치료 목적
- 증상완화, 분비액 보충 혹은 분비 촉진 시켜 만성적 구강 건조증과 건성각막결막염에 의한 국소적 손상을 최소화
치료방법
- 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
- 구강 건조
- 충분한 수분 섭취
- 분비 촉진 : pilocarpine 또는 cevimeline 경구 투여
- 질 건조
- 프로피온산 겔(propionic acid) 사용
- 관절 증상 : Hydroxychloroquine
- 콩팥세뇨관산증 : sodium bicarbonate 경구투여
- 전신적인 혈관염 : glucocorticoid, 혹은 immunosuppressive agents
- 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
