26th February 2025

Management of Sjögren’s syndrome

Treatment depends on the patient’s symptoms. Artificial tears and saliva can be useful for xerophthalmia and xerostomia, as well as close contact with opticians and dentists. Advice regarding lubricants can be given for vaginal dryness. Regular pilocarpine can also help with sicca symptoms. 

Hydroxychloroquine is the most common DMARD (disease-modifying antirheumatic drug) used and can be particularly helpful for joint symptoms; evidence of other benefits is limited. With more severe features such as vasculitis or ILD, systemic immunosuppression may be required, such as glucocorticoids or cyclophosphamide.

Patients who are Ro or La positive should be carefully monitored during pregnancy due to the risk of development of foetal heart block. These patients will have regular ultrasounds throughout pregnancy to detect this at an early stage, in order to prepare for potential pacemaker insertion after birth. Babies born to Ro- or La-positive mothers can also exhibit a photosensitive skin rash due to passive transfer of antibodies across the placenta, called cutaneous neonatal lupus erythematosus.