Sjogren Syndrome (cont.)
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Sjögren's Syndrome Medications
Drugs that increase saliva secretion: These can be used if topical therapy is not sufficient to treat dry mouth. Examples include pilocarpine (Salagen) and cevimeline (Evoxac). The most common adverse effect is increased sweating (in as many as 29%). Some studies suggest that interferon alpha may be useful therapy in the future.
Nonsteroidal anti-inflammatory drugs (NSAIDs): These agents reduce inflammation and mild to moderately severe pain. Examples are ibuprofen (Advil), naproxen (Naprosyn), and celecoxib (Celebrex). These agents should be used with caution if you have aspirin sensitivity or kidney disease. If you are older than 65 years of age, have ever had peptic ulcer disease, use steroids or blood thinners, smoke cigarettes, or drink alcohol, talk to your health-care provider about alternatives. Long-term use of these medications has been linked to a increased risk for myocardial infarctions.
Disease-modifying antirheumatic drugs: These drugs treat rheumatoid arthritis and other rheumatic conditions that do not get better with NSAIDs. Examples include hydroxychloroquine (Plaquenil), azathioprine (Imuran), and methotrexate (Rheumatrex). Newer biological agents are being studied for the treatment of Sjögren's syndrome.
Immunosuppressive drugs: These agents may be suitable for people with Sjögren's syndrome who develop a major organ manifestation such as interstitial lung disease. Examples include prednisone (cortisone), methotrexate, cyclophosphamide (Cytoxan), azathioprine (Imuran), and mycophenolate mofetil (CellCept). These medications have a number of different side effects that should be discussed carefully with your health-care provider. If you take one of these medications, you may have to have regular blood tests to monitor you for possible side effects.
Recent research studies suggest that rituximab (Rituxan) may be beneficial in certain forms of Sjögren's syndrome. Rituximab works by decreasing the number of B cells, which are specialized white blood cells that are involved in the pathophysiology of Sjögren's syndrome. Belimumab (Benlysta) is also showing promise in treatment of Sjögren's syndrome. It is also an intravenous medication used in systemic lupus erythematosus that affects activity of overactive immune-mediating cells.
Kanchan Pema, MD
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