쇼그렌증후군(Sjögren’s syndrome): 치료


목차

치료 목적

  •  증상완화, 분비액 보충 혹은 분비 촉진 시켜 만성적 구강 건조증과 건성각막결막염에 의한 국소적 손상을 최소화

 

 

 

치료방법

  1. 안구 건조 
    • 눈물 보충위해 안약 이용 : Tearisol, Liquifilm, 0.5% methylcellulose, Hypo Tears 등
    • 각막궤양 : 안대, 붕산연고
    • 눈물과 침 분비를 감소시키는 약제 피한다 : 이뇨제, 항고혈압제, 항콜린작용약, 항우울제 
  2. 구강 건조
    • 충분한 수분 섭취
    • 분비 촉진 : pilocarpine 또는 cevimeline 경구 투여 
  3. 질 건조 
    • 프로피온산 겔(propionic acid) 사용 
  4. 관절 증상 : Hydroxychloroquine 
  5. 콩팥세뇨관산증 : sodium bicarbonate 경구투여
  6. 전신적인 혈관염 : glucocorticoid, 혹은 immunosuppressive agents 
  7. 고등급 림프종 : 전통적 CHOP 요법과 항CD20 단클론항체 병합치료

 

쇼그렌증후군의 치료

Glandular manifestation

Dry eye

 

Avoid

Smoking areas, windy, low humidity environment, drugs with anticholinergic action, diuretics

Lubrication

Artificial tears without preservatives, bicarbonate-buffered elec-trolyte solutions

Local stimulation

Cyclic adenosine mono-phosphate, cyclosporine 2% olive solu-tion

Systemic stimulation

Pilocarpine (5 mg twice daily orally); convimetine (30 mg twice daily orally)

Severe dry eyes

Nasolacrimal duct occlusion (temporary or permanent); soft con-tact lenses; corneal transplantation

Dry mouth


 

Oral hygiene after each meal Topical application of fluoride

 

Lubrication

Water

Local stimulation

Sugar-free, flavored lozenges or gum

Systemic stimulation

 As for dry eyes

Oral candidiasis

Topical nystatin or clotrimazole lozenges

Parotid gland enlargement

Apply 

Local wet heat

Treat superinfection

Antibiotics, analgesics

Persistent, hard

Rule out lymphoma

Extraglandular manifestation

Arthritis

Hydroxychloroquine (200~400 mg/d) or Methotrexate (0.2-0.3 mg/kg body weight weekly) 

plus Prednisolone (10 mg daily orally)

 

Raynaud’s phenomenon

Cold protection: gloves

Nifedipine (10 mg twice daily)

 

Renal tubular acidosis

Bicarbonate replacement

 

Vasculitis 

Standard treatment

 

lymphoma 

CHOP + anti-CD 20

 


참고자료

  • 해리슨 20/e(2018). 354장
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