Rheumatic diseases are painful conditions usually caused by inflammation, swelling, and pain in the joints or muscles.
Some rheumatic diseases like osteoarthritis are the result of "wear and tear" to the joints. Other rheumatic diseases, such as rheumatoid arthritis, happen when the immune system becomes hyperactive; the immune system attacks the linings of joints, causing joint pain, swelling, and destruction.
Almost any joint can be affected in rheumatic disease. There are more than 100 rheumatic diseases but we'll focus on some of the common types.
  Osteoarthritis is a condition caused by the breakdown of the cartilage that surrounds and protects the ends of the bones in the hip joints. Not only does the cartilage around the joints act as a shock absorber, but it also prevents the bones from crushing other bones and causing pain. It is the most common form of arthritis, affecting approximately 16 million Americans. Osteoarthritis is also referred to as degenerative joint disease. Osteoarthritis is not just limited to the hip, but can also appear in the knees, hands and other weight-bearing joints.
Symptoms of osteoarthritis typically develop before age 45 in men and after 55 in women, though it is more common for people over the age of 65. In addition to osteoarthritis of the hip, men can develop it in their knees and spine, and women can develop osteoarthritis in their hands and knees.
 
What causes the pain?
Osteoarthritis is caused by both primary and secondary factors. Primary osteoarthritis is linked to old age when the cartilage begins to break down due to daily use of the joint. Secondary osteoarthritis, however, is caused by physical factors such as congenital defects and obesity. Some other factors that may cause osteoarthritis are bow legs, a dislocated hip, genetic defects to the cartilage, overuse or injury to the joint, and diabetes and other hormone disorders.
  Arthritis is a general term that describes inflammation in joints. Inflammation is characterized by redness, warmth, swelling, and pain in the joint.
Rheumatoid arthritis is a type of chronic (ongoing) arthritis that occurs in joints on both sides of the body (such as both hands, wrists, and/or knees). This symmetric multiple joint involvement helps distinguish rheumatoid arthritis from other types of arthritis.
In addition to affecting the joints, rheumatoid arthritis may occasionally affect organs outside of the joints including the skin, eyes, lungs, heart, blood, nerves, or kidneys.
 
What are the symptoms of rheumatoid arthritis?

• Joint pain
• Joint swelling
• Stiffness – especially in the morning or after sitting for long periods
• Fatigue – best defined as tiredness and excessive sleepiness

How does rheumatoid arthritis affect people?
Rheumatoid arthritis affects each individual differently. In most people, joint symptoms may develop gradually over several years. In other people, rheumatoid arthritis may progress rapidly. Other people may have rheumatoid arthritis for a limited period of time and then enter a remission (a time with no symptoms).
 
Who is affected by rheumatoid arthritis?
Rheumatoid arthritis affects more than 1% of the United States population. It is three to five times more common in women than men. It usually occurs between the ages of 20 to 50; however, young children and the elderly can also develop rheumatoid arthritis.
 
What causes rheumatoid arthritis?
The exact cause of rheumatoid arthritis is unknown. However, it is believed to be caused by a combination of genetic factors, abnormal immunity, environmental factors, and hormonal factors.
Normally, the immune system protects the body from disease. In rheumatoid arthritis, something triggers the immune system to attack the joints and sometimes other organs. Some theories suggest that a virus or bacteria may alter the immune system, causing it to attack the joints. Some people have a genetic or inherited factor that makes them more likely to develop rheumatoid arthritis.
 
What are the results of joint inflammation?
Once the immune system is triggered, cells migrate from the blood into the joints and produce substances that cause inflammation.
The increased number of cells and inflammatory substances within the joint cause:

• Irritation/disruption
• Wearing down of cartilage (cushions at the end of bones)
• Swelling of the joint lining (synovium)
• Production of fluid in the diseased joint lining (synovial fluid)

As the cartilage wears down, the space between the bones narrows. If the condition worsens in the late stage, the bones could rub against each other just like what is seen in osteoarthritis (degeneration) in the elderly.
As the joint lining grows, it may invade or erode into the bone, resulting in irreversible damage to the bone. All of these factors cause the joint to become very painful, tender, swollen and warm to touch.
 
How is rheumatoid arthritis diagnosed?
The diagnosis of rheumatoid arthritis is based on a combination of factors, including:

• The specific location and symmetry of painful joints
• The presence of joint stiffness in the morning
• Presence of bumps/nodules under the skin (rheumatoid nodules)
• Results of x-ray tests that suggest rheumatoid arthritis
• Positive results of a blood test called the rheumatoid factor
  • Approximately 70% of people with rheumatoid arthritis have the rheumatoid factor antibody in their blood. The rheumatoid factor may be present in 5% of people who do not have rheumatoid arthritis. Other diseases can also cause the rheumatoid factor to be produced in the blood. A test called CCP antibody can sometimes help to determine whether the rheumatoid factor antibody is due to rheumatoid arthritis or some other disease. That is why the diagnosis of rheumatoid arthritis is based on a combination of several factors and NOT just the presence of the rheumatoid factor in the blood.

How is rheumatoid arthritis treated?
There are many different ways to treat rheumatoid arthritis. Treatments include medications, rest and exercise, physical therapy/occupational therapy, and surgery to correct damage to the joint.
The type of treatment prescribed will depend on several factors including the person’s age, overall health, medical history and severity of the arthritis.
Medications
There are many medications available to decrease joint pain, swelling and inflammation and hopefully prevent or minimize the progression of the disease. These medications include:

• Non-steroidal anti-inflammatory drugs (NSAIDs – such as aspirin, ibuprofen or naproxen)
• Corticosteroids (oral and injectable forms)
• COX-2 inhibitors (celecoxib)
• Disease-modifying anti-rheumatic drugs (DMARDs)* such as hydroxychloroquine, methotrexate, sulfasalazine, cyclophosphamide, and leflunomide
• Biologic agents (such as infliximab, etanercept, adalimumab, anakinra, rituxamab, abatacept, certolizumab and golimumab)

*Some of these medications are traditionally used to treat other conditions such as cancer, inflammatory bowel disease, malaria, and organ transplant rejection. When these drugs are used to treat rheumatoid arthritis, the doses are significantly lower and the risks of side effects tend to be considerably less than when these drugs are used to treat cancer or other conditions.
When you are prescribed any medication, it is important to meet with your physician regularly so he or she can detect the development of any side effects.
 
Rest and exercise
A balance of rest and exercise is important in treating rheumatoid arthritis. During flare-ups (worsening of joint inflammation), it is best to rest the joints that are inflamed. This may be accomplished by the temporary use of a cane or joint splints.
When joint inflammation is decreased, guided exercise programs are necessary to maintain flexibility of the joints and to strengthen the muscles that surround the joints. Range-of-motion exercises should be done regularly to maintain joint mobility. Physical therapy and occupational therapy have also been found to be helpful.
 
Surgery
When bone damage from the arthritis has become severe or pain is not controlled with medications, surgery is an option to restore function to a damaged joint.
 
Is there hope for people with rheumatoid arthritis?
Yes. Although there is not yet a cure for rheumatoid arthritis, there are many effective methods available for decreasing the pain and inflammation, and slowing down the disease process. Early diagnosis and effective treatment is of great importance.
Extensive research is in progress to determine the cause of rheumatoid arthritis and the best method of treatment.
  Systemic lupus erythematosus (lupus) is a disease of the immune system. Normally, the immune system protects the body from infection. However, in lupus, the immune system inappropriately attacks tissues in various parts of the body. This abnormal activity of the immune system leads to tissue damage and illness.
 
Who is affected by lupus?
Lupus can affect men and women of any race or age. One in 2,000 people in the United States has lupus. People of African, Asian and Native American descent are more likely to develop lupus than Caucasians.
If only women of childbearing age (14 to 45 years old) are considered, as many as 1 in 250 may develop lupus. This suggests a possible role for female hormones influencing vulnerability to this disease.
Areas of the body which may be affected during the course of lupus are shown in this drawing. The blood may also be affected.
 
What problems may lupus patients develop?
Many patients with active lupus feel poorly in general and complain of fever, weight loss and tiredness. Patients with lupus also develop specific problems when the immune system attacks a particular organ(s) or area(s) in the body.
Specific areas of the body that may be affected during the course of lupus are illustrated at the right. The blood may also be affected during the course of lupus, resulting in low red blood cell count (anemia), low white blood cell count and low platelet count.
 
Skin
Skin problems are a common feature of lupus. Some patients with lupus have a red rash over their cheeks and the bridge of their nose. Because the location of this rash is the same as the common markings of a wolf, the name "lupus" (wolf in Latin) was given to this disease many years ago.
Other skin problems that occur include large red, circular rashes (plaques), which may scar (called discoid lupus). Skin rashes are usually aggravated by sunlight.
Hair loss and mouth sores are also common.
 
Joints
Arthritis is very common in people who have lupus. There may be pain, with or without swelling. Stiffness and pain may be especially evident in the morning. Arthritis may be a problem for only a few days to weeks or may be a permanent feature of the disease. Fortunately, arthritis is usually not crippling.
 
Kidneys
Kidney involvement in people with lupus is potentially life threatening and may occur in up to half of lupus patients. Kidney problems may become apparent when lupus patients feel ill with arthritis, have a rash, fever and weight loss. Less often, kidney disease may occur when there are no other symptoms of lupus. Kidney disease itself usually does not produce symptoms until it is in the advanced stages. It is important that kidney disease be diagnosed early and treated appropriately. The earliest signs of kidney disease are apparent from a urinalysis.
 
Blood
Blood involvement can occur with or without other symptoms. Patients may have dangerous reductions in the number of red blood cells, white blood cells or platelets (cells that help clot the blood).
Sometimes changes in blood counts may contribute to symptoms of fatigue (low red blood cell count, anemia), serious infections (low white blood cell count), or easy bruising (low platelet count). However, many patients do not have symptoms that indicate blood abnormalities, so it is important for lupus patients to have periodic blood tests in order to detect any problems.
Blood clots are seen with increased frequency in lupus. Clots often occur in the legs (a vein clot, called deep venous thrombosis), lungs (a lung clot, called pulmonary embolus), or brain (stroke). Blood clots that develop in lupus patients may be associated with the production of antiphospholipid antibodies. These antibodies are abnormal proteins that may increase the tendency of the blood to clot.
 
Brain
Brain involvement is fortunately a rare problem in people with lupus. When present, it may cause confusion, depression, seizures and rarely strokes.
 
Heart and lungs
Heart and lung involvement is often caused by inflammation of the covering of the heart (pericardium) and lungs (pleura). When these structures become inflamed, patients may develop chest pain, irregular heartbeat and accumulation of fluid around the lungs (pleuritis or pleurisy) and heart (pericarditis).
 
What causes lupus?
The cause of systemic lupus erythematosus (SLE or lupus) is unknown. Finding the cause is the object of major research efforts.
Factors that may contribute to the cause of lupus include viruses, environmental chemicals and the person's genetic makeup.
Female hormones are believed to play a role in the development of lupus because women are affected more commonly than men. This is especially true of women during their reproductive years, a time when hormone levels are highest.
The observation that lupus may affect more than one member of the same family has raised the possibility that the tendency to develop lupus may be inherited. Having such a tendency, however, does not predict that a relative will develop lupus. About 10 percent of lupus patients have a close relative with lupus.
 
How is lupus diagnosed?
The diagnosis of lupus is best made by an experienced clinician who fully understands the disease and other diseases with similar features that can mimic lupus. The diagnosis is made when a patient has several features of the disease (including symptoms, findings on examination and blood test abnormalities). The American College of Rheumatology has devised criteria to assist clinicians in making the correct diagnosis of lupus.
 
Does a positive ANA test mean that I have lupus?
Not necessarily. The antinuclear antibody (ANA) test is positive in most patients with lupus, but it may also be positive in many people who do not have lupus. Therefore, a positive ANA test alone is not adequate for the diagnosis of lupus -- there must be at least three additional clinical features for the diagnosis to be made.
 
How is lupus treated?
The type of treatment prescribed will depend on several factors, including the person's age, type of medications he or she is taking, overall health, medical history and location and severity of disease.
Because lupus is a condition that can change over time and is not always predictable, a critical part of good care includes periodic visits with a knowledgeable, available physician.
Some patients with mild features of the disease do not require treatment, while patients with serious involvement (such as kidney complications) may require the use of powerful medications. Medications used to treat lupus include:

• Steroids or prednisone and related derivatives of cortisone. Steroid creams can be directly applied to rashes. The use of creams is usually safe and effective, especially for mild rashes. The use of steroid creams or pills in low doses can be effective for mild or moderate features of lupus. Steroids can also be used in higher doses when internal organs are threatened. Unfortunately, high doses are also most likely to produce side effects.
• Hydroxychloroquine (Plaquenil) is commonly used to help keep mild lupus-related problems, such as skin and joint disease, under control.
• Cyclophosphamide (Cytoxan) is a chemotherapy drug that has very powerful effects on reducing the activity of the immune system. It is used to treat severe forms of lupus.
• Azathioprine (Imuran) is a medication originally used to prevent rejection of transplanted organs. It is commonly used to treat the more serious features of lupus.
• Methotrexate (Rheumatrex) is another chemotherapy medication used to suppress the immune system. Its use is becoming increasingly popular for skin disease, arthritis, and other non-life threatening forms of disease that have not responded to medications such as hydroxychloroquine or low doses of prednisone.

  Spondyloarthritides are a group of arthritic diseases that share several common features. They can cause inflammation of the spine; however, other joints may be affected. The tendon and ligament tissue near the spine or joint is also involved. A high percentage of people with these diseases share a similar gene called HLA B27. Finally, many patients also have inflamed areas in the eye, bowel, genital tract or skin.

• The spondyloarthritides include:
• Ankylosing spondylitis
• Psoriatic arthritis
• Reactive arthritis/Reiter's syndrome
• Enteropathic arthritis
• Undifferentiated: Patients with features of more than one disease who do not fit in the defined categories above

 Ankylosing spondylitis (AS)
AS is a chronic, systemic, inflammatory disease of the joints and ligaments of the spine. Other joints may be involved. This typically results in pain and stiffness in the spine. The disease may be mild to severe. The bones of the spine may fuse over time causing a rigid spine.
Early diagnosis and treatment may help control the symptoms and reduce debility and deformity.
 
Who gets AS?
The onset is typically in late adolescence to early adulthood. It is rare for AS to begin after age 45. The disease is more common in men and in Caucasians. The incidence is 1 in 1000 persons. About 90% of people with AS have the HLA B27 gene.
 
What causes AS?
The cause of AS is unknown although there appears to be some genetic component. AS is associated with the HLA B27 gene but it is unclear why. The gene is seen in about 8% of normal Caucasians. There are no known infectious or environmental causes.
 
What are the signs and symptoms?
Early on, there is pain and stiffness in the buttocks and low back due to sacroiliac joint involvement. Over time, the symptoms can progress up the spine to involve the low back, chest and neck. Ultimately, the bones may fuse together causing limited range of motion of the spine and limiting one's mobility. Shoulders, hips and sometimes other joints may be involved. AS may affect tendons and ligaments. For example, the heel may be involved with Achilles tendonitis and plantar fasciitis. Since it is a systemic disease, patients can get fever and fatigue, eye or bowel inflammation, and rarely, there can be heart or lung involvement. AS is typically non life threatening. Usually, it is a slowly progressive disease. Most people are able to work and function normally.
 
How is AS diagnosed?
The diagnosis is typically suspected by the doctor based on the signs and symptoms. The doctor will take a thorough history and do a physical examination. X-rays, especially those of the sacroiliac joints and spine can be confirmatory. The HLA B27 gene may be checked by a blood test, but its presence or absence does not ultimately confirm or reject the diagnosis.
 
How is AS treated?
At this time there is no known curative treatment. Goals of treatment are to reduce pain and stiffness, slow progression of disease, prevent deformity, maintain posture and preserve function. Exercise programs are an essential part of the treatment. Patients may be referred for a formal physical therapy program. Patients with AS are given daily exercises for stretching and strengthening, deep breathing exercises and posture exercises to avoid stooping and slumping.
Medications are also used to treat AS. Non-steroidal anti-inflammatory drugs (NSAIDs) are traditionally used to control symptoms. Steroids, such as cortisone or prednisone, are rarely used, except for with injections to a tendon or joint. Sometimes, medications that are normally used for rheumatoid arthritis, such as sulfasalazine or methotrexate, may be used. These appear to be less helpful for the spine disease. More recently, the biologic anti-TNF-a agents etanercept
(Enbrel®), adalimumab (Humira®), and infliximab (Remicade®) have been approved for use in AS. These drugs may not only help symptoms but also slow the progression of the disease. They are only given as IV's in the doctor's office or by self-administered shots at home.
Surgical options are limited. There are no specific surgical interventions for the spine. Sometimes, in severe cases, replacement of the shoulder or hip joint is beneficial.
 
Reactive arthritis (ReA)
Reactive arthritis is a non-infectious inflammation of one or several joints. It may be self-limited, relapsing or chronic. The condition sometimes follows an infection of the gastrointestinal or genitourinary system. There may be other non-joint features such as eye, genital tract, bowel or skin inflammation. The term Reiter's Syndrome is an older term that most rheumatologists have now replaced with Reactive Arthritis. Reiter's Syndrome was a term originally used to refer to a syndrome of non-infectious eye, genital and joint inflammation following a previous bowel or genital bacterial infection. All of these features are rarely seen together.
 
Who gets reactive arthritis?
ReA may follow an infection of the genital tract or bowel, but this is not always identified. It is more common in men and Caucasians. ReA is rare after the age of 50. The disease is associated with the HLA B27 gene in 50 - 80% of patients.
 
What causes reactive arthritis?
The cause of ReA is unknown. It is associated with the HLA B27 gene, but it is unclear why. It is also unclear why ReA is sometimes associated with infection. (Bacterial infections of genital tract with Chlamydia or gastrointestinal tract with Shigella, Salmonella, or Campylobacter).
 
What are the signs and symptoms of reactive arthritis?
ReA may follow several weeks after a genital tract or bowel infection.
The patient may have acute swelling, pain and redness in one or more joints. Typically, it is more common in the lower extremity joints.
During the joint symptoms, one may also have non-infectious genital tract, skin or eye inflammation. ReA patients may have tendonitis, especially of the heel. There may be spine involvement (like ankylosing spondylitis). Traditionally, ReA is self-limited to 3 to 12 months, but up to 50% may have relapsing or chronic disease. The disease is not life threatening, and most people are able to work and function normally.
 
How is reactive arthritis diagnosed?
The diagnosis is typically made by a doctor taking a thorough history and physical examination. A swollen joint may be aspirated to rule out an infection or gout. There is no specific test for the diagnosis of ReA. The HLA B27 gene may be checked by blood test in selected cases, but it is not diagnostic.
 
How is reactive arthritis treated?
At this time, there is no curative treatment. Any existing infection, if discovered, should be treated. The role of routine antibiotics is controversial. Physical therapy, stretching and exercise are prescribed. Non-steroidal anti-inflammatory drugs (NSAIDs) are given for pain and stiffness. Steroid injections to involved tendons or joints can help relieve pain and inflammation. In chronic or relapsing cases, similar treatments to rheumatoid arthritis can be considered to include methotrexate, sulfasalazine and the biologic anti-TNF-a drugs (as listed for AS).
 
Enteropathic arthritis
Enteropathic arthritis is peripheral joint or spine disease associated with inflammatory bowel disease (IBD), such as Crohn's Disease or Ulcerative Colitis.
 
Who gets enteropathic arthritis?
Enteropathic arthritis is seen in up to 10 - 20% of those with IBD. It is more common in juveniles and young adults. The male to female ratio is equal.
 
What causes enteropathic arthritis?
The cause is unknown.
 
What are the signs and symptoms of enteropathic arthritis?
The arthritis typically occurs after the bowel disease is well established. Rarely, the arthritis can start before IBD is diagnosed. There is pain and swelling in one or more joints. Typically, the arthritis occurs in the lower extremity joints. The arthritis may mirror the activity of the bowel disease. There may also be spine involvement (like ankylosing spondylitis). The HLA B27 gene is seen in up to 50% with spine involvement. The spondylitis (spine involvement) is less likely to correlate with the bowel disease activity. Patients may have other systemic symptoms such as fever, skin or eye inflammation, and oral ulcers. Enteropathic arthritis rarely causes joint destruction, deformity or significant disability.
 
How is enteropathic arthritis treated?
Like the other spondyloarthropathies, the patient needs physical therapy and exercise. Treatment of the bowel disease may help the peripheral joints but not the spine. Removing the colon (colectomy) in ulcerative colitis may "cure" the arthritis. One can use non-steroidal anti-inflammatory drugs (NSAIDs), but there is a need to be aware of the bowel effects. Local injection of steroids into joint(s) can be very helpful. Oral steroids can be used in more severe cases. In resistant cases, medications normally used to treat rheumatoid arthritis, such as methotrexate, azathioprine (Imuran®) or sulfasalazine can be tried for the joints. Anti-TNF-a drugs, like adalimumab (Humira®) and infliximab (Remicade®) have shown benefit with joint and bowel disease.
  Sjögren’s syndrome is a chronic disorder that causes insufficient moisture production in certain glands of the body.
Sjögren’s syndrome occurs when a person’s normally protective immune system attacks and destroys moisture-producing glands, including salivary (saliva-producing) glands and lacrimal (tear-producing) glands. The lungs, bowel and other organs are less often affected by Sjögren’s syndrome.
Sjögren’s syndrome is named after the Swedish eye doctor, Henrik Sjogren, who first described the condition.
Sjögren’s syndrome is characterized by dry eyes and mouth. In some patients, the parotid glands may become visibly enlarged.
 
What are the symptoms of Sjögren’s syndrome?

• Extremely dry eyes causing:
  • feeling of grit or sand in the eyes
  • Burning
  • Redness
• Extremely dry mouth and throat causing:
  • difficulty chewing and swallowing
  • decreased sense of taste
  • difficulty speaking
  • increase in dental cavities
  • dry cough or hoarseness

• Enlarged parotid glands (located at the angle of jaw) and sometimes infection of the parotid glands
• Excessive fatigue
• Aches and pains in muscles and joints

Less common features of Sjögren’s syndrome are:

• Irritation of the nerves in the arms, hands, legs or feet (neuropathy)
• Thyroid gland abnormalities
• Skin rashes
• Memory loss or confusion
• Feeling of numbness or tingling
•     Gastrointestinal problems
•     Inflammation of the lungs, kidneys, liver or pancreas
•     Cancer of the lymphatic tissue (occurs in up to 5% of patients with the disease)

 
What causes Sjögren’s syndrome?
Normally, the immune system (the body’s defense system) protects the body from infection and foreign substances such as bacteria and viruses.
In autoimmune diseases such as Sjögren’s syndrome, the immune system triggers an inflammatory response when there are no foreign substances to fight off. This inflammatory response causes the body’s white blood cells to attack and destroy certain moisture-producing glands.
The exact cause for the abnormal immune response in Sjögren’s syndrome is unknown. Some theories suggest that a virus or bacteria may alter the immune system, causing it to attack the glands. Certain people may have a genetic or inherited factor that makes them more likely to develop Sjögren’s syndrome.
 
What are the forms of the disease?
Sjögren’s syndrome occurs in two basic forms:
Primary Sjögren’s syndrome – the disease by itself, not associated with any other illness
Secondary Sjögren’s syndrome – disease that develops in the presence of another autoimmune disease such as rheumatoid arthritis, systemic lupus erythematosus or vasculitis
 
Who is affected by the disease?
More than one million people in the United States have Sjögren’s syndrome. Over 90% of people affected by Sjögren’s syndrome are women. The disease can affect people of any race or age.
 
How is primary Sjögren’s syndrome diagnosed?
The diagnosis of Sjögren’s syndrome is based on several factors, including:

• Presence of dry eyes and mouth
  • Dry eyes can be detected by an ophthalmologist (eye doctor) by measuring tear production or carefully examining the cornea (clear part of the eye).
• Certain laboratory tests also suggest that dry eyes and mouth are caused by autoimmune mechanisms
  • Examples include the presence of autoantibodies in the blood, known as anti-SSA or anti-SSB (also known as anti-Ro or anti-La).
• Biopsy of the inner lip (performed in some cases to prove the diagnosis of primary Sjögren’s syndrome). The biopsy may show the inflammation that is damaging the salivary glands.

How is secondary Sjögren’s syndrome diagnosed?
Secondary Sjögren’s syndrome is generally diagnosed when someone with an established autoimmune disease such as rheumatoid arthritis or systemic lupus erythematosus develops extreme dryness of the eyes and mouth. This diagnosis only rarely requires a lip biopsy.
 
Can other problems mimic Sjögren’s syndrome?
The use of certain medications such as tricyclic anti-depressants and antihistamines can mimic the symptoms of Sjögren’s syndrome. Radiation treatments to the head and neck and other autoimmune disorders can also cause severely dry eyes and mouth.
 
How is Sjögren’s syndrome treated?
There is no cure for Sjögren’s syndrome, but it can be treated and controlled. The goals of treatment are to decrease discomfort and reduce the harmful effects of dryness. The type of treatment prescribed will be tailored to each patient’s symptoms and needs.
 
Good oral hygiene
Good mouth care may not prevent a dry mouth, but it helps prevent infection. Toothpastes and oral gels are available for people with dry mouth symptoms. These products contain low doses of peroxide (high amounts could make dryness worse). These products may also have antibacterial action to reduce the severity of dental cavities over a long period of time.
 
Increasing eye moisture
Dry eyes are mainly treated with the use of artificial tears, and a wide variety of products are available. Artificial tears must be used regularly and more often in dry environmental conditions such as on airplanes, in air-conditioned buildings and on windy days.
While artificial tears are helpful, they often do not last long enough. Thicker preparations are available that last longer. These are often used at bedtime because they can sometimes cause blurry vision.
Surgery to slow the disappearance of tears is another treatment option when artificial tears are not sufficient.
 
Medications
Medications that tend to deplete body fluids should be avoided.
Mild pain-relieving medications (analgesics) including acetaminophen (such as Tylenol®) or nonsteroidal anti-inflammatory drugs (NSAIDs, such as Motrin® and Aleve®) can reduce muscle or joint pain.
In some patients, the anti-rheumatic drug, hydroxychloroquine, has been beneficial in decreasing pain and salivary gland swelling.
For patients with generalized symptoms, particularly when the disease affects internal organs (including the gastrointestinal system, kidneys or nervous system), high doses of immunosuppressive medications may be necessary. These include medicines such as prednisone (a steroid) and rarely, chemotherapy-type medications.
Balance of rest and exercise
Guided exercise programs can help patients overcome fatigue, maintain flexibility and overcome joint and muscle pain.