Updated clinical practice guidelines for rheumatologic manifestations of Sjögren’s syndrome

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The first Clinical Practice Guidelines (CPG) from Sjögren’s Syndrome Foundation (SSF) are published online July 7, 2016 in the journal Arthritis Care & Research.

Physicians are advised to use nonpharmacologic approaches such as exercise to reduce fatigue in patients with primary Sjögren’s syndrome. Pharmacologic therapy should be initiated with the drugs having the lowest potential for adverse effects and then escalated according to clinical response.

The guidelines include a decision tree for the use of oral disease-modifying antirheumatic drugs (DMARDs) for inflammatory musculoskeletal pain beginning with hydroxychloroquine (HCQ) and progressing to methotrexate (MTX), then HCQ + MTX, then short-term corticosteroids, then long-term (>1 month) corticosteroids.

Use of tumor necrosis factor-α (TNFα) inhibitors for sicca symptoms is strongly discouraged, but they can be considered in patients who also have rheumatoid arthritis (RA) or related conditions.

Rituximab can be considered for treating keratoconjunctivitis sicca in primary Sjögren’s inadequately controlled by conventional therapies or for xerostomia in patients with primary Sjögren’s who have some residual salivary production and significant evidence of oral damage