Sjögren's syndrome medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Pharmacologic medical therapies for [[dry eyes]], [[Xerostomia|dry mouth]], and other sicca symptom of Sjögren's syndrome are [[pilocarpine]], [[cevimeline]] and [[artificial tears]]. | |||
==Medical Therapy== | ==Medical Therapy== | ||
*Pharmacologic medical therapies for dry | *Pharmacologic medical therapies for [[dry eyes]], [[Xerostomia|dry mouth]], and other sicca symptom of Sjögren's syndrome include:<ref name="pmid18984418">{{cite journal |vauthors=Wu AJ |title=Optimizing dry mouth treatment for individuals with Sjögren's syndrome |journal=Rheum. Dis. Clin. North Am. |volume=34 |issue=4 |pages=1001–10, x |date=November 2008 |pmid=18984418 |doi=10.1016/j.rdc.2008.08.013 |url=}}</ref><ref name="pmid17714766">{{cite journal |vauthors=Thanou-Stavraki A, James JA |title=Primary Sjogren's syndrome: current and prospective therapies |journal=Semin. Arthritis Rheum. |volume=37 |issue=5 |pages=273–92 |date=April 2008 |pmid=17714766 |doi=10.1016/j.semarthrit.2007.06.002 |url=}}</ref><ref name="pmid22549247">{{cite journal |vauthors=Ramos-Casals M, Brito-Zerón P, Sisó-Almirall A, Bosch X, Tzioufas AG |title=Topical and systemic medications for the treatment of primary Sjögren's syndrome |journal=Nat Rev Rheumatol |volume=8 |issue=7 |pages=399–411 |date=May 2012 |pmid=22549247 |doi=10.1038/nrrheum.2012.53 |url=}}</ref><ref name="pmid22161442">{{cite journal |vauthors=Furness S, Worthington HV, Bryan G, Birchenough S, McMillan R |title=Interventions for the management of dry mouth: topical therapies |journal=Cochrane Database Syst Rev |volume= |issue=12 |pages=CD008934 |date=December 2011 |pmid=22161442 |doi=10.1002/14651858.CD008934.pub2 |url=}}</ref> | ||
**Preferred regimen (1): Pilocarpine 5 mg PO q8h | **Preferred regimen (1): [[Pilocarpine]] 5 mg PO q8h | ||
**Preferred regimen (2): Cevimeline 30 mg PO q8h | **Preferred regimen (2): [[Cevimeline]] 30 mg PO q8h | ||
**Preferred regimen (3): | **Preferred regimen (3): [[Artificial tears]] as needed | ||
*Pharmacologic medical therapies for organ-based disease and constitutional symptoms of Sjögren's syndrome include: | *Pharmacologic medical therapies for organ-based disease and constitutional symptoms of Sjögren's syndrome include:<ref name="pmid24801928">{{cite journal |vauthors=Nobeyama Y, Matsuzaki H, Nakagawa H |title=Annular erythema of Sjögren's syndrome treated successfully with low-dose cyclosporine |journal=J. Dermatol. |volume=41 |issue=5 |pages=463–4 |date=May 2014 |pmid=24801928 |doi=10.1111/1346-8138.12475 |url=}}</ref><ref name="pmid15953102">{{cite journal |vauthors=Yokota K, Shichinohe R, Hayasaka T |title=Topical tacrolimus in the treatment of annular erythema associated with Sjögren's syndrome |journal=Clin. Exp. Dermatol. |volume=30 |issue=4 |pages=450–1 |date=July 2005 |pmid=15953102 |doi=10.1111/j.1365-2230.2005.01803.x |url=}}</ref><ref name="pmid15028963">{{cite journal |vauthors=Ramos-Casals M, Anaya JM, García-Carrasco M, Rosas J, Bové A, Claver G, Diaz LA, Herrero C, Font J |title=Cutaneous vasculitis in primary Sjögren syndrome: classification and clinical significance of 52 patients |journal=Medicine (Baltimore) |volume=83 |issue=2 |pages=96–106 |date=March 2004 |pmid=15028963 |doi= |url=}}</ref><ref name="pmid24647977">{{cite journal |vauthors=Shahin AA, El-Agha S, El-Azkalany GS |title=The effect of leflunomide on the eye dryness in secondary Sjögren's syndrome associated with rheumatoid arthritis and in rheumatoid arthritis patients |journal=Clin. Rheumatol. |volume=33 |issue=7 |pages=925–30 |date=July 2014 |pmid=24647977 |doi=10.1007/s10067-014-2548-8 |url=}}</ref> | ||
**Preferred regimen (1): Hydroxychloroquine 200 mg PO q24h | **Preferred regimen (1): [[Hydroxychloroquine]] 200 mg PO q24h | ||
**Preferred regimen (2): Methotrexate 0.2 mg/kg weekly | **Preferred regimen (2): [[Methotrexate]] 0.2 mg/kg weekly | ||
**Preferred regimen (3): Leflunomide 20 mg/day | **Preferred regimen (3): [[Leflunomide]] 20 mg/day | ||
**Preferred regimen (4): Azathioprine 3 to 5 mg/kg once daily | **Preferred regimen (4): [[Azathioprine]] 3 to 5 mg/kg once daily | ||
**Preferred regimen (5): Sulfasalazine 30 mg PO q8h | **Preferred regimen (5): [[Sulfasalazine]] 30 mg PO q8h | ||
**Preferred regimen (6): Cyclosporine 5 mg/kg/day | **Preferred regimen (6): [[Cyclosporine]] 5 mg/kg/day | ||
**Preferred regimen (7): Cyclophosphamide 50-100 mg/m²/day | **Preferred regimen (7): [[Cyclophosphamide]] 50-100 mg/m²/day | ||
**Preferred regimen (8): Rituximab 375 mg/m2 once weekly for 4 doses | **Preferred regimen (8): [[Rituximab]] 375 mg/m2 once weekly for 4 doses | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Medicine]] | |||
[[Category:Immunology]] | [[Category:Immunology]] | ||
[[Category:Rheumatology]] | [[Category:Rheumatology]] | ||
[[Category:Up-To-Date]] | |||
Latest revision as of 00:12, 30 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]
Overview
Pharmacologic medical therapies for dry eyes, dry mouth, and other sicca symptom of Sjögren's syndrome are pilocarpine, cevimeline and artificial tears.
Medical Therapy
- Pharmacologic medical therapies for dry eyes, dry mouth, and other sicca symptom of Sjögren's syndrome include:[1][2][3][4]
- Preferred regimen (1): Pilocarpine 5 mg PO q8h
- Preferred regimen (2): Cevimeline 30 mg PO q8h
- Preferred regimen (3): Artificial tears as needed
- Pharmacologic medical therapies for organ-based disease and constitutional symptoms of Sjögren's syndrome include:[5][6][7][8]
- Preferred regimen (1): Hydroxychloroquine 200 mg PO q24h
- Preferred regimen (2): Methotrexate 0.2 mg/kg weekly
- Preferred regimen (3): Leflunomide 20 mg/day
- Preferred regimen (4): Azathioprine 3 to 5 mg/kg once daily
- Preferred regimen (5): Sulfasalazine 30 mg PO q8h
- Preferred regimen (6): Cyclosporine 5 mg/kg/day
- Preferred regimen (7): Cyclophosphamide 50-100 mg/m²/day
- Preferred regimen (8): Rituximab 375 mg/m2 once weekly for 4 doses
References
- ↑ Wu AJ (November 2008). "Optimizing dry mouth treatment for individuals with Sjögren's syndrome". Rheum. Dis. Clin. North Am. 34 (4): 1001–10, x. doi:10.1016/j.rdc.2008.08.013. PMID 18984418.
- ↑ Thanou-Stavraki A, James JA (April 2008). "Primary Sjogren's syndrome: current and prospective therapies". Semin. Arthritis Rheum. 37 (5): 273–92. doi:10.1016/j.semarthrit.2007.06.002. PMID 17714766.
- ↑ Ramos-Casals M, Brito-Zerón P, Sisó-Almirall A, Bosch X, Tzioufas AG (May 2012). "Topical and systemic medications for the treatment of primary Sjögren's syndrome". Nat Rev Rheumatol. 8 (7): 399–411. doi:10.1038/nrrheum.2012.53. PMID 22549247.
- ↑ Furness S, Worthington HV, Bryan G, Birchenough S, McMillan R (December 2011). "Interventions for the management of dry mouth: topical therapies". Cochrane Database Syst Rev (12): CD008934. doi:10.1002/14651858.CD008934.pub2. PMID 22161442.
- ↑ Nobeyama Y, Matsuzaki H, Nakagawa H (May 2014). "Annular erythema of Sjögren's syndrome treated successfully with low-dose cyclosporine". J. Dermatol. 41 (5): 463–4. doi:10.1111/1346-8138.12475. PMID 24801928.
- ↑ Yokota K, Shichinohe R, Hayasaka T (July 2005). "Topical tacrolimus in the treatment of annular erythema associated with Sjögren's syndrome". Clin. Exp. Dermatol. 30 (4): 450–1. doi:10.1111/j.1365-2230.2005.01803.x. PMID 15953102.
- ↑ Ramos-Casals M, Anaya JM, García-Carrasco M, Rosas J, Bové A, Claver G, Diaz LA, Herrero C, Font J (March 2004). "Cutaneous vasculitis in primary Sjögren syndrome: classification and clinical significance of 52 patients". Medicine (Baltimore). 83 (2): 96–106. PMID 15028963.
- ↑ Shahin AA, El-Agha S, El-Azkalany GS (July 2014). "The effect of leflunomide on the eye dryness in secondary Sjögren's syndrome associated with rheumatoid arthritis and in rheumatoid arthritis patients". Clin. Rheumatol. 33 (7): 925–30. doi:10.1007/s10067-014-2548-8. PMID 24647977.