Effect of Pilocarpine on impaired salivary secretion in patients with Sjögren's syndrome.

The aim of this study was to analyze resting whole saliva (RWS) and stimulated whole saliva (SWS) flow rates before and after administration of Pilocarpine in secondary Sjögren's Syndrome patients. Fifty-one patients (49 women, 2 men, mean age 61 years, range 38-85), all with a resting saliva < or =0.1 ml/min, participated. Volumes of RWS and SWS collected over periods of 15 and 5 min, respectively, using standardized protocols were measured and the same procedure was repeated after oral administration of Pilocarpine (0.7 mg per 10 kg body weight). The sample was then divided into two groups, according to those in whom Pilocarpine stimulation had caused RWS flow to reach >0.1 ml/min (responders) and those who remained at values < or =0.1 ml/min (non-responders). All participants completed a questionnaire related to general and oral health status, as well as their subjective intraoral complaints before and after administration of Pilocarpine. Thirteen patients (25%) were classified as non-responders and the remaining 38 (75%) as responders. No statistically significant differences between the non-responders and responders were detected as regards general health parameters or intake of medicines with anticholinergic affect. As regards intraoral subjective complaints, no difference between the groups was found before Pilocarpine administration. After administration of Pilocarpine, complaints were significantly fewer among the responders (p<0.01). Both groups exhibited a significant decrease of intraoral symptoms after administration of Pilocarpine (responders P<0.001 and non-responders P<0.05) compared to baseline. For the whole group, more severe intraoral complaints were significantly associated with a lower SWS (P<0.05), but not a RWS, rate at baseline. It is concluded that a subgroup of Sjögren patients do not respond to Pilocarpine stimulation. The clinical implications of this finding need further investigation.