Does the thought of taking medications for Sjogren’s sometimes make you feel more overwhelmed than relieved?

Managing chronic illnesses like Sjogren's can be like learning to juggle a dozen balls while walking a tightrope! Balancing symptoms, medication schedules, potential side effects, long-term risks –– it’s all a part of this unpredictable disease.

I’m here to guide you, both as a doctor and a fellow patient on this Sjogren’s path. We’ll break down the different medications used to manage those pesky symptoms and, importantly, discuss ways to help keep yourself healthy along the way.

Your Sjogren's Medication Roadmap: A Peek Inside the Toolkit

From over-the-counter (OTC) remedies to prescription medications that help calm the immune system, there’s a wide array of options. Here's a peek at what's often used:

OTC: The Dryness Allies

Let's face it –– those classic Sjogren's symptoms of dry eyes and dry mouth can feel like sandpaper against your insides! Thankfully, these over-the-counter friends provide relief and help protect those precious tissues.

• Artificial Tears (Drops, Gels, Ointments): It’s like a moisturizing hug for those tired, scratchy eyes. Choosing the right form –– and using them as often as recommended by your doc –– can really make a difference! Opting for preservative-free eye drops is a MUST if you are using them more than a few times per day.
• Oral Moisturizers (Gels, Sprays, Lozenges): Don't let that sandpapery mouth get you down! Oral moisturizers can offer soothing hydration and help keep things feeling comfortable.
• Sugar-free Gum (Chewing for Comfort!): It might seem surprising, but that chomping action of chewing sugar-free gum stimulates saliva production and can help support the good microbes in our mouths. Talk about multi-tasking!

Prescription Medications: Guiding the Immune System:

• Hydroxychloroquine (Plaquenil): This DMARD (disease-modifying antirheumatic drug) is a bit like a traffic director for your immune system –– it helps calm things down, lessen inflammation, and it can prevent those painful Sjogren's flares.
  • Side Effects to Know: The good news? Hydroxychloroquine is generally safe for long-term use, but some potential side effects can include:
    • Vision changes: It’s important to see your eye doctor regularly while on this drug for early detection! Recommendations are to get a baseline screening within the first year of use and then ongoing monitoring yearly after 5 years of use. Certain risk factors may require more frequent monitoring.
    • Tummy troubles and skin rashes: While not super common, these can occur but often these symptoms improve with time or adjusting the regimen. It’s essential to let your doctor know if anything pops up so you can discuss next steps together.
• Methotrexate: Another DMARD, methotrexate works in different ways than hydroxychloroquine. It’s like giving your immune system a bit of a timeout by inhibiting an enzymer called dihydrofolate reductase (DHFR). This interupts DNA synthesis, repair and cell replication in immune system cells. Additionally, it promotes the accumulation of adenosine which helps modulate immune responses and reduce inflammation and affects other cell signaling including JAK-STAT and NF-kB pathways.
  • What to Watch Out For: Side effects can include:
    • Liver problems: Regular monitoring of liver enzymes and avoiding alcohol are important if you are on methotrexate. The risk is a bit higher for those with psorasis, diabetes and obesity too.
    • Tummy troubles: Nausea and vomiting are common but may be improved by using injections rather than pills.
    • Fatigue: The dreaded "Sjogren's fatigue" is enough. Let your doctor know if this side effect worsens! Often folate is prescribed along with methotrexate to help with this side effect.
    • Mouth sores: They can occur, and it's important to get any oral pain evaluated (dental issues are also more likely with Sjogren’s!).
    • Blood cell problems: Blood counts are also monitored to ensure levels of infection fighting white blood cells don’t drop too low.
• Corticosteroids (Like Prednisone): These powerful medications help tame intense immune system activity –– like bringing in the fire extinguisher for those bad flares!
  • Short-Term vs. Long-Term: They can be lifesavers short-term but those potential side effects can really sneak up on you. Some are:
    • Osteoporosis Risk: Prolonged corticosteroid use increases the risk of thinning bones, a big concern with Sjogren's. Regular bone density screenings, calcium and vitamin D supplementation, and a focus on weight-bearing exercise are your allies here!
    • Weight Gain: Diet and exercise help manage this but often it is really challenging due to effects on appetite.
    • Elevated blood pressure and blood sugar: Corticosteroids changes our body’s metabolism and fluid balance increasing both blood sugar and also blood pressure.
    • Mood Swings and Other Impacts: Those pesky corticosteroids don't just target inflammation –– they can impact our hormones and mood too. Always work closely with your doc, discuss changes you notice, and make sure to track any new symptoms.
• Rituximab: For my patients who have severe cases that aren’t responding to other medications, we might consider this treatment, which removes those “fighter” B-cells.
  • Potential Reactions & Risks: Rituximab can bring on an “infusion reaction” which is an immune system response to the treatment. Often this is improved with medications like antihistamines and corticosteroids. You also need to stay more vigilant because it could put you at higher risk for infections. Frequent handwashing, wearing masks as appropriate in crowds, and avoiding contact with anyone who's ill –– your immune system may need extra support while taking this one.

Living Your Best Life with Sjogren’s: It’s Not Just About Medication

I'll say it a thousand times to patients: living with a chronic illness isn't just about medication. Those day-to-day habits can either sabotage or support your Sjogren's journey!

• Those Doctor’s Visits Really Are Important: Keeping up with your checkups (especially those regular blood draws to assess how those organs are doing), listening to what your doctor suggests, and staying alert for potential changes, are your foundation.
• Embrace Healthy Habits: It's no secret, but moving your body, nourishing it with good food, getting enough rest – all these everyday choices will support you in surprising ways!

Sjogren’s, Side Effects & Me: Striking My Own Balance

Just like all my patients, I grapple with Sjogren's medications and their side effects! It’s why I'm constantly researching, staying updated, and striving to find ways to keep those annoying side effects (and long-term risks) at bay.

I tell patients this: when it comes to chronic illness, the most powerful relationship you'll ever build is the one with your doctor. Honest, open communication, detailed tracking of your symptoms –– all this is crucial! They will advocate for you and find a plan that allows you to thrive, despite the curves Sjogren's throws your way.

Let’s Chat About It – You’re Not Alone

The world of medications – and autoimmune diseases! – is vast and sometimes a bit scary, isn’t it? Do you have questions about Sjogren's treatments? Have you learned anything from your personal journey navigating these medications? Share your experiences, ask those questions you’ve been pondering. We learn so much from each other –– join the conversation!