Sjögren’s Syndrome (SS) is a chronic, systemic autoimmune disorder where the immune system mistakenly attacks the body’s moisture-producing glands, primarily the lacrimal and salivary glands. This results in the characteristic symptoms of severe dryness, known as sicca. Beyond the classic dry eyes and dry mouth, SS is a multi-system disease that can cause inflammation and damage to organs like the lungs, kidneys, and nervous system. Managing Sjögren’s Syndrome demands a specialized, collaborative approach involving multiple medical disciplines.
The Primary Specialist: The Rheumatologist’s Role
The rheumatologist, specializing in inflammatory and autoimmune conditions, serves as the primary manager for a patient with Sjögren’s Syndrome. Their initial responsibility is confirming the diagnosis, which involves objective measures like blood tests for specific autoantibodies (anti-Ro/SS-A and anti-La/SS-B). They also assess glandular function using tests such as the Schirmer test or a minor salivary gland biopsy.
Once SS is confirmed, the focus shifts to managing the underlying systemic autoimmune response and preventing organ damage. Systemic control is achieved through medications aimed at modifying the disease course. First-line treatment involves disease-modifying anti-rheumatic drugs (DMARDs), such as hydroxychloroquine, to reduce inflammation and manage symptoms like joint pain and fatigue.
For severe systemic involvement affecting major organs or causing vasculitis, the rheumatologist may prescribe potent immunosuppressive agents or biologic therapies, such as rituximab. They continually monitor the patient for extraglandular disease progression or complications like B-cell non-Hodgkin lymphoma, which carries an increased risk in SS.
Addressing Localized Symptoms: Key Supporting Specialists
While the rheumatologist manages the systemic disease, various specialists address the severe localized symptoms that significantly impact a patient’s daily life. Ophthalmologists or optometrists are essential for managing the severe dry eye condition, known as keratoconjunctivitis sicca, to prevent corneal damage. Treatment often starts with prescription eye drops like cyclosporine or lifitegrast, which reduce inflammation on the eye’s surface.
For patients with severe dryness refractory to drops, the eye specialist may recommend procedures such as the insertion of punctal plugs to block tear drainage or prescribe autologous serum tears. Oral specialists, including dentists and oral medicine specialists, are equally important for managing dry mouth (xerostomia). Xerostomia can rapidly lead to severe dental decay and oral infections.
Oral specialists employ aggressive preventive strategies, including frequent cleanings and the application of topical fluoride or remineralizing agents to protect tooth enamel. They may also recommend prescription medications like pilocarpine or cevimeline, which stimulate the remaining salivary gland function. Depending on the extent of the disease, other specialists are brought in, such as a neurologist for peripheral neuropathy or a pulmonologist to manage potential interstitial lung disease.
Strategies for Coordinated Care
Effective Sjögren’s management depends heavily on seamless communication among the diverse group of healthcare providers. The Primary Care Physician (PCP) serves as the central coordinator for the patient’s overall health and facilitates referrals to the various specialists. The PCP is responsible for routine health maintenance, including screening for common comorbidities associated with SS, such as thyroid disorders.
The primary care doctor also manages non-specialty medications and carefully reviews the patient’s entire drug regimen. This review identifies any medications that could worsen dryness, such as those with anticholinergic properties. For the patient, clear communication is an active part of coordinated care, ensuring that the rheumatologist is aware of any localized treatments prescribed by the ophthalmologist and vice versa.
This integrated approach prevents conflicting treatments and ensures that all providers are working toward the same goal: minimizing symptoms and preventing disease complications.