Fast Five Quiz: Sjögren Disease Management
B cells have been shown to significantly impact the pathogenesis of primary Sjögren disease. However, B-cell targeted therapies are generally considered in severe, refractory cases, or in patients with systemic involvement. Specially, the EULAR recommends considering B-Cell targeted therapies only in severe, refractory systemic disease. This is consistent with recommendations from the Sjögren's Foundation, wherein most biologic therapies are recommended for refractory cases or those with systemic involvement. Additionally, the Sjögren's Foundation specifically recommends against the use of tumor necrosis factor inhibitors to treat sicca symptoms in patients with Sjögren disease.
Learn more about B-cell therapies for Sjögren disease.
Pulmonary manifestations of Sjögren disease, which include interstitial lung disease, are a potentially serious complication of the disease. For patients with symptomatic cystic vocal cord lesions (bamboo nodules), the Sjögren's Foundation recommends voice therapy, inhaled corticosteroids, or intralesional corticosteroid injections. A recent review has further confirmed these approaches are most appropriate in this setting.
Nebulized saline is usually recommended for patients with Sjögren disease and ' clinically relevant bronchiectasis.' Systemic corticosteroids are not usually recommended as an initial treatment in this setting; they are typically used for other pulmonary manifestations, such as interstitial lung disease and certain small airway diseases. Surgical resection is typically considered when these approaches fail and after a consultation with a laryngologist.
Learn more about pulmonary manifestations in Sjögren disease.
For patients with Sjögren disease and acute musculoskeletal pain, EULAR recommends limiting NSAID use to no more than 10 days at full dosage, citing evidence that one third of patients will have a rapid clinical response to short-term analgesics. For inflammatory musculoskeletal pain, the Sjögren's Foundation guidelines recommend hydroxychloroquine and/or methotrexate, progressing to corticosteroids, then leflunomide, sulfasalazine, azathioprine, and cyclosporine. EULAR also suggests hydroxychloroquine for this indication due its effectiveness in other systemic autoimmune diseases but note a pivotal RCT did not show significant benefit. As such, they emphasize nonpharmacologic management of chronic pain and note that treatment should follow general chronic pain guidance.
Learn more about pain in Sjögren disease.
Editor's Note: This article was created using several editorial tools, including generative AI models, as part of the process. Human review and editing of this content were performed prior to publication. Lead image: Peakstock/Science Source
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