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Oral pilocarpine for Sjögren’s syndrome

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Sjögren’s syndrome is an autoimmune disease that affects exocrine glands and causes keratoconjunctivitis sicca. Ocular complications include corneal ulceration, episcleritis, keratitis, and bacterial or viral infection. The use of artificial tears is the mainstay of treatment. It has been suggested that pilocarpine, a cholinergic parasympatheticomimetic agonist, might improve the symptoms of keratoconjunctivitis sicca. Researchers in Greece have used oral pilocarpine with good effect.

Eighty five women (mean age 58 years) with Sjögren’s syndrome were randomised to 12 weeks treatment with oral pilocarpine 5 mg twice daily plus artificial tears, artificial tears only, or occlusion of the inferior lachrymal puncta plus artificial tears. Changes in symptoms were assessed on a 100 mm visual analogue scale (VAS). Symptom improvement was 90% (pilocarpine) v 30% (artificial tears only), v 60% (punctal occlusion). Improvement with pilocarpine was significantly better than with punctal occlusion (p<0.05) and highly significantly better than with artificial tears alone (p<0.001). With the rose bengal test improvement was significantly greater in the pilocarpine group than in the other two groups but there were no significant differences between groups with Schirmer’s-I test. Four of 29 patients on pilocarpine complained of headache and three of those also complained of nausea, vomiting, and sweating. No patient withdrew from the study because of adverse effects of pilocarpine.

Oral pilocarpine may give symptomatic relief for patients with Sjögren’s syndrome.

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