause of dry mouth for these patients. With this cell therapy, we are hopeful we can do more than offer temporary relief and give these people back these critical human functions.

• #57 Experimental cell therapy trial treats first Sjögren’s disease patient – School of Medicine and Public Health

  https://www.med.wisc.edu/news/trial-treats-sjogrens-disease-patient/

  This Phase 0 trial is enrolling six patients and will be followed by a larger Phase 1 trial to establish safety and dose levels. Preliminary data on efficacy will be obtained in a cohort of 12 participants in an expansion phase of the study. […] While the goal of the first phase of the trial is to show that the therapy is safe, McGowan said she has noticed some improvement. […] Sjögren’s disease impacts women more than men, about eight to one, according to McCoy, but there seems to be a lack of awareness of this condition, McGowan said.

• #58 EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies | Annals of the Rheumatic Diseases

  https://ard.bmj.com/content/79/1/3

  The therapeutic management of Sjgren syndrome (SjS) has not changed substantially in recent decades: treatment decisions remain challenging in clinical practice, without a specific therapeutic target beyond the relief of symptoms as the most important goal. […] The Task Force (TF) endorsed the presentation of general principles for the management of patients with SjS as three overarching, general consensus-based recommendations and 12 specific recommendations that form a logical sequence, starting with the management of the central triplet of symptoms (dryness, fatigue and pain) followed by the management of systemic disease. […] The recommendations address the use of topical oral (saliva substitutes) and ocular (artificial tear drops, topical non-steroidal anti-inflammatory drugs, topical corticosteroids, topical CyA, serum tear drops) therapies, oral muscarinic agonists (pilocarpine, cevimeline), hydroxychloroquine, oral glucocorticoids, synthetic immunosuppressive agents (cyclophosphamide, azathioprine, methotrexate, leflunomide and mycophenolate), and biological therapies (rituximab, abatacept and belimumab).

• #59 Overview of the management and prognosis of Sjögren’s disease – UpToDate

  https://www.uptodate.com/contents/overview-of-the-management-and-prognosis-of-sjogrens-disease

  INTRODUCTION […] An overview of the systemic treatment and prognosis of SjD will be reviewed here. The clinical manifestations and diagnosis of SjD and the treatment of dry eyes, dry mouth (including the use of muscarinic agonists such as pilocarpine and cevimeline as secretagogues), other nonocular sicca symptoms, and manifestations affecting other organs and tissues are described in detail separately. […] […] The goals of therapy in patients with Sjögren’s disease (SjD) are to ameliorate symptoms of dry eye and mouth, prevent complications of mucosal dryness (such as dental decay, corneal ulceration, or oral candidal infection), and detect and manage systemic manifestations and glandular and lymphoproliferative disease. The following general principles apply to the management of patients with SjD: […] • Evaluation and management should be provided by a multidisciplinary team; a rheumatologist, an eye care professional, and a dentist or oral medicine specialist are often required for optimal care.

• #60 Treatment for Sjögren Syndrome | Hospital Clínic Barcelona

  https://www.clinicbarcelona.org/en/assistance/diseases/sjogren-syndrome/treatment

  Despite extensive work and research, no cure has yet been found for Sjgren Syndrome, and palliative measures are the central treatment focus. There are many saliva substitutes and artificial tears that help to reduce and alleviate the symptoms of a dry mouth and eyes. This type of local palliative treatment focuses specifically on dryness symptoms (dry eyes and mouth). Preservative-free gels and mouthwashes to combat a dry mouth and artificial tears, in single doses, under the supervision of an ophthalmologist, are very helpful. […] The treatment must be carried out by a multidisciplinary medical team coordinated by a specialist in internal medicine (or rheumatologist), but which also includes other specialists in dryness (ophthalmologists, dentists, otolaryngologists, and gynaecologists) and experts on the possible effects on internal organs (pulmonologists, dermatologists, nephrologists, neurologists, haematologists, etc.). It is equally important that the primary care physician is involved in the care process, especially for patients with no systemic or internal effects, and that patients are educated about their disease so that they can help manage their own treatment.

• #61 Sjogren’s syndrome | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/sjogrens-syndrome

  There is no cure, but the condition can be managed with medications and products such as artificial tears and saliva as well as mouth washes and lozenges. […] Treatment may include: artificial tears and lubricating ointments for the eyes, artificial saliva, mouth rinses and lozenges, nasal sprays, vaginal lubricants, moisturising lotion for the skin, non-steroidal anti-inflammatory drugs (NSAIDs) these medications (for example naproxen and ibuprofen) help control inflammation and provide temporary pain relief, corticosteroid medications may be used as a temporary treatment for joint pain, immunosuppressive medications (for example hydroxychloroquine and methotrexate) may be used to help control your overactive immune system. […] There are many things you can do to manage your Sjogren’s syndrome including: Avoid dry and dusty environments, Avoid air drafts or windy weather, Wear protective glasses when outside in the wind and sun, Sip water regularly or suck ice cubes, Avoid strong soaps that may dry out your skin, Try to increase the humidity in your home, Exercise regularly, eat a healthy diet, stop smoking and reduce stress to help your overall health and wellbeing, Eat soft, moist foods if you have trouble swallowing, Eat smaller, more frequent meals to stimulate saliva flow, Use warm (not hot) water when taking a shower or bath, Chew sugarless gum to stimulate saliva, Avoid salty, acidic or spicy foods and carbonated drinks that may be painful if your mouth is dry, Practice good dental hygiene and visit your dentist often.

• #62 Sjogren’s syndrome: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/233747

  Antifungal medication: If oral thrush occurs, medication may be prescribed to combat the fungus. […] Vaginal lubricants: For vaginal dryness, water-based vaginal lubricants can provide a solution, especially during sexual intercourse. […] Punctual occlusion: When all conservative treatment options have been exhausted, this surgical option seals the tear ducts with small plugs to reduce the drainage of tears from the eye. This keeps the eye moist for longer. Temporary silicone plugs are likely to be used until the procedure is confirmed successful. […] Autologous eye serum: In severe cases of eye dryness, eye drops can be made from the persons blood serum. […] Here are some easy ways to keep the mouth lubricated: […] consuming more liquids. […] rinsing the mouth regularly to prevent infection and soothe the area

• #63 Sjogren’s syndrome: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/233747

  maintaining excellent oral and dental hygiene […] topical fluoride gels or varnish […] quitting smoking, as smoke irritates the mouth and speeds up the evaporation of saliva […] chewing sugar-free gum, which stimulates the production of saliva […] applying coconut oil to the dry areas, as it is both moisturizing and anti-microbial.

• #64 New Treatment Guidelines for Sjögren’s Disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5812283/

  The only strongly recommended treatment of fatigue in SD was exercise, which provides the same benefit for SD patients that is seen in patients with RA, SLE, or multiple sclerosis. […] CPGs for use of biologics in SD are summarized in Box 4. The CEP recommended against the use of TNF- inhibitors in SD, based on findings from 2 earlier studies, but emphasized this recommendation does not preclude the use of these agents in SD patients if needed for other indications (eg, overlapping manifestations with RA). […] Rituximab may be considered as a therapeutic option for KCS in patients with primary SD and for whom conventional therapies, including topical moisturizers, secretagogues, anti-inflammatories, immunomodulators, and punctual occlusion, have proven insufficient. […] Guidelines will be revised as new information becomes available.

• #65 The Best Natural Treatments for Sjogren’s Syndrome – Caplan Health Institute

  https://caplanhealthinstitute.com/the-best-natural-treatments-for-sjogrens-syndrome/

  Staying away from foods that cause inflammation like sugar and too many omega-6 fatty acids can prevent Sjogrens flare-ups. Eating foods rich in omega-3 fatty acids, such as salmon and fatty fish, and foods rich in antioxidants like fruits and vegetables will help calm your Sjogrens symptoms. […] Exposure to environmental toxins such as chemicals and mold can put stress on the body and lead to autoimmune disease. […] For many—but not all—Sjogrens patients, the gut is the main driver behind their disease. […] Balancing hormones that may be outside of normal ranges and resolving insulin resistance are two other ways to improve the health of people with Sjogrens. […] One of the best natural remedies for Sjogrens is to take a fish oil supplement to boost your omega-3 fatty acid levels. Omega-3s from fish oil not only reduce inflammation, but studies also have shown that omega-3s can reduce dry eyes.

• #66 Natural treatments for Sjögren’s syndrome | EBSCO Research Starters

  https://www.ebsco.com/research-starters/complementary-and-alternative-medicine/natural-treatments-sjogrens-syndrome

  Colostrum is the fluid that a womans breasts produce during the first day or two after she has given birth. Preliminary evidence suggests that oral hygiene products containing bovine colostrum (colostrum from cows) may provide beneficial effects for the mouth symptoms of Sjgrens syndrome. […] Other natural treatments for Sjgrens are suggested as well. These include evening rose oil, the essential fatty acid gamma-linolenic acid (GLA), omega-6 fatty acids, and sulfur. […] People with Sjgrens are also recommended to eat an anti-inflammatory diet rich in vegetables, lean proteins, and fruits. Nuts, leafy greens, fatty fish, avocados, olive oil, whole grains, and foods prepared with turmeric, garlic, or ginger have proven to benefit some individuals. […] If constipation, diarrhea, or leaky gut syndrome accompany Sjgrens syndrome, balancing gut bacteria may help alleviate these symptoms and other symptoms that may be indirectly caused by gastrointestinal upset. Opting for goats milk products over cow’s milk and taking probiotics may improve symptoms. Natural probiotics and gut-friendly foods include sauerkraut, kombucha, miso, kimchi, pickled foods, and tempeh.

• #67 EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies | Annals of the Rheumatic Diseases

  https://ard.bmj.com/content/79/1/3

  The therapeutic management of Sjgren syndrome (SjS) has not changed substantially in recent decades: treatment decisions remain challenging in clinical practice, without a specific therapeutic target beyond the relief of symptoms as the most important goal. […] The Task Force (TF) endorsed the presentation of general principles for the management of patients with SjS as three overarching, general consensus-based recommendations and 12 specific recommendations that form a logical sequence, starting with the management of the central triplet of symptoms (dryness, fatigue and pain) followed by the management of systemic disease. […] The recommendations address the use of topical oral (saliva substitutes) and ocular (artificial tear drops, topical non-steroidal anti-inflammatory drugs, topical corticosteroids, topical CyA, serum tear drops) therapies, oral muscarinic agonists (pilocarpine, cevimeline), hydroxychloroquine, oral glucocorticoids, synthetic immunosuppressive agents (cyclophosphamide, azathioprine, methotrexate, leflunomide and mycophenolate), and biological therapies (rituximab, abatacept and belimumab).

• #68 EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies | Annals of the Rheumatic Diseases

  https://ard.bmj.com/content/79/1/3

  The first therapeutic approach to dryness should be symptomatic relief using topical therapies. […] Systemic therapies may be considered for the treatment of active systemic disease. […] The preferred first therapeutic approach for oral dryness according to salivary gland function may be: Non-pharmacological stimulation for mild dysfunction; pharmacological stimulation for moderate dysfunction; saliva substitution for severe dysfunction. […] The first-line therapeutic approach to ocular dryness includes artificial tears and ocular gels/ointments. […] Refractory/severe ocular dryness may be managed using topical immunosuppressive-containing drops and serum eye drops. […] The systemic organ-specific therapeutic approach may, as a general rule, follow the sequential (or combined) use of GCs, immunosuppressive agents and biologics. […] B-cell targeted therapies may be considered in patients with severe, refractory systemic disease.

• #69 New subgroups of Sjögren’s patients mean better treatments possible | IHI Innovative Health Initiative

  https://www.ihi.europa.eu/news-events/newsroom/new-subgroups-sjogrens-patients-mean-better-treatments-possible

  The NECESSITY project carried out a study that showed that Sjgrens patients can be categorised into three different subgroups, meaning that more personalised and better treatments could be possible. […] As of 2024, no treatment has been marketed specifically for Sjgrens disease. Typically, we compare the predominant symptoms to other autoimmune diseases, and treat the Sjgrens patient with immunomodulatory drugs known to work in patients with those autoimmune diseases. […] Worldwide, there are more than 20 clinical trials and 10 drugs that are in development for Sjogrens. […] Within the NECESSITY consortium, a large clinical trial is ongoing across 8 European countries that is evaluating combinations of drugs that are already available for treating rheumatoid arthritis and lupus, and we are assessing their effect on patients with Sjgrens.

• #70 New subgroups of Sjögren’s patients mean better treatments possible | IHI Innovative Health Initiative

  https://www.ihi.europa.eu/news-events/newsroom/new-subgroups-sjogrens-patients-mean-better-treatments-possible

  For the cluster with low systemic activity, the treatment is currently symptomatic. They can use tear drops and other treatments that help with the production of saliva. But usually for these patients we dont need to use any immunomodulatory or immunosuppressive drugs. On the other hand, the patients with high systemic activity frequently require an immunosuppressive drug. […] We are going to apply this clusterisation approach to the results of these nine trials to see if we observe a better response to treatment once the patients are clustered. This could help researchers when designing future clinical trials, because they can focus on the cluster that is more likely to benefit from a specific treatment under investigation.

• #71 New subgroups of Sjögren’s patients mean better treatments possible | IHI Innovative Health Initiative

  https://www.ihi.europa.eu/news-events/newsroom/new-subgroups-sjogrens-patients-mean-better-treatments-possible

  For the cluster with low systemic activity, the treatment is currently symptomatic. They can use tear drops and other treatments that help with the production of saliva. But usually for these patients we dont need to use any immunomodulatory or immunosuppressive drugs. On the other hand, the patients with high systemic activity frequently require an immunosuppressive drug. […] We are going to apply this clusterisation approach to the results of these nine trials to see if we observe a better response to treatment once the patients are clustered. This could help researchers when designing future clinical trials, because they can focus on the cluster that is more likely to benefit from a specific treatment under investigation.

• #72 Treatment | Sjögren’s Foundation

  https://sjogrens.org/understanding-sjogrens/treatment

  A number of different medications are available that can be used to manage symptoms. […] A Sjgrens patients 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 Sjgrens 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. Sjgrens 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.

• #73 Sjögren’s Syndrome: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/4929-sjogrens-syndrome

  Your provider will suggest treatments to manage your symptoms. Theres no cure for Sjgrens syndrome, but your provider will help you find a treatment plan that reduces its impact on your daily routine and quality of life. […] Some common treatments for dryness in your eyes, mouth or vagina include: […] Artificial tears: Your eye care specialist might suggest over-the-counter (OTC) eye drops, prescription drops or lubricants to keep your eyes moist. […] Dry eye surgery (punctal plugs): An ophthalmologist (eye surgeon) can surgically close some or all of your tear ducts to keep your natural tears in your eyes for longer. […] Saliva producers: Your dentist may suggest over-the-counter saliva (spit) supplements or prescriptions to help your body make more saliva. […] Special mouthwash or dental care products: People with Sjgrens syndrome have a higher risk of dental health issues, so you may need more frequent cleanings, special fluoride treatments or prescription toothpaste and mouthwash.

• #74 Manifestations and management of Sjögren’s disease | Arthritis Research & Therapy | Full Text

  https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-024-03262-4

  The management of patients with Sjgrens disease should be based on a multidisciplinary evaluation of symptoms and systemic manifestations. […] Recommendations published by EULAR provide a framework for the use of therapies to treat symptoms of dryness, such as muscarinic agonists, saliva substitutes, and ocular tears, and for the use of immunosuppressive agents to treat systemic manifestations. […] It is recommended that systemic immunomodulatory therapies be reserved for patients with active systemic disease, defined as a clinical ESSDAI score1. […] Glucocorticoids should be used at the minimum dose and for the shortest time necessary to control systemic disease. […] Immunosuppressive agents such as leflunomide, methotrexate, azathioprine, mycophenolate, or cyclophosphamide, and biologics such as rituximab or tocilizumab are second/third-line options for patients who are intolerant or refractory to glucocorticoids have severe disease, or for whom long-term glucocorticoid use is anticipated.

• #75 Congress of Clinical Rheumatology Annual Meeting

  https://www.healio.com/news/rheumatology/20210918/promising-treatments-for-sjgrens-syndrome-may-enter-clinical-use-in-35-years

  It is likely that one or more promising treatments currently being investigated for Sjgrens syndrome will come into use within the next 3 to 5 years, according to a presenter at the 2021 Congress of Clinical Rheumatology-West. […] Those treatments, all the subjects of studies published in either 2019 or 2020, include combination therapy with hydroxychloroquine and leflunomide, combination therapy with rituximab (Rituxan; Genentech, Biogen) and belimumab (Benlysta, GlaxoSmithKline), the anti-CD40 antibody iscalimab (Novartis) and the BAFF receptor inhibitor and B-cell depletion agent ianalumab (Novartis). […] These are the ones that have made it through phase 2 trials and have shown positive results, Vivino said. One would predict that one or more of these treatment strategies will likely come into use sometime within the next 3 to 5 years.

• #76 Congress of Clinical Rheumatology Annual Meeting

  https://www.healio.com/news/rheumatology/20210918/promising-treatments-for-sjgrens-syndrome-may-enter-clinical-use-in-35-years

  In addition, patients with early interstitial lung disease in Sjgrens syndrome should be treated with steroids as the first line, followed by mycophenolate mofetil or azathioprine. […] If the conclusion remains inflammatory, the next step in the guidelines would be either rituximab or calcineurin inhibitors. If the consensus is that the issue is mainly a fibrotic process, the treatment of choice would be nintedanib (Ofev, Boehringer Ingelheim). […] Vivino noted that although there are no cures for Sjgrens syndromes, it can nonetheless be treated. He recommended that providers triage patient issues based on eye, mouth and systemic symptoms. […] Even though we cant cure it, we can certainly treat it. Id like you to think of people in terms of the eyes, the mouth and the systemic manifestations, and if you take that approach, I think you will rarely miss anything that needs your attention. What you choose depends on severity, whether they have had complications, and on the internal organs involved. We now have some clinical practice guidelines to help us deal with some of these problems, and more guidelines, fortunately, are on the way.

• #77 Sjogren syndrome: Symptoms, Causes, and Treatment – DermNet

  https://dermnetnz.org/topics/sjoegren-syndrome

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