Sjögren’s Syndrome: Treating This Autoimmune Condition

Sjögren’s syndrome is an autoimmune condition that causes dry eyes, dry mouth, and sometimes other symptoms. The name of primary Sjögren’s syndrome was recently changed to Sjögren’s disease (SJD), with the intention of validating Sjögren’s as a disease. But many people are not yet aware of this change, so it’s common to see both “disease” and “syndrome” when you read about it.

The symptoms of Sjögren’s are different for everybody. In addition to dry eyes and mouth, some people may experience fatigue, joint pain, or body aches. Others may have more severe symptoms that are caused by inflammation of internal organs, including the lungs or brain. 

People who have Sjögren’s may or may not need treatment. In this article, we cover options for those who do. 

What medications treat Sjögren’s syndrome?

Since the symptoms of Sjögren’s are different for every person who has it, so is the treatment. There’s no one-size-fits-all approach, but you can manage most symptoms with lifestyle changes and medication. Together with your provider, you’ll develop a personalized treatment plan to help you feel better.

Treatments for dryness

Dry eyes and/or dry mouth (sicca symptoms) are the most common Sjögren’s symptoms. In fact, at least one of these symptoms must be present to diagnose Sjögren’s. Other symptoms include dry skin, dry cough, and vaginal dryness.

The recommended first course of treatment is to make lifestyle changes, since this often helps and costs little to nothing. Examples of these changes include:

• Avoiding long periods of computer or phone screen time without breaks, which can make dry eyes worse

• Placing a large bowl of water or a humidifier in the bedroom at night to moisten the air and help with both dry eyes and mouth

• Avoiding fans, which can make dry eyes worse

• Taking frequent sips of water (even if it’s not swallowed)

• Avoiding acidic liquids like coffee, citrus juices, and alcohol, which make dry mouth worse

• Stopping smoking to help with dry mouth

• Sucking on sugar-free candies or chewing sugar-free gum to stimulate the flow of saliva

• Reviewing your medication list to see if you are taking any medications that worsen dryness, like antihistamines

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Over-the-counter medications for sicca symptoms include:

• Eye drops: It’s important to read the labels of eye drops to find out how often to use them and when to replace the bottle. Eye drops with preservatives have a longer shelf life but can only be applied a few times a day, because the preservatives can irritate eyes. On the other hand, preservative-free (PF) eye drops can be used as often as needed, but the bottles need to be replaced more frequently (often every day). Without preservatives, bacteria can grow in the bottles and cause eye infections. 

• Eye gels or ointments: These medications can only be applied to eyes right before bedtime, since they can make it hard to see.

• Saliva substitutes: Medications like Biotene and Xylimelts can help moisten the inside of the mouth.

• Personal lubricants: These medications help address vaginal dryness.

There isn’t a brand of eye drop or saliva substitute that has been shown to be more effective than another. But it might take some time to find the brand that works best for you. 

Prescription medications for sicca symptoms include:

• Cevimeline (Evoxac) and pilocarpine (Salagen): These oral medications can help increase the production of tears and saliva. But some people may not be able to tolerate these medications due to side effects like sweating and nausea.

• Prescription eye drops like Restasis and Xiidra: If over-the-counter drops aren’t enough, your provider may recommend giving these treatments a try.

Treatments for other symptoms

For some people, Sjögren’s may cause symptoms other than dryness. These might include:

• Body and joint aches

• Fatigue

• Rash

• Shortness of breath 

• Severe confusion, headache, or weakness and numbness in parts of the body

• Burning and tingling of the skin (neuropathy)

• Swollen glands, especially around the sides of the face and neck

Treatment depends on the specific symptom(s), as well as a person’s other health conditions. Medications that tweak or turn off the parts of the immune system that are causing inflammation can be helpful. Examples include:

• Hydroxychloroquine (Plaquenil)

• Methotrexate

• Azathioprine (Imuran)

• Rituximab (Rituxan)

• Mycophenolate (Cellcept) or mycophenolic acid (Myfortic)

• Cyclophosphamide (Cytoxan)

• Intravenous immunoglobulin (IVIG)

It’s important to note that these medications are not FDA-approved to treat Sjögren’s disease. But small studies show that they may be safe and effective options for some people. Your provider can help you determine which medication may be right for you.

Are there any natural treatments or diets for Sjögren’s syndrome?

At this time, there are no specific diets or natural remedies to treat Sjögren’s disease. However, eating a healthy diet can help you feel your best. And limiting sugar or sticking to sugar-free products is also a good idea for people with dry mouth, because they’re at a greater risk of getting cavities.  

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Written by:

Samantha C. Shapiro, MD

Samantha Shapiro, MD, is a board-certified rheumatologist and internist with expertise in autoimmune and inflammatory conditions. She founded the division of rheumatology at Dell Medical School at The University of Texas at Austin.

Edited by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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