Fatigue in Sjögren syndrome
1. Fatigue can be an isolated presenting symptom in SS.
2. It is one of the most common and disabling symptoms of SS, with a severe impact on quality of life.
3. There are multiple causes.
4. It is challenging to treat, but not impossible.
|1. Start hydroxychloroquine(Drug information on hydroxychloroquine)|
|2. For treatment failures consider other symptoms such as polyarthralgias. Add second line agent after several months if appropriate (e.g. methotrexate(Drug information on methotrexate)).|
|3. When in doubt, prescribe prednisone(Drug information on prednisone) 15 mg daily for 2 weeks followed by rapid taper. If condition truly is inflammatory fatigue will resolve within 1-2 days, invariably followed by a flare at taper.|
|4. If you see a response to steroids, start a second line agent (methotrexate or azathioprine(Drug information on azathioprine)) or in the worst case consider IV rituximab(Drug information on rituximab).1|
|5. Treat nocturnal dryness with ocular gels; coat tongue with vitamin E(Drug information on vitamin e) oil or moisturizing gels. Recommend a humidifier at night and secretagogues at bedtime.|
|6. Prescribe sleep medications, but beware of the risk of increasing dryness.|
|7. When in doubt, order a sleep study.|
|Anxiety and depression|
|Medication side effects|
|Vitamin D deficiency|
|Vitamin B12 deficiency|
|Associated celiac disease|