Management of Sjögren's Syndrome

General Treatment Approach

The American College of Rheumatology recommends a multidisciplinary approach to managing Sjögren's syndrome, starting with topical therapies for dryness symptoms, followed by muscarinic agents for patients with residual glandular function, and targeted treatments for systemic manifestations based on the specific severity of each organ involved 1, 2, 3
The treatment should be coordinated by specialists in autoimmune diseases, with a shared decision-making approach between the patient and specialist 2
It is essential to clearly distinguish between the treatment of dryness symptoms and systemic disease 1, 3
Regular assessment of disease activity using the ESSDAI index is crucial for guiding therapeutic decisions 4

The European League Against Rheumatism recommends the use of artificial tears with methylcellulose or hyaluronate at least twice a day as first-line treatment for dry eyes 2, 3
For persistent cases, ocular gels and ointments, especially for nighttime use, are recommended 2
For refractory cases, autologous serum drops and topical immunosuppressants may be considered 2, 3
For mild salivary gland dysfunction, non-pharmacological stimulation (sugar-free gum, frequent water sips) is recommended 2, 3
For moderate dysfunction with residual glandular function, muscarinic agents like pilocarpina may be used 2, 3
For severe dysfunction without salivary production, saliva substitutes are recommended 2, 3
Rigorous oral hygiene is essential to prevent infections and caries 3

The American College of Rheumatology recommends evaluating concomitant conditions that may contribute to fatigue or pain 2, 3
For musculoskeletal pain, analgesics should be used according to the severity of pain, following the WHO analgesic ladder 3
Glucocorticoids at moderate doses for short-term use may be considered for acute pain 3
A sequential therapeutic approach should be used, starting with glucocorticoids, followed by immunosuppressive agents, and finally biologic therapies for severe and refractory disease 4, 2
For pulmonary disease, a short course of systemic steroids, bronchodilators, and/or corticosteroids may be used 3
For interstitial lung disease, systemic corticosteroids at 0.5-1.0 mg/kg as first-line treatment, with micofenolato mofetil or azatioprina as steroid-sparing agents 3

The American College of Rheumatology recommends avoiding prolonged use of glucocorticoids without adequate steroid-sparing strategies 2, 3
Smoking cessation should be strongly recommended for all patients with Sjögren's syndrome 3
Influenza and pneumococcal vaccination should be ensured 3
Potential side effects of immunosuppressive medications should be monitored 3