Editing Sjögren's disease (section)

== Treatment ==

===Overview===
Treatment is directed at managing the person's [[symptomatic treatment|symptoms]].<ref name=NIH2014Fact/> For dry eyes, [[artificial tears]]; medications to reduce inflammation; [[punctal plugs]] or other surgery to shut the [[tear ducts]] may be tried.<ref name=NIH2014Fact/> For a dry mouth, [[chewing gum]] (preferably sugar-free); sipping water; or a [[saliva substitute]] may be used.<ref name=NIH2014Fact/> In those with joint or muscle pain, [[ibuprofen]] may be used.<ref name=NIH2014Fact/> Medications that can cause dryness, such as [[antihistamines]], may also be stopped.<ref name=NIH2014Fact/> The most specific extant diagnostic test requires lip biopsy.<ref>{{Cite journal |last1=Giovelli |first1=Raquel A |last2=Santos |first2=Maria CS |last3=Serrano |first3=Érica V |last4=Valim |first4=Valéria |date=2015-02-15 |title=Clinical characteristics and biopsy accuracy in suspected cases of Sjögren's disease referred to labial salivary gland biopsy |journal=BMC Musculoskelet Disord |volume=16 |pages=Article 30 |doi=10.1186/s12891-015-0482-9 |doi-access=free |pmc=4332430 }}</ref>

===Treatments===
Neither a cure nor a specific treatment for Sjögren's disease is known to permanently restore gland [[secretion]]. Instead, treatment is generally symptomatic and supportive.<ref>{{cite web |title=Sjogren syndrome: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/article/000456.htm |access-date=2022-11-18 |website=medlineplus.gov |language=en |archive-date=2024-07-19 |archive-url=https://web.archive.org/web/20240719114508/https://medlineplus.gov/ency/article/000456.htm |url-status=live }}</ref><ref>{{cite web |title=Sjogren's Syndrome |url=https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Sjogrens-Syndrome |access-date=2022-11-18 |website=www.rheumatology.org |archive-date=2024-07-19 |archive-url=https://web.archive.org/web/20240719114450/https://rheumatology.org/patients/sjogrens-disease |url-status=live }}</ref>

==== Eye care ====
Moisture replacement therapies such as [[artificial tears]] may ease the symptoms of dry eyes. Some patients with more severe problems use [[goggles]] to increase local [[humidity]] or have [[punctal plugs]] inserted to help retain tears on the [[ocular]] surface for a longer time.<ref>{{Cite web |date=2017-04-07 |title=Sjögren's Syndrome |url=https://www.niams.nih.gov/health-topics/sjogrens-syndrome |access-date=2024-03-11 |website=National Institute of Arthritis and Musculoskeletal and Skin Diseases |language=en |archive-date=2018-06-27 |archive-url=https://web.archive.org/web/20180627062443/https://www.niams.nih.gov/health-topics/sjogrens-syndrome |url-status=live }}</ref>

Additionally, [[cyclosporine]] (Restasis) is available by prescription to treat chronic dry eye by suppressing the inflammation that disrupts tear secretion. [[Prescription drug]]s are also available that help to stimulate salivary flow, such as [[cevimeline]] (Evoxac) and pilocarpine. [[Salagen]], a manufactured form of [[pilocarpine]], can be used to help produce tears, as well as saliva in the mouth and intestines.<ref>{{cite journal |last1=Vivino |first1=Frederick B. |title=The treatment of Sjögren's syndrome patients with Pilocarpine-tablets |journal=Scandinavian Journal of Rheumatology |date=2009 |volume=30 |issue=115 |pages=1–13 |doi=10.1080/030097401300232583 |pmid=11469515 |s2cid=21260961 }}</ref> It is derived from the [[Pilocarpus|jaborandi]] plant.<ref>{{cite journal |last1=de Abreu |first1=Ilka Nacif |title=Production of pilocarpine in callus of jaborandi (pilocarpus microphyllus stapf) |journal=In Vitro Cellular & Developmental Biology – Plant |date=2005 |volume=41 |issue=6 |pages=806–811 |doi=10.1079/IVP2005711 |s2cid=26058596 }}</ref><!-- .[17] [18] [19] -->

==== Vaginal dryness ====
In women with Sjögren's disease, [[vaginal dryness]], [[vulvodynia]] and [[dyspareunia]] (painful [[sexual intercourse]]) are often reported; [[personal lubricants]] are recommended to help lessen irritation or pain that may result from dryness in the vaginal and [[vulva]]l areas.<ref name="Fox, R. I 2005"/>

==== Musculoskeletal ====
[[Nonsteroidal anti-inflammatory drugs]] (NSAIDs) may be used to treat musculoskeletal symptoms. For individuals with severe [[Complication (medicine)|complications]], [[corticosteroids]] or [[immunosuppressive drugs]] may be prescribed, and sometimes [[IVIG|intravenous immunoglobulins]]. Also, [[disease-modifying antirheumatic drugs]]  such as [[methotrexate]] may be helpful. [[Hydroxychloroquine]] (Plaquenil) is another option and is generally considered safer than methotrexate. However, these prescribed drugs have a range of [[side effects]] such as [[nausea]], [[loss of appetite]], [[dizziness]], [[hair loss]], [[Abdominal pain|stomach aches/cramps]], [[headache]], [[liver toxicity]] and increased risk of [[infections]].{{cn|date=December 2024}}

==== Systemic ====
For systemic symptoms, including fatigue, joint pain, myositis, and [[neuropathy]], biologic [[immunosuppression|immunosuppressant]] drugs such as [[rituximab]] and [[belimumab]] that work via [[B-cell]] pathology are often used and have less toxic profiles than traditional immunosuppressive regimens.{{citation needed|date=October 2020}}

==== Dental care ====
[[Preventive healthcare|Preventive]] [[dentistry|dental]] treatment is also necessary (and often overlooked by the patient), as the lack of saliva associated with xerostomia creates an ideal environment for the [[Cell growth|proliferation]] of bacteria that cause [[dental caries|cavities]].<ref>{{cite journal | last1 = Xin | first1 = W | last2 = Leung | first2 = KC | last3 = Lo | first3 = EC | last4 = Mok | first4 = MY | last5 = Leung | first5 = MH | year = 2016| title = A randomized, double-blind, placebo-controlled clinical trial of fluoride varnish in preventing dental caries of Sjögren's disease patients | journal = BMC Oral Health | volume = 16 | issue = 1| page = 102 | doi = 10.1186/s12903-016-0296-7 | pmc = 5034648 | pmid = 27664129 | doi-access = free }}</ref> Treatments include at-home [[topical]] [[Fluoride therapy|fluoride application]] to strengthen tooth enamel and frequent teeth cleanings by a dental hygienist. Existing cavities must also be treated, as cavities that extend into the tooth cannot be effectively treated by teeth cleaning alone, and are at a high risk of spreading into the [[Pulp (tooth)|pulp of the tooth]], leading to the loss of vitality and need for extraction or [[root canal]] therapy. This treatment regimen is the same as for all xerostomia patients, such as for those undergoing head and neck radiation therapy, which often damages the salivary glands; these glands are more susceptible to radiation than other body tissues.{{citation needed|date=October 2020}}

====Fatigue====
Fatigue, depression, and aerobic capacity all showed a significant difference after a 12-week exercise program compared with controls, in favor of the exercise intervention.<ref>{{Cite journal |last1=Strömbeck |first1=B. E. |last2=Theander |first2=E. |last3=Jacobsson |first3=L. T. H. |date=May 2007 |title=Effects of exercise on aerobic capacity and fatigue in women with primary Sjogren's syndrome |url=https://pubmed.ncbi.nlm.nih.gov/17308315 |journal=Rheumatology |volume=46 |issue=5 |pages=868–871 |doi=10.1093/rheumatology/kem004 |issn=1462-0324 |pmid=17308315}}</ref> A small study showed possible efficacy of [[vagus nerve stimulation]] for Sjogren's [[fatigue]] reduction.<ref>{{cite journal |last1=Tarn |first1=Jessica |last2=Evans |first2=Evelyn |last3=Traianos |first3=Emmanuella |last4=Collins |first4=Alexis |last5=Stylianou |first5=Mryto |last6=Parikh |first6=Jehill |last7=Bai |first7=Yang |last8=Guan |first8=Yu |last9=Frith |first9=James |last10=Lendrem |first10=Dennis |last11=Macrae |first11=Victoria |last12=McKinnon |first12=Iain |last13=Simon |first13=Bruce S. |last14=Blake |first14=Justyna |last15=Baker |first15=Mark R. |last16=Taylor |first16=John Paul |last17=Watson |first17=Stuart |last18=Gallagher |first18=Peter |last19=Blamire |first19=Andrew |last20=Newton |first20=Julia |last21=Ng |first21=Wan-Fai |title=The Effects of Noninvasive Vagus Nerve Stimulation on Fatigue in Participants With Primary Sjögren's Syndrome |journal=Neuromodulation: Technology at the Neural Interface |date=1 April 2023 |volume=26 |issue=3 |pages=681–689 |doi=10.1016/j.neurom.2022.08.461 |pmid=37032583 |s2cid=253172246 |issn=1094-7159|doi-access=free }}</ref>