Non-Pharmacological Interventions for Primary Sjögren's Syndrome: A Systematic Review of the Evidence

Background: Symptoms of primary Sjögren's syndrome are varied and impact on quality of life. Non pharmacological interventions such as complimentary therapies, psychotherapy and medical devices aim to relieve symptoms and improve function. We pre-registered a protocol with PROSPERO (CRD42013004997), then conducted a systematic review. Objectives: To determine the efficacy of non-pharmacological interventions on all outcomes in primary Sjögren's syndrome. Methods: A predefined list of databases were searched from inception to July 2013 with a list of search terms. Randomised controlled trials (RCTs) of any non-pharmacological interventions for adults with PSS were included. Any comparator was allowed. Titles and abstracts of studies were considered according to the inclusion/exclusion criteria. Full texts were reviewed for inclusion independently by two authors. Two review authors separately extracted the data of included studies onto standardised forms. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Outcomes fell within the main domains addressed by the World Health Organisation International Classification of Functioning. Results: 996 studies were identified of which 17 full text articles were screened and 5 studies were included in this review with a total of 130 participants randomised. The included studies investigated effectiveness of an oral lubricating device for dry mouth, acupuncture for dry mouth, lacrimal punctum plugs for dry eyes and psychodynamic group therapy for coping with symptoms. One study showed improvement in salivary flow and speed of speech with an oral lubricating device but was at high risk of bias. One study of punctum plugs had no extractable data and another comparing punctum plugs to artificial tears reported improvements on tear volume and film with punctum plugs, but this study was small (n=42). No benefits were reported on psychodynamic therapy in a small, poor quality study. Conclusions: We identified no evidence that any non-pharmacological interventions improved symptoms of PSS.