YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==SJOGREN'S SYNDROME== 9 AUTHOR Hecht A TITLE How Sjogren's syndrome makes the body a desert SOURCE Pharm. Times; VOL 56 ISS Jan 1990, P60-63, (REF ) ABSTRACT IPA COPYRIGHT: ASHP The symptoms of dry eyes and dry mouth, onset, groups at risk, association with connective tissue diseases, other symptoms such as nasal dryness and research into Sjogren's syndrome are discussed. Treatments for the symptoms including artificial tears, saline sprays, saliva substitutes and vaginal lubricants available over-the-counter are listed. 13 AUTHOR Alexander EL AUTHOR Malinow K AUTHOR Lejewski JE AUTHOR Jerdan MS AUTHOR Alexander GE AUTHOR et al TITLE Primary Sjogren's syndrome with central nervous system disease mimicking multiple sclerosis SOURCE Ann. Intern. Med.; VOL 104 ISS Mar 1986, P323-330, (REF 53) ABSTRACT IPA COPYRIGHT: ASHP The features of 20 patients (aged 26-61 yr) with primary Sjogren's syndrome and central nervous system involvement whose neurologic findings, evoked abnormalities, and cerebrospinal fluid profiles resembled those of multiple sclerosis were presented; therapy with 40-60 mg prednisone a day showed an improvement or stabilization of neurologic function. 16 AUTHOR Talal N TITLE How to recognize and treat Sjogren's syndrome SOURCE Drug Therapy; VOL 14 ISS Feb 1984, P48-49, 52-54, (REF ) ABSTRACT IPA COPYRIGHT: ASHP The differential diagnosis and management of Sjogren's syndrome and its associated connective tissue diseases are discussed, including symptomatic treatment and the use of corticosteroids or immunosuppressive drugs such as cyclophosphamide in patients with severe complications. 3 AUTHOR Fox RI AUTHOR Saito I TITLE Sjogren's syndrome: immunologic and neuroendocrine mechanisms. SOURCE Adv Exp Med Biol; VOL 350, 1994, P609-21 (REF: 49) ABSTRACT SS patients are characterized by decreased volume of lacrimal and salivary secretions. The dryness results from a combination of destroyed glandular elements as well as by interference with the neuro-endocrine innervation of the residual glands. Specific genetic factors (i.e. HLA class II alleles) have been associated with increased risk of SS in Caucasian (US), Chinese and Japanese populations. However, different class II MHC alleles are risk factors in each population. The environmental factors that precipitate SS remain unknown. Future understanding of the mechanisms of destruction of the salivary and lacrimal glands may provide a more rationale approach to therapy. 10 AUTHOR Atkinson JC AUTHOR Wu AJ TITLE Salivary gland dysfunction: causes, symptoms, treatment. SOURCE J Am Dent Assoc; VOL 125, ISS 4, 1994, P409-16 (REF: 62) ABSTRACT The three most common known causes of salivary gland dysfunction are medication usage, radiation therapy and Sjogren's syndrome. Current therapeutic options to treat salivary dysfunction are limited. Clinical considerations as well as the outlook for individuals experiencing salivary dysfunction are discussed. 1 AUTHOR Fox RI AUTHOR Dixon R AUTHOR Guarrasi V AUTHOR Krubel S TITLE Treatment of primary Sjogren's syndrome with hydroxychloroquine: a retrospective, open-label study. SOURCE Lupus; VOL 5 Suppl 1, 1996, PS31-6 ABSTRACT OBJECTIVES: To determine whether patients with primary Sjogren's syndrome (SS), diagnosed according to San Diego criteria, had improvement in their laboratory or clinical features during treatment with hydroxychloroquine (6-7 mg/kg/day) for at least two years. METHODS: The study population included 50 consecutive patients with primary SS who were diagnosed according to San Diego criteria, and in whom hydroxychloroquine was suggested as treatment. This group included 10 patients who were early dropouts (side effects or desire not to take antimalarial drugs) and 40 patients who received drugs for at least two years (range 24-48 months). In a subset of SS patients, values for ESR (westergren) and quantitative immunoglobulins were available for comparison. Improvement with therapy was defined as: (a) > or = 20% improvement in variables of tear flow (Schirmer's test I) or corneal integrity (rose Bengal): (b) > or = 20% salivary function (flow rate); and (c) improvement in at least two of the following measures: physicians assessment of global disease activity by > or = 20%, patient assessment of improvement in pain or fatigue by > or = 20%, and ESR improved by > or = 20 mm/hr. RESULTS: In a retrospective study of SS patients who completed the trial, a significant improvement was noted in ocular symptoms (pain and dryness) in patients (55 and 57%) and improved corneal integrity (rose Bengal straining) in 53% of patients. The Schirmer's test was improved by > or = 2 mm/5 minutes in 50% in patients. Improvement was noted in oral symptoms (pain and dryness) in patients (57 and 60%) and salivary flow rate was increased in 82% of patients. In a subset of SS patients evaluated, the ESR improved by > or = 20 mm/hr in 17/32 patients (53%) and quantitative IgG level by > or = 20% in 8/13 patients (61%). Physician global assessment of overall patient status and patient assessment of overall status indicated improvement in over 62% of patients. CONCLUSION: In a retrospective study of patients fulfilling San Diego Criteria for SS, we found: (a) sustained improvement of local symptoms (painful eyes, painful mouth) and improvement of systemic manifestations (arthralgias and myalgias) after treatment with hydroxychloroquine 6-7 mg/kg/day over mean three-year follow-up; (b) laboratory analysis showed a significant improvement in their ESR and their quantitative IgG levels; (c) no significant late toxicity was observed in this study cohort. A prospective study of hydroxychloroquine in patients fulfilling San Diego criteria for SS is indicated. 9 AUTHOR Kruize AA AUTHOR Hene RJ AUTHOR Kallenberg CG AUTHOR van Bijsterveld OP AUTHOR van der Heide A AUTHOR Kater L AUTHOR Bijlsma JW TITLE Hydroxychloroquine treatment for primary Sjogren's syndrome: a two year double blind crossover trial. SOURCE Ann Rheum Dis; VOL 52, ISS 5, 1993, P360-4 ABSTRACT OBJECTIVES--In 1985 and 1988 a positive effect of treatment of primary Sjogren's syndrome with hydroxychloroquine was reported in two small open studies. To investigate further the clinical and laboratory effects of hydroxychloroquine in primary Sjogren's syndrome a two year study was performed. METHODS--The design of the study included a prospective, placebo controlled, two year double blind crossover trial in 19 patients. RESULTS--A significant decrease in IgG and IgM and a tendency for a decrease in the erythrocyte sedimentation rate (ESR) during treatment with hydroxychloroquine compared with treatment with placebo were found. No beneficial clinical effect of the use of hydroxychloroquine as expressed in preference for treatment with hydroxychloroquine or placebo with regard to symptoms and signs of primary Sjogren's syndrome could be shown, however, nor any relevant change in tear gland activity and sequelae of peripheral tear function deficiency, nor salivary gland scintigraphy. CONCLUSIONS--The use of hydroxychloroquine at a dose of 400 mg daily taken over a 12 month period does not have a worthwhile clinical benefit in patients with primary Sjogren's syndrome despite an improvement of hyperglobulinaemia and slight changes in the ESR and IgM. 8 AUTHOR Power WJ AUTHOR Mullaney P AUTHOR Farrell M AUTHOR Collum LM TITLE Effect of topical cyclosporin A on conjunctival T cells in patients with secondary Sjogren's syndrome. SOURCE Cornea; VOL 12, ISS 6, 1993, P507-11 ABSTRACT The effect of topical cyclosporin A on conjunctival T cells was studied in nine patients with secondary Sjogren's disease. Patients had conjunctival biopsies performed before and after a 6-week course of topical cyclosporin. Epithelium and substantia propria in the Sjogren's patients before treatment showed significantly more CD4+ cells than specimens taken from nine age- and sex-matched controls. Following treatment with topical cyclosporin, there was a significant reduction in the number of CD4+ cells in both the conjunctival epithelium and substantia propria. Despite the fact that the treatment resulted in immunopathological improvement, the clinical benefit was not as favorable. Our results suggest that topical cyclosporin may have a local immunosuppressive effect on the conjunctiva in patients with Sjogren's disease. 24 AUTHOR Drosos AA AUTHOR Moutsopoulos NM TITLE [Effectiveness and safety of using cyclosporin A in the treatment of primary Sjogren's syndrome] SOURCE Ter Arkh; VOL 60, ISS 4, 1988, P77-80 ABSTRACT We used oral cyclosporine-A (CyA) (5 mg/kg/day) initially in a double blind study for 6 mos. 10 patients received CyA and 10 placebo. At the end of this study it was observed that CyA improved subjective xerostomia, while subjective xerophthalmia, parotid gland enlargement, Schirmer-I-test and parotid flow rate did not show any significant differences in the two study groups. 9 of 10 patients who had received CyA for 6 mos and 9 of 10 in the placebo group continued in an open trial (CyA at the same dose) for an additional 6 mos. At the end of the study the only efficacy of CyA observed was improvement of subjective xerostomia. The side-effects observed were hypertrichosis (14 persons), mild hypertension (4), infections (5) and 3 dropped out because of nausea, tremor, paresthesias and infections. In conclusion, small doses of CyA for 12 mos are rather ineffective for Sjogren's syndrome. 10 AUTHOR Fox PC AUTHOR Datiles M AUTHOR Atkinson JC AUTHOR Macynski AA AUTHOR Scott J AUTHOR Fletcher D AUTHOR Valdez IH AUTHOR Kurrasch RH AUTHOR Delapenha R AUTHOR Jackson W TITLE Prednisone and piroxicam for treatment of primary Sjogren's syndrome. SOURCE Clin Exp Rheumatol; VOL 11, ISS 2, 1993, P149-56 ABSTRACT Primary Sjogren's syndrome is a systemic autoimmune exocrinopathy characterized by a lymphoplasmacytic infiltrate and destruction of salivary and lacrimal glandular tissues. There is no widely accepted or effective systemic therapy for this disorder. The purpose of this 6-month randomized, double-blinded, placebo-controlled study was to examine the effects of prednisone (30 mg, alternate days), piroxicam (20 mg, daily), or placebo on the salivary, lacrimal and immunologic alterations of primary Sjogren's syndrome. Eight patients were enrolled in each group. Salivary and lacrimal function were assessed at entry and at the completion of treatment. Labial minor salivary gland tissue was obtained at these times and examined for intensity of infiltration (focus scores) and for the relative proportion of glandular elements. Serologic and subjective evaluations were done as well, and patients were monitored for therapy-related side effects. Neither active treatment led to significant improvement in salivary or lacrimal function, although prednisone improved salivary flow in selected patients and was associated with positive subjective responses. Prednisone also significantly decreased the serum total protein, IgG, IgA, and sedimentation rate and increased the white cell count. There were no significant alterations in either focus scores or the percentage of glandular component tissues of minor glands with either active treatment. This study demonstrated that 6 months of prednisone or piroxicam at the doses utilized failed to improve the histological or functional parameters of salivary and lacrimal glands in primary Sjogren's syndrome. 22 AUTHOR Ichikawa Y AUTHOR Tokunaga M AUTHOR Shimizu H AUTHOR Moriuchi J AUTHOR Takaya M AUTHOR Arimori S TITLE Clinical trial of ambroxol (Mucosolvan) in Sjogren's syndrome. SOURCE Tokai J Exp Clin Med; VOL 13, ISS 3, 1988, P165-9 ABSTRACT A clinical trial is described in which twelve patients with Sjogren's Syndrome (SS) were given a dose of 135 mg ambroxol (Mucosolvan) daily for eight weeks. Nine of the patients completed the trial. Three patients dropped out because they developed side effects (generalized rashes in two patients and stomatitis in one). The side effects, however, were mild and cleared off after cessation of treatment. Ambroxol improved sicca symptoms, especially ocular symptoms, in the SS patients, although lacrimal and salivary gland functions measured by Schirmer test or gum test were not changed. Furthermore, the treatment did not alter any chemical findings determined in the stimulated tear and saliva. Our results suggest that ambroxol is useful for the management of sicca symptoms in some patients with SS. 25 AUTHOR Vasil'ev VI AUTHOR Simonova MV AUTHOR Safonova TN AUTHOR Mach ES TITLE [Comparative evaluation of the treatment of Sjogren's syndrome with anti-rheumatic preparations] SOURCE Ter Arkh; VOL 60, ISS 4, 1988, P67-72 ABSTRACT The paper is devoted to comparative assessment of combined therapy of prednisolone, chlorambucil, chloroquine phosphate and ibuprofen at small doses and its effect on clinicolaboratory signs of Sjogren's disease in 80 patients in the course of 1 and 5 years. Patients of the control group received only local therapy of the parotid glands. The results have demonstrated that combined therapy at small doses of prednisolone and chlorambucil (5 mg + 4 mg) is an effective method of treatment of the stomatological, ophthalmological and articular manifestations of SD and is also capable of preventing the systemic signs of disease. Combined therapy with chloroquine phosphate and ibuprofen neither influenced the clinicolaboratory signs of disease nor prevented disease progression with the development of systemic signs of diseases of various degrees. Disease progression was observed in 80% of patients receiving no basic drugs or receiving chloroquine phosphate+ibuprofen while in groups of patients receiving small doses of prednisolone and chloambucil disease progression was observed in 20% only.