Pediatric Sjogren Syndrome Medication

Updated: Dec 10, 2015
  • Author: Eyal Muscal, MD, MS; Chief Editor: Lawrence K Jung, MD  more...
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Medication

Medication Summary

Primary Sjögren syndrome usually follows a benign course in adult patients, and conservative management is indicated. Therapeutic approaches may include increasing lubrication with artificial tears, stimulating salivary flow with sugar-free gum or lozenges, and using vaginal lubricants. Saliva substitutes (eg, carboxymethylcellulose) are not usually effective. Cholinergic agonists have been shown to help increase salivary secretion and are approved by the US Food and Drug Administration (FDA) for this use. The treatment of secondary Sjögren syndrome is determined by the severity of the overlapping autoimmune disorder and may include the use of additional agents, such as methotrexate, cyclophosphamide, rituximab, and mycophenolate.

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Cholinergic agonists

Class Summary

These agents stimulate salivary secretion.

Pilocarpine (Salagen)

Pilocarpine is a muscarinic M3 receptor agonist.

Cevimeline (Evoxac)

Cevimeline is a muscarinic M3 agonist. It has 40-fold less binding affinity to M2 receptors and therefore has the theoretical benefit of causing less stimulation of cardiac tissues. This agent has a longer duration of action than pilocarpine.

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Immunosuppressive agents

Class Summary

These agents are used to treat extraglandular disease (ie, interstitial pneumonitis, glomerulonephritis, polyarthritis, vasculitis, pseudolymphoma, neurologic manifestations).

Prednisone

Prednisone is a corticosteroid with salt-retention properties used for its potent anti-inflammatory effects.

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Nonsteroidal Anti-Inflammatory Drugs

Class Summary

The use of NSAIDs in Sjögren syndrome is similar to agents used for juvenile arthritis. These agents may be used to treat polyarthritis associated with Sjögren syndrome.

Ibuprofen (Motrin, Advil, Caldolor)

Ibuprofen is the drug of choice for patients with mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. It also has anti-inflammatory and antipyretic properties. Ibuprofen is available in 200-, 400-, 600-, and 800-mg doses.

Naproxen (Aleve, Naprosyn, Naprelan)

Naproxen is used for the relief of mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which is responsible for prostaglandin synthesis.

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Disease-Modifying Antirheumatic Drugs

Class Summary

These agents are used for polyarthritis not controlled with nonsteroidal anti-inflammatory drugs (NSAIDs). Methotrexate has been shown to be effective in managing polyarthritis. Other DMARDs, such as hydroxychloroquine, may be synergistic when coadministered with methotrexate.

Methotrexate (Trexall, Rheumatrex)

Methotrexate has an unknown mechanism of action in the treatment of inflammatory reactions (although it may involve adenosine receptors). The drug, which may affect immune function, ameliorates symptoms of inflammation (eg, pain, swelling, stiffness). Adjust the dose gradually to attain a satisfactory response.

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Antimalarial Agents

Class Summary

These agents may inhibit chemotaxis of eosinophils and the locomotion of neutrophils and may impair complement-dependent antigen-antibody reactions.

Hydroxychloroquine sulfate (Plaquenil)

The mechanism of action for this drug is unclear; in the treatment of inflammatory arthritis, the mechanism of action is unknown. Hydroxychloroquine sulfate may inhibit chemotaxis of eosinophils and the locomotion of neutrophils and impairs complement-dependent antigen-antibody reactions.

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