Sjögren's Syndrome

Home Treatment

Sjögren's syndrome is a disease that causes dry eyes and dry mouth. The following steps and treatments can be very helpful in relieving your symptoms and improving the quality of your life. Also, getting plenty of rest, eating well, and doing mild exercise daily play an important role in successful home treatment of this condition.

Eyes

• Use artificial teardrops throughout the day. Artificial tears come in different formulas, so if one type does not help, try another. Try to use preservative-free drops, which are less irritating to the eyes. Artificial tears are available in single-dose packets, which help to avoid bacterial contamination.
• Use lubricating ointments at night. Lubricants are thicker and last longer than artificial tears, so there is less burning, dryness, and itching when you wake up in the morning. Be aware that nighttime lubricants may temporarily blur your vision when you first apply them.
• Avoid medicines that are known to cause dry eyes, such as antidepressants, antihistamines, and diuretics.
• Protect your eyes from wind, breeze, and drafts.
• Avoid smoke.
• Keep eye makeup away from your eyes.
• Use wraparound sunglasses to better protect your eyes from the sun, wind, and grit.

Mouth

• Drink fluids throughout the day to keep your mouth moist. Keep water by your bedside at night. But be aware that drinking large amounts of water does not reduce mouth dryness and causes excessive urination during the night. Try drinking small sips of water and rinsing your mouth frequently. Sucking on ice chips can also help.
• Use artificial saliva substitutes (mouthwash or spray), which coat the mouth.
• Avoid medicines that are known to cause a dry mouth, such as antidepressants, antihistamines, and diuretics.
• Brush your teeth twice a day and after meals with fluoride toothpaste, and floss your teeth every day.
• Make frequent visits to the dentist to prevent and treat tooth decay.
• Use antifungal medicines to treat thrush, a yeast infection that develops in the mouth.
• Use sugar-free gum or candies such as lemon drops that naturally stimulate saliva production. (Sugar can increase your risk for cavities and yeast infections.)

Skin

• Use moisturizing skin creams or ointments throughout the day.
• Shower instead of taking a bath. Use only moisturizing soaps.
• After showering, pat excess water off, leaving the skin moist. Then, replenish the moisture in your skin by applying a skin cream or ointment.
• Your skin may be extra-sensitive to the sun. Avoid the midday sun, from about 10 a.m. to 4 p.m. Cover your skin when you are outside—for example, wear long pants and long sleeves and wide-brimmed hats—and use SPF 30 or stronger sunscreen. Many experts recommend using sunscreen with SPF 50. For more information, see the Prevention section of the topic Sunburn.

Respiratory tract

• Place a humidifier (and an air purifier, if you feel it helps) in your home and at work to increase your comfort.
• Use nasal spray made of water and salt (saline) to help a dry nose or nasal congestion.

Vagina

It is common for women with Sjögren's syndrome to experience vaginal dryness and painful intercourse.

Vaginal moisturizing products help to replenish natural moisture and relieve discomfort. These products include:

• Replens, a nonhormonal vaginal moisturizer that lasts for hours or even days.
• K-Y Silk-e.
• Vagisil Personal Moisturizer.

Vaginal lubricants can make intercourse more comfortable for you by relieving the friction you might experience if you have vaginal dryness. But vaginal lubricants do not add moisture to the vagina and are not useful for everyday moisturizing. Look for a water-based lubricant instead of an oil-based lubricant, which can interfere with the vagina's natural cleansing process. Vaginal lubricants include:

• Astroglide.
• Wet Lubricant Gel.
• K-Y Jelly.
• Maxilube.
• Surgilube.

Stomach

• Take a nonprescription antacid or acid reducer, such as Pepcid AC or Zantac 75, when needed, to reduce heartburn.
• Raise the head of your bed 6 inches to reduce the backflow (reflux) of stomach acid into your esophagus when you sleep.
• See your doctor if you have heartburn or reflux that does not respond to self-care.

Energy (reducing fatigue)

• Listen to your body. Alternate rest with exercise. Gradually doing more exercise may help lower your fatigue.
• Limit medicines that might make you feel sleepy, such as those used to treat anxiety, colds, or pain. But do not stop or change your medicine usage before talking with your doctor.
• Don't skip meals, especially breakfast. Improving your diet may increase your energy level.
• Reduce your use of caffeine, nicotine, and alcohol, which tend to contribute to fatigue.
• Cut back on watching television, and instead spend time with friends, try new activities, or travel to break the fatigue cycle.
• Get a good night's sleep. This may significantly reduce fatigue.

Your fatigue may be related to another health problem. Sjögren's syndrome may increase your risk of thyroid problems (hypothyroidism or hyperthyroidism) and depression. Effective treatments for these health problems are available. You should see your doctor if you feel persistent fatigue.

Comfort (relieving inflammation and pain)

• Try daily gentle exercise—swimming in a warm pool may be good if your joints ache—and get plenty of rest every night to relieve aches.
• Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, can help reduce mild swelling and pain. See a doctor for severe swelling and pain in the glands, joints, and muscles, which may require a different medicine or further evaluation.

Medication safety

Several types of medications can cause dryness or allergic reactions and can make your symptoms worse. Talk to your doctor if you are taking any of the following medicines, but continue to take them unless advised to stop by your doctor:

• Antihistamines
• Bladder medicines that are not antibiotics
• Muscle spasm medicines
• Blood pressure medicines
• Antidepressants
• Decongestants
• Diuretics
• Heart medicines
• Parkinson's disease medicines

Other treatments that may help

More research is needed to determine the benefits and risks of these alternative treatments for Sjögren's syndrome.

• Acupuncture. Some studies suggest that acupuncture might offer some improvement in dry eyes and dry mouth symptoms.¹
• Evening primrose. The oil of the evening primrose is a source of omega-3 fatty acids, whose mild anti-inflammatory properties may relieve the symptoms of dry eyes and dry mouth.

Before using any treatment for your symptoms, consider the risks and benefits. If you decide to use an alternative medicine or supplement, follow these precautions.

• Talk with your doctor before taking an alternative medicine or supplement, especially if you are pregnant or trying to become pregnant, take prescription medicines, or have another health problem.
• As with all conventional medicines and supplements, it is important to follow the directions on the label.
• Do not exceed the maximum recommended dose.

For more information on alternative medicines and supplements, see the topic Complementary Medicine.

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Author:	Shannon Erstad, MBA/MPH	Last Updated: May 6, 2008
Medical Review:	Martin Gabica, MD - Family Medicine Stanford M. Shoor, MD - Rheumatology
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