Sjogren's Disease

Management of Sjogren's disease focuses on controlling symptoms and at the same time calming the immune attack. There is really no outright cure yet, but we aim to improve the quality of life and at the same time try to prevent complications.

For the dryness, we use a lot of supportive measures for dry eyes. For example, patients use artificial tears or lubricating eye drops frequently. There are even prescription eye drops, like the one containing different concentration of cyclosporine that reduce eye inflammation and help you produce more tears.

For the dry mouth, we encourage staying hydrated, chewing sugar-free gums and lozenges to stimulate with the goal of stimulating saliva basically. And we have medications like pilocarpine or cevimeline that can stimulate the salivary glands to produce more saliva. Good oral hygiene and regular dentist visits would be super important here obviously, also dry mouth can be quite rough on the teeth, as highlighted in the case of Jane. So we try to prevent cavities early on with fluoride treatments.

Now, beyond moisture replacement, we often use immunomodulatory therapies such as hydroxychloroquine, a famous drug. It's actually a malaria drug, but it is also immune system-altering, it has autoimmune or immune system-altering properties. It can help with fatigue. It can help with joint pain, rashes. With this drug is it's sort of like tamps down the overactive immune system, if you will. It's not a miracle drug I have to highlight here, but many patients do benefit from it. Indeed, if a patient has more severe disease, let's say lung involvement or kidney inflammation, then we might use stronger immunosuppressants, and those could include drugs like methotrexate, azathioprine, sometimes with steroids, corticosteroids like prednisone.

And in certain cases, we even use biological therapies such as, for example, rituximab, especially if the disease is affecting organs in a serious manner or causing a lot of systemic problems.

Overall, what's working best these days is a personalized combination approach. We address the dryness with local treatments and lifestyle changes, and at the same time address the immune system activity or overactivity with immune-altering medications if needed. And overall, I would say that by tailoring the treatment to each patient's particular set of symptoms and problems, we can usually get patients to feel reasonably better. It's all about managing Sjogren’s as a marathon, really, rather than a sprint. It's through ongoing care, monitoring and adjusting treatment as we go.

I think, without any doubt, Sjogren’s demands a team effort. In our clinic, the rheumatologist, that is me, might be coordinating the care, and as we rely on other providers, with other specialties.

So an ophthalmologist, for example, is crucial for the management of dry-eye symptoms, but also for other aspects of the care, checking for damage of the cornea, for example. Ophthalmologists can prescribe special treatments like the medicated drops or even procedures like the punctal plugs. And these are the little plugs in the tear duct that help keep the tears in your eyes longer.

We also involve the patient's dentist, as they do help patients combat dry mouth, treat fungal infections of the mouth, and generally save as many teeth as possible.

We also work closely with an ENT physician, that's an ear, nose and throat specialist, and what they do is they actually help us quite a bit with a lip biopsy to confirm the diagnosis, but also to manage enlarged salivary glands and chronic sinus issues of dryness.

If the patient has, let's say, lung involvement, the pulmonologist or lung specialist would be consulted here. The same case, if you have kidney involvement, you bring in a nephrologist. Neuropathies or nervous system involvement would sometimes require consulting with a neurologist. So we all collaborate with other specialists in order to optimize patient's care.

And then finally, I should highlight that mental care can be an important aspect. This is a chronic illness that can be tough emotionally on the patients. So sometimes psychologists and counselors can be quite helpful and contribute to patients' care. So yes, it's truly multidisciplinary approach, as each specialist addresses a different piece of the puzzle, and together, we can try to improve care and cover all the bases basically.