Management of Sjögren's Syndrome Flare Symptoms

Management of Sicca Symptoms

The American College of Rheumatology recommends non-pharmacological stimulation with sugar-free gum and frequent sips of water for mild salivary gland dysfunction 1
For moderate salivary gland dysfunction, the European League Against Rheumatism suggests pharmacological stimulation with muscarinic agonists, such as pilocarpine or cevimeline, to increase salivary flow 1
The American College of Rheumatology recommends saliva substitution products for severe salivary gland dysfunction with no salivary output 4, 1
For ocular dryness, the American Academy of Ophthalmology recommends first-line therapy with artificial tears containing methylcellulose or hyaluronate at least twice daily 4
The American Academy of Ophthalmology suggests autologous serum eye drops for persistent symptoms of ocular dryness 4, 1

The American College of Rheumatology recommends evaluating for contributing conditions and using analgesics according to pain severity following the WHO pain ladder for fatigue and musculoskeletal pain 1, 2
The American College of Rheumatology suggests considering short-term moderate-dose glucocorticoids for acute pain 1

For small airway disease, the American Thoracic Society recommends complete pulmonary function testing to assess severity and high-resolution CT imaging with expiratory views 3, 5
The American Thoracic Society suggests a short course of systemic steroids and nebulized or inhaled bronchodilators and/or corticosteroids for physiological obstruction 5
For interstitial lung disease, the American Thoracic Society recommends first-line treatment with systemic corticosteroids and first-line maintenance with mycophenolate mofetil or azathioprine 6, 7
The American Thoracic Society suggests antifibrotic therapy with nintedanib as second-line maintenance for progressive fibrotic interstitial lung disease 7

The American College of Rheumatology recommends initial therapy with glucocorticoids at minimum effective dose and duration, and targeting specific organ manifestations using ESSDAI definitions 1, 2
The American College of Rheumatology suggests maintenance therapy with immunosuppressive agents, such as azathioprine or mycophenolate, as steroid-sparing options 1, 7
The American College of Rheumatology recommends B-cell targeted therapies, particularly rituximab, for refractory disease 1, 2

The American Thoracic Society recommends smoking cessation for all Sjögren's patients and vaccination against influenza and pneumococcal infection 5, 6
The American College of Rheumatology suggests avoiding common pitfalls, such as failing to distinguish between treatment of sicca symptoms versus systemic disease, and overlooking potential side effects of immunosuppressive medications 1, 6, 7