Sorry that you had to join the SS club so young. Plaquenil has worked wonders, but I still get flare-ups. I'm finding that keeping a low carb diet helps (avoiding sugar...white bread, rice, candy, sodas, baked goods, etc.). Other people I know with auto-immune issues find this diet helps. I fell off the wagon during Thanksgiving and now I'm paying the price =-6 Good luck to you!

Please consider changing your diet. I am unable to tolerate any medications at all, including NSAIDS and pilocarpine, so the only thing I can do is modify my diet and my activities. This is what has helped me (helped, not cured):

-Drink a LOT of water. Even if it feels like it's not helping, it helps with general weakness.

-Eliminate all grains, this means ALL grains - no wheat,corn, rice, oats, barley, millet, quinoa, etc. This is hard at first, but if you focus on what you can eat (complex carbs), it will help. Your friends are potatoes, sweet potatoes and yam, all winter squashes, all root vegetables, like beets, turnips, rutabaga, carrot, parsnip, etc. You will end up eating things like leftover cooked potatoes, sweet potatoes, and veggies for breakfast. Not so bad when you get used to it!

-Reduce the amount of animal protein you eat. Eat NO red meat, and concentrate on turkey, chicken, eggs,(organic if possible) and fish with low mercury. Eat no more than a 3 oz serving, no more than once a day.

-Eat all the fruits and vegatables you want, except for highly acidic ones (citrus, tomatoes) that will irritate. Eat lots!

-Keep legumes to a minimum. This means beans, chickpeas and hummus. Personally, I have no problem with peas.

-Cut out all sugar. This will be hard for a couple of weeks, but as you shift to a whole-food diet I promise you that even plain food with start to taste amazing, and a handful of raisins or a few dried prunes or apricots will totally satisfy your sweet tooth. This from a former total cookie monster. Use sweet n Low in your coffee and tea (not organic, but nobody said we had to be perfect)

-Cut out ALL dairy. Subsitute with almond milk or coconut milk. In tea or coffee, I use coffee mate - again, not exactly health food, but you have to do what works for you while minimizing damage. I just make an amazing pumpkin custard with full-fat coconut milk, and you don't taste the coconut. Puddings, too.

-Avoid all oils that come from seeds, and use only olive oil and butter (preferably butter from grass-fed cows).

-If you do any kind of aerobic exercise, do not do more than 10 minutes at a time. I have discovered that anything that increases your metabolic rate causes Sjogren's symptoms to flare badly. For me, that's exercise, and too much animal protein.

-I know this sounds depressing, and I totally get that you are in grad school with high pressure and little money (I was a grad student 10 years ago, and both my son and daughter are now). However, without stabilizing your health and learning how to manage things life will be hugely difficult, and this approach can certainly slow down and sometimes arrest the damage the Sjogren's is doing.

One more thing - There are a few new products out that are grain-free, and allow you to feel like you can eat normally - potato chips fried in olive oil, a cracker/chip called "Cracklesnax" made from potato, and flatbread/crackers by a company called "Absolutely Gluten Free" - these are awesome. The other thing to do is not try to duplicate what you are missing, but concentrate on what you CAN eat and enjoying it on it's own merits. My husband has discovered he really likes the food I cook now, and he dropped ten pounds and ten years off his face. Feels better, too.

-Last but not least - take high-quality EPA and DHA fish oil, 3000mg a day in two doses. Take a small amount of high quality flax oil as well (1/4 tsp). Also take probiotics - this will help your digestion, and one in particular will help prevent yeast infecions in your mouth- bacillus laterosporus, and it's in FloraBalance by O'Donnell. Also take S. Boulardii, Reuteri, and a couple of high-dose broad-spectrum ones. Take this first thing in the morning, on an empty stomach with a lot of water.

One final note - do not try to hide your condition from your facutly advisor and professors. If they are decent people (and I recognize not all are) they will understand and occasionally make allowances for your condition. Most people understand and respect someone who tries hard with a disability.

Afterthought: get tested for Celiac disease, even if you have no overt symptoms of it. It is highly associated with Sjogren's. In any case, getting off of gluten grains (and ALL grains have some gluten) is the only treatment.

Best of luck to you. You are not alone out there.

Thank you both for your helpful input!

What do you find is helpful to prevent cavities? I brush and floss after every meal, use biotene mouthwash, pilocarpine, fluoride rinse and I still had 5 cavities this year.

My rheumatologist said to not be surprised if I have dentures in 10 years .... thoughts?

My dentist prescribes Prevident, which is a very high-flouride toothpaste she has me using at night, after brushing with regular toothpaste. You spit it out, but don't rinse. Only time will tell if it makes a difference. Make sure you use either an electric toothbrush or a spinbrush (Oral B's are best) This will go a long way toward preserving your gums. Also, chew sugarless gum - vulgar as gum-chewing may be. It keeps what little saliva you've got flowing.

Hello. I cannot imagine being so young and dealing with sjogrens.
Taking plaquenil will help with the joint pain some but it takes awhile to get into your system. A clean diet does help. I am gluten free and all my food is baked;steamed;fresh;raw. Read labels. Modified food starch is bad unless it says corn or rice. Gluten free can taste really good. Quinoa pasts by ancient harvest is best.
UDI'S. Bread products are the best tasting breads; Pamela 's products are good too. No more processed pre-packaged foods.
Biotene is a great mouth rinse and toothpaste.
pilocarpine drops are what I use as a swish for dry mouth. Its cheaper than evoxac and there's no side effects.

Omega 3 fishoil supplements; vitamin D; Biofreeze spray or gel rubbed on joints beautifully. Rest; stretch; tai Chi ; walking all good. Pace yourself. Don't sweat the little stuff.Take care of you and ask for help when you need it..