Long-Term Effects of Medications for Sjögren's Syndrome: What to Know

Sjögren's syndrome

Hello, Doctor.
Last year, I was diagnosed with Sjögren's syndrome by a rheumatologist.
I am currently taking Hydroxychloroquine once a day, Aspirin once a day, Prednisolone twice a day, and Methotrexate twice a week.
I have been on these four medications for nearly two years.
Could you please advise me on the potential side effects of long-term use of these medications? The medication bag mentions that long-term use of Hydroxychloroquine requires regular retinal examinations, which seems concerning for my eyes, especially since I have myopia of about 800 degrees.
Additionally, what should I pay extra attention to in my daily life? I apologize for bothering you during your busy schedule! Thank you!

boy, 10~19 year old female. Ask Date: 2003/11/22

Dr. Zeng Guosen reply Internal Medicine

Hello! Long-term use of Bokey, prednisolone, MTX (methotrexate), and hydroxychloroquine for Sjögren's syndrome can lead to side effects, especially with corticosteroids, MTX, and Plaquenil (hydroxychloroquine).
If the condition allows, unnecessary medications should be discontinued to avoid side effects from corticosteroids, which can cause elevated blood sugar, high blood pressure, osteoporosis, adrenal insufficiency, immunosuppression, oral ulcers, and folate deficiency.
Hydroxychloroquine can lead to allergic reactions, gastrointestinal discomfort, hemolysis, and long-term high doses can cause retinal damage, necessitating ophthalmologic examinations every six months.

In daily life, it is important to maintain oral hygiene, brush teeth after meals, and drink plenty of water to prevent cavities.
Use artificial tears for eye dryness and have regular eye check-ups.
The use of antihistamines, neuropsychiatric medications, and antihypertensive drugs may exacerbate symptoms.

Sincerely, Dr.
Tseng Kuo-Sen, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2003/11/22

More Info

Long-term management of Sjögren's syndrome often involves the use of various medications, including Hydroxychloroquine, Aspirin, Prednisolone, and Methotrexate (MTX). Each of these medications has its own potential side effects, and understanding these can help you manage your health more effectively.

Hydroxychloroquine is commonly used to treat autoimmune conditions like Sjögren's syndrome. While it can be effective in managing symptoms, long-term use can lead to serious side effects, particularly concerning eye health. One of the most significant risks associated with Hydroxychloroquine is retinal toxicity, which can lead to irreversible vision loss. This is why regular eye examinations are crucial; typically, it is recommended to have a comprehensive eye exam every six months to monitor for any changes in the retina. Given your existing myopia (nearsightedness), it is even more important to keep a close watch on your eye health.

Aspirin, while often used for its anti-inflammatory properties, can cause gastrointestinal issues, including ulcers and bleeding, especially with long-term use. It can also affect kidney function and increase the risk of bleeding disorders. Regular monitoring of kidney function and gastrointestinal health is advisable.

Prednisolone, a corticosteroid, is effective in reducing inflammation but comes with a range of potential side effects when used long-term. These include weight gain, increased blood sugar levels, hypertension, osteoporosis, and adrenal suppression. It is essential to discuss with your doctor the possibility of tapering down the dose if your symptoms allow, as reducing the dose can help mitigate some of these risks.

Methotrexate (MTX) is another medication that can have significant side effects, including liver toxicity, bone marrow suppression, and lung issues. Regular blood tests are necessary to monitor liver function and blood cell counts while on this medication.

In terms of lifestyle recommendations, there are several strategies you can adopt to help manage your condition and mitigate the side effects of your medications:
1. Regular Check-ups: Keep up with your scheduled appointments for eye exams, blood tests, and any other necessary evaluations. This will help catch any potential issues early.

2. Hydration: Staying well-hydrated is crucial, especially for managing dry mouth and dry eyes, which are common symptoms of Sjögren's syndrome. Drinking plenty of water can help alleviate some of these symptoms.

3. Oral Hygiene: Since dry mouth can lead to dental issues, maintaining good oral hygiene is essential. Brush your teeth after meals, use fluoride toothpaste, and consider using mouth rinses designed for dry mouth.

4. Diet and Exercise: A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support overall health. Regular exercise can help manage weight, improve mood, and enhance overall well-being.

5. Moisturizing: Use artificial tears for dry eyes and consider using saliva substitutes or mouth moisturizers to help with dry mouth.

6. Avoiding Triggers: Be mindful of environmental factors that can exacerbate dryness, such as smoke, wind, and air conditioning. Using a humidifier at home can help maintain moisture in the air.

7. Medication Management: Discuss with your healthcare provider about the potential need for adjustments in your medication regimen, especially if you experience side effects.

8. Mental Health: Living with a chronic condition can be challenging. Consider seeking support from mental health professionals or support groups to help cope with the emotional aspects of your condition.

In conclusion, while the medications you are taking are essential for managing Sjögren's syndrome, they come with potential side effects that require careful monitoring. Regular communication with your healthcare provider, along with proactive lifestyle choices, can help you manage your condition effectively and maintain a good quality of life.

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