For moderate joint pain, your doctor may prescribe an immunosuppressant. These medications work by curbing an overactive immune system, thereby decreasing inflammation. Your doctor may prescribe a mild medication first, such as hydroxychloroquine, sold as Plaquenil®.
This medication was originally formulated to prevent and treat malaria, but is now also classified as a disease-modifying antirheumatic drug, or DMARD, which means it treats the underlying disease rather than its symptoms. It’s used in people with Sjogren’s syndrome, rheumatoid arthritis, and lupus to relieve joint pain, fatigue, and rashes. It may take up to 12 weeks for you to notice the effects of hydroxychloroquine.
Hydroxychloroquine is safe, even for pregnant women with Sjogren’s syndrome. Rarely, it can accumulate in the retina, the tissue at the back of the eye that helps to create images to be processed by the brain. Deposits on the retina can lead to vision changes. If you’re taking hydroxychloroquine, it’s recommended that you have a vision test every 6 to 12 months to ensure your eyes are not affected.
If joint pain is severe and does not respond to hydroxychloroquine, your doctor may prescribe methotrexate. This medication is effective in treating joint inflammation in conditions such as rheumatoid arthritis. It is generally well tolerated but requires monitoring by your rheumatologist. Side effects may include liver damage. Unlike hydroxychloroquine, it should not be used by women who are pregnant or by women who are planning to get pregnant in the next few months.
If severe Sjogren’s syndrome affects other major organs, such as the lungs, brain, or kidneys, doctors may prescribe more powerful medications that suppress the immune response, including cyclophosphamide, rituximab, and azathioprine. Taking these medications requires close monitoring because of potential side effects, such as lowered numbers of blood cells, abnormalities in the kidneys and liver, and infections.