This protocol applies to patients with Sjögren syndrome presenting with oral dryness (xerostomia) in the setting of moderate salivary gland dysfunction. The severity of glandular involvement places these patients in a distinct functional category with its own preferred therapeutic approach.
Moderate glandular dysfunction is characterised by the following salivary flow measurements:
Unstimulated whole salivary flow <0.1 mL/min · Stimulated whole salivary flow 0.1–0.7 mL/minPatients who fall within these thresholds are candidates for pharmacological secretagogue stimulation. The preferred first-line approach for oral dryness is stratified by degree of residual glandular function.
When standard pharmacological stimulation is not tolerated or does not achieve an adequate response, rescue secretagogue therapy with certain oral agents may be considered. This class of agents has been used in Sjögren syndrome since the 1980s and carries a well-established safety profile.
The complete protocol — including agent selection, decision criteria, and the full clinical algorithm — is available via the link below.
DOI: 10.1136/annrheumdis-2019-216114
In patients with moderate glandular dysfunction, pharmacological stimulation with muscarinic agonists may be considered.
The preferred first therapeutic approach for oral dryness according to salivary gland function may be: Non-pharmacological stimulation for mild dysfunction; pharmacological stimulation for moderate dysfunction; saliva substitution for severe dysfunction.
In patients who are intolerant or non-responders to muscarinic agents, some choleretic (anetholtrithione) or mucolytic (bromhexine, N-acetylcysteine) agents used as secretagogues in SjS since the 1980s may be considered as rescue therapies due to their good safety profile in the absence of alternative therapeutic options.
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