Dry eyes + dry mouth
Confirm: Anti-SSA (Ro) / SSB (La); Schirmer test
Treat: Artificial tears/saliva → pilocarpine; hydroxychloroquine for systemic
Order set
- Anti-Ro/La, ANA
- Schirmer test
- Salivary gland assessment
- FBC (cytopenias)
Criteria
AdmitSystemic complication / lymphoma workup
DischargeSymptomatic care, systemic therapy if needed, follow-up
Key
- ↑Lymphoma risk — baseline ESSDAI assessment + annual lymphoma surveillance.
- Cevimeline is an alternative muscarinic agonist if pilocarpine fails/intolerant; rituximab may be considered for severe systemic disease (EULAR 2019).
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
- Parotid mass/persistent swelling (lymphoma)
Differentials
- Sicca from drugs/age
- Sarcoid
- IgG4 disease
Common mistakes
- Missing lymphoma risk
- Overlooking systemic features
Disposition & follow-up
Symptomatic sicca care; hydroxychloroquine for systemic.
Discharge package
MedicationsSymptomatic sicca care ± hydroxychloroquine
Follow-upRheumatology
Warning symptomsPersistent gland swelling, systemic symptoms
💊 Treatment detail — doses & preparation
Pilocarpinemuscarinic agonist
Dose5 mg PO QID (Sjögren sicca)
Preparation5 mg tablets
MonitorSweating, flushing; take before meals for dry mouth
HydroxychloroquineDMARD
Dose200–400 mg OD (≤5 mg/kg/day)
Preparation200 mg tablets
MonitorAnnual retinal screening after 5 yr; slow onset 6–12 wk
Artificial tears/salivasymptomatic
DoseHypromellose drops q2–4h + saliva spray + sugar-free gum
PreparationOTC preparations
MonitorDental review (caries risk)
📖 EULAR SjögrenReviewed July 2026