Current and potential treatments for primary Sjögren's syndrome

A precise definition of primary Sjögren's syndrome resting on 'revised' or 'international' criteria has been accepted by most experts. This is important because the symptoms of primary Sjögren's syndrome, namely, dryness, fatigue, and pain, are common in the population at large and can occur in the absence of autoimmune disease as a result of medication use, anxiety and depression, or normal aging. This widely accepted definition is particularly valuable as a tool for obtaining homogenous patient populations for trials of new therapeutic agents. In this review article, before discussing treatments for complications and current hopes about second-line drugs, we present an update on available treatments forthe symptomatic triad (dryness, fatigue, and diffuse pain) seen in autoimmune Sjögren's syndrome and in some cases of isolated sicca syndrome. These very bothersome and permanent symptoms have a negative effect on quality of life. The most recent data show that systemic cholinergic agonists (pilocarpine and cevimiline) are effective in the symptomatic treatment of dryness, that cyclosporine eye drops may relieve ocular symptoms, and that TNFalpha inhibitors may find a new indication in Sjögren's syndrome.