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TREATMENTS
Understanding Treatment Options
On Sjogren’s Advocate, I do not go into extensive detail about medications, but provide links to reliable resources. My one exception is providing detailed information about hydroxychloroquine (HCQ, also known as Plaquenil), because it is often misunderstood by clinicians. The content on this page is intended to inform readers about treatment options so you can have more productive conversations with your doctors.
Treatment decisions are highly individualized and best made in partnership with your care team. The information on this page, including external links, does not constitute medical advice.
Visit the Lifestyle page for additional resources and practical ways to support your overall health.
Sjogren’s Treatments and Drug Trials Map by Dr. Kara Wada
This downloadable reference clearly explains core treatment concepts and provides a thorough overview of both current therapies and promising new drugs in clinical trials. This document is offered free of charge. You will need to sign up for her Immune Confident Institute email newsletter to download it, which offers the added benefit of receiving future updates. However, just like with Sjogren’s Advocate, you can unsubscribe at any time.
Download the Map
How to Download:
Click on the salmon-colored link
Click on the brown PRINT/SAVE button
Click on "Destination" and choose "Save as PDF".
Treatments for Sjogren’s from the Sjogren's Foundation Website
This page provides a basic overview with an emphasis on sicca treatments, along with a small section on supplements, complementary medicine, and alternative therapies. Importantly, this page also includes a direct link to their "Find a Clinical Trial" database.
Hydroxychloroquine
See HCQ II - WHY TREAT SJOGREN'S? Learn about treatment goals, how HCQ can benefit Sjogren's, and how rheumatologists often misinterpret a single highly flawed clinical tiral to claim that it does not work for Sjogren's.
See HCQ III - Practical Considerations An in-depth look at side effects, risks. and monitoring.
Retinal screeing guidelines for HCQ , 2026 Academy of Ophthalmology (AAO).
Article by Donald Thomas, MD about hydroxychloroquine use in lupus (updated 05-2026)
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Benefits. Although better research is needed in Sjogren's, many of the benefits of taking HCQ are similar. See HCQ II, WHY TREAT SJOGREN'S? for Sjogren's specific information.
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Practical tips about dosage and when to take the pills.
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Managing side effects, including gastrointestinal, rashes, mood changes, and sleep problems.
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Testing HCQ blood levels is recommended to determine if your current dose is not too high or too low. See the TIP below.
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Desensitization method for patients who develop a rash (Discuss with your doctor first)!
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Retinal screening recommendations, based on AAO recommendations.
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Baseline: Testing is performed once just as you are starting hydroxychloroquine (HCQ).
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Five-Year Window: After that, most people can wait 5 years before annual testing is needed.
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Annual Screenings: Two tests are performed once a year on non-Asian patients, while 3 tests are required for Asian patients.
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Frequency Adjustment: Discuss screening frequency with your ophthalmologist; every 6 months is not necessary for most patients.
This is not medical advice: Be sure to discuss your infividualized screening needs with your eye doctor and rheumatologist.
Self-Advocacy TIP: Use the article, Hydroxychloroquine: 5mg/kg/day Is Only the Starting Point, to talk to your rheumatologist about monitoring hydroxychloroquine blood levels.
Why check blood levels? The "Goldilocks" Range
Ideal dosing maximizes the drug's clinical benefit while avoiding the higher blood levels that increase toxicity risks, most notably retinopathy. While this article was written with lupus in mind, hydroxychloroquine (HCQ) works in a similar way in Sjogren’s, and the exact same concepts apply.
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Key Insights From the Authors
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Exposure vs. Dosage: “Whole-blood HCQ levels tell us what we need to know: how much drug the patient is exposed to. They help identify patients who are underdosed, overdosed, or taking HCQ inconsistently.”
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The Biology of Absorption: “Two patients of the same weight may take the same 400 mg dose, yet one may absorb only a fraction of the dose while the other absorbs nearly all of it. Treating them identically because they weigh the same makes little pharmacologic sense.”
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Moving Beyond Weight-Based Dosing: “Weight-based dosing cannot tell us who is underexposed, overexposed, or not taking the medication consistently. For a drug as important as HCQ, weight-based dosing is no longer good enough.”
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Read the full piece: Hydroxychloroquine: 5mg/kg/day Is Only the Starting Point.
For more practical tips, see HCQ III - PRACTICAL CONSIDERATIONS
Methotrexate
Methotrexate is commonly used to treat Sjogren's arthritis and arthralgia (joint pain) . It is taken by mouth once a week or injected once a week. It should never be taken orally or injected on a daily basis. Injections provide more stable blood levels and are associated with fewer side effects.
Tips from Donald Thomas, MD about methotrexate use
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Myths about methotrexate
This article was written for rheumatoid arthritis, but the same concepts apply to Sjogren's.
10-18-2026