Embarrassing Illnesses

The two main goals of treatment are to help replicate or compensate for the reduced activities of your tear and saliva glands.

Eye care

Artificial tears

Mild to moderate cases of dry eye can normally be successfully treated with eye drops that contain 'artificial tears' - a liquid designed to mimic the properties of tears. These eye drops are available from a pharmacist without prescription.

There are many different types of eye drops so you can try a different type if your original choice proves ineffective.

A short-term dose of eye drops containing corticosteroids may be recommended if you experience a particularly severe episode of irritation and inflammation of the eyes. But their long-term use is not recommended as they can cause serious side effects.

Moisture chamber spectacles

Some cases of dry eye can be treated through the use of specialised equipment. This includes specially made glasses known as moisture chamber spectacles. These wrap around the eyes much like goggles and help retain moisture and protect the eyes from irritants.

Moisture chamber spectacles used to be unpopular as they had a strange looking design and people were embarrassed to wear them. Now they are becoming a more popular treatment option as the modern designs look like sports sunglasses.

Surgery

If your dry eyes fail to respond to other forms of treatment, surgery may be an option.

One widely used technique is known as punctual occlusion, and involves using small plugs to seal the tear ducts into which the tears drain. This should help keep the eye better protected by tears. Temporary plugs made of silicone are normally used first to see if the surgery has a positive effect. If it does, more permanent plugs can be used to replace the silicone plugs.

Mouth care

Self-care techniques

There are a number of self-care techniques that you can use to keep your mouth lubricated and to deal with any associated symptoms. These are listed below.

• It is important to maintain a rigorous and meticulous oral hygiene regime to help prevent tooth decay and gum disease. See the 'prevention' section for more information.
• Increase your fluid intake.
• Many people find that using sugar-free chewing gum helps stimulate the production of saliva.
• Sucking ice cubes can help lubricate the mouth and reduce unpleasant feelings of dryness.
• If you are a smoker you should give up. Smoke both irritates the mouth and increases the rate at which saliva evaporates.
• Regular use of mouth rinses can help soothe the mouth and protect against infection.

Saliva substitutes

There are a number of products that can help replicate the lubricating function of saliva. However, they do not replicate the role saliva plays in preventing infection so you will still need to maintain excellent oral hygiene.

These products are usually available as a spray, in lozenge form or in gel or gum form. Your GP or pharmacist will be able to advise which product is most suitable for you.

Medicines for Sjogren's syndrome

Pilocarpine

The medicine pilocarpine is often used to help treat the symptoms of dry eyes and mouth. Pilocarpine works by stimulating the tear and saliva glands to produce more saliva and tears.

Side effects of pilocarpine include:

• excessive
• sweating,
• nausea,
• diarrhoea,
• heartburn,
• abdominal pain,
• headaches,
• dizziness, and
• an increased need to go to the toilet.

Less common side effects include:

• vomiting,
• palpitations,
• high blood pressure, and
• blurred vision.

For some people, the side effects are mild. Others find that the disadvantages of the side effects outweigh the benefits of pilocarpine.

Hydroxychloroquine

You may also be recommended to take a medicine called hydroxychloroquine. Hydroxychloroquine has been shown to slow the immune system's attack on the exocrine glands. It can also help reduce any associated symptoms of muscle and joint pain and stiffness.

You will need to take hydroxychloroquine for several weeks before you notice any improvements and it could be six months before you experience the full benefit of the treatment.

Side effects are uncommon and, if experienced, usually mild. They include:

• headache,
• nausea,
• skin rash,
• itching,
• loss of appetite,
• stomach cramps, and
• vomiting.

Very rarely, hydroxychloroquine can damage the retina, leading to impairment in vision. You will probably be asked to attend an eye examination so the state of your retina can be checked before you commence treatment. Regular eye examinations are also recommended after you begin treatment; usually once every year.

Hydroxychloroquine should not be used by pregnant and breastfeeding women.

Treating other symptoms of Sjogren's syndrome

Dry skin

There are a number of specially designed soaps and creams designed for people with dry skin. Your pharmacist or GP will be able to advise you.

Vaginal dryness

The symptoms of vaginal dryness can be treated using a lubricant, such as KY Jelly.

Muscle and joint pains

Muscle and joint pains can be treated by taking the over-the-counter painkillers known as nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. If these prove ineffective, you should see your GP as stronger NSAIDs are available on prescription.

Ideally, you should take NSAIDs, either with food or shortly after eating. This will help minimise the risk of the medicine upsetting your stomach

Some people find swallowing NSAIDs difficult due to their symptoms of dry mouth. In these circumstances, NSAIDs are available in cream form which you can rub into any affected joints. Alternatively, NSAIDs are available as suppositories.