Palavras-chave
Síndrome de Sjögren,
Tratamento
Como Citar
Resumo
Objetivo: Informar sobre o estado atual das evidências sobre a eficácia e segurança dos principais tipos de terapias aplicadas à Síndrome de Sjögren (SS). Revisão Bibliográfica: Atualmente não existe nenhuma substância curativa para a SS, sendo o objetivo terapêutico a melhora sintomática, a prevenção de danos sistêmicos e a melhora na qualidade de vida. Existem as terapias tópicas orais e oftalmológicas cujo objetivo é melhorar os sintomas da xerostomia e xeroftalmia, conhecidos como síndrome sicca. Sobre as terapias farmacológicas orais na SS, o foco principal é suprimir a atividade imune anormal em pacientes críticos. Quando o dano visceral está presente e grave, a terapia com glicocorticoides é utilizada além dos agentes imunossupressores como a hidroxicloroquina, metotrexato, rituximabe e os inibidores do fator de necrose tumoral. Conclusão: Observou-se uma grande divergência no uso dessas drogas, por isso, existem poucas recomendações oficiais no uso da terapia farmacológica, fazendo com que muitas escolhas terapêuticas sejam baseadas na prática clínica. Assim, conclui-se que é necessário mais estudos para apoiar a decisão dos especialistas, bem como identificar aqueles pacientes que apresentarão mais benefícios com uma determinada terapia.
Referências
BOTH T, et al. Reviewing primary Sjögren's syndrome: beyond the dryness - From pathophysiology to diagnosis and treatment. Int J Med Sci., 2017;14(3):191-200. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370281/
BRITO-ZERÓN P, et al. Efficacy and safety of topical and systemic medications: a systematic literature review informing the EULAR recommendations for the management of Sjögren's syndrome. RMD Open., 2019;5(2):e001064. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827762/
DOOLAN G, et al. Treatment strategies for Sjögren's syndrome with childhood onset: a systematic review of the literature. Rheumatology (Oxford)., 2022;61(3):892-912. https://pubmed.ncbi.nlm.nih.gov/34289032/
HACKETT KL, et al. A systematic review of non-pharmacological interventions for primary Sjögren's syndrome. Rheumatology (Oxford)., 2015;54(11):2025-2032. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603277/
KIM J, KIM YS, PARK SH. Metformin as a Treatment Strategy for Sjögren's Syndrome. Int J Mol Sci., 2021;22(13):7231. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269365/
KIM JW, et al. Metformin improves salivary gland inflammation and hypofunction in murine Sjögren's syndrome. Arthritis Res Ther., 2019;21(1):136. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549273/
KRUIZE AA, et al. Hydroxychloroquine treatment for primary Sjögren's syndrome: a two year double blind crossover trial. Ann Rheum Dis., 1993;52(5):360-364. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1005050/
MARIETTE X, et al. A randomized, phase II study of sequential belimumab and rituximab in primary Sjögren's syndrome. JCI Insight., 2022;7(23):e163030. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9746921/
MEIJER JM, et al. Effectiveness of rituximab treatment in primary Sjögren's syndrome: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum., 2010;62(4):960-968. https://onlinelibrary.wiley.com/doi/epdf/10.1002/art.27314
MIYAWAKI S, et al. Efficacy of low-dose prednisolone maintenance for saliva production and serological abnormalities in patients with primary Sjo¨gren’s syndrome. Intern Med., 1999;38:938–43. https://pubmed.ncbi.nlm.nih.gov/10628930/
RAMOS-CASALS M; TZIOUFAS AG; FONT J. Primary Sjögren's syndrome: new clinical and therapeutic concepts. Ann Rheum Dis., 2005;64(3):347-354. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1755414/
SHIBOSKIi CH, et al. 2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren's Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts. Arthritis Rheumatol., 2017;69(1):35-45. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5650478/
SRIVASTAVA A, MAKARENKOVA HP. Innate Immunity and Biological Therapies for the Treatment of Sjögren's Syndrome. Int J Mol Sci., 2020;21(23):9172. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730146/
STEFANSKI AL, et al. The Diagnosis and Treatment of Sjögren's Syndrome. Dtsch Arztebl Int., 2017;114(20):354-361. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5471601/
WANG SQ, et al. Is hydroxychloroquine effective in treating primary Sjogren's syndrome: a systematic review and meta-analysis. BMC Musculoskelet Disord., 2017;18(1):186. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427554/
WU CH, et al. Pilocarpine hydrochloride for the treatment of xerostomia in patients with Sjögren's syndrome in Taiwan--a double-blind, placebo-controlled trial. J Formos Med Assoc., 2006;105(10):796-803. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7134824/
ZANDBELT MM, et al. Reversibility of histological and immunohistological abnormalities in sublabial salivary gland biopsy specimens following treatment with corticosteroids in Sjo¨gren’s syndrome. Ann Rheum Dis, 2001;60:511–13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1753654/
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Copyright (c) 2024 Raphaella Salgado Oliveira, Adriel Leite Costa, Danielly Aemi Ohfugi, Francine Miyuki Nishi de Castro, Gustavo Lucas Foltran, Larissa Braz Gomes Vitoriano, Márcio de Figueiredo Andrade Júnior, Natália Guimarães dos Santos, Nilton Mitsuo Kakinoki Nomoto, Andrezza Vasconcelos do Vale Aguiar