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Letters
November 10, 2010

Treatment Approaches in Primary Sjögren Syndrome

JAMA. 2010;304(18):2015-2016. doi:10.1001/jama.2010.1582

To the Editor: The systematic review of primary Sjögren syndrome by Dr Ramos-Casals and colleagues1 summarized evidence for a variety of treatment approaches. However, regarding treatment of the oral component of Sjögren syndrome, the review did not include the effects of saliva replacement. Because some saliva substitutes have been registered as drugs, this might be relevant. Randomized clinical trials suggest that saliva substitutes have the potential to reduce oral dryness in patients with moderate to severe xerostomia, but not in patients with mild xerostomia,2,3 in contrast with the statement by Ramos-Casals et al that saliva replacements may be effective for mild xerostomia as well. For mild to moderate xerostomia, sialogogues such as pilocarpine and cevimeline are more appropriate.1

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