Sjögren Syndrome: 5 True/False Questions
Rheumatology Network Staff
Apr 19, 2018
Sjögren's Syndrome
TRUE: Rituximab may be considered for xerostomia in patients with primary Sjögren syndrome who have residual salivary production and significant oral damage, for whom conventional therapies have proved inadequate. This recommendation is based on data from an analysis of secondary outcome measures and a small randomized controlled trial. However, rituximab may be associated with significant risks (eg, infectious complications), and clinicians are advised to monitor patients closely.
Treatment guidelines for systemic Sjögren syndrome from the Sjögren’s Syndrome Foundation focus on the appropriate use of biologic agents and the management of fatigue and inflammatory musculoskeletal pain.1 The recommendations are intended to alleviate symptoms, improve quality of life, and prevent further damage.
(Images used in this slide show: ©MisterEmil/Shutterstock.com)
True or false? Tumor necrosis factor (TNF) inhibitors are recommended for the treatment of sicca symptoms in patients with primary Sjögren syndrome.
FALSE: TNF inhibitors should not be used to treat sicca symptoms in patients with primary Sjögren syndrome. This recommendation is based on a small controlled trial and a multicenter trial that showed little to no improvement in these patients. However, the authors caution that this recommendation should not be interpreted to discourage use of TNF inhibitors in settings where there is overlap of Sjögren syndrome with rheumatoid arthritis or other conditions for which TNF inhibition therapy is indicated.
True or false? Dehydroepiandrosterone (DHEA) is not recommended for the treatment of fatigue in Sjögren syndrome.
TRUE: DHEA is not recommended for the treatment of fatigue in patients with Sjögren syndrome. This recommendation is based on the results of clinical trials in which patients experienced no improvement.
True or false? The only strong therapeutic recommendation for fatigue in Sjögren syndrome is exercise.
TRUE: Fatigue is one of the most difficult symptoms to manage in Sjögren syndrome, and exercise is the only strongly recommended intervention.
True or false? The first line of treatment for inflammatory musculoskeletal pain in primary Sjögren syndrome should be corticosteroids.
FALSE: The guidelines outline recommendations for inflammatory musculoskeletal pain in primary Sjögren syndrome as a decision tree, with the first-line treatment as hydroxychloroquine (HCQ). If HCQ is not effective, methotrexate may be considered first as monotherapy and then in combination with HCQ. If combination therapy is ineffective, the next option is a short‐term corticosteroid regimen.
True or false? Rituximab may be considered as a therapeutic option for xerostomia in patients with primary Sjögren syndrome who have evidence of residual salivary production and significant evidence of oral damage, for whom conventional therapies (eg, topical moisturizers and secretagogues) have been inadequate.
TRUE: Rituximab may be considered for xerostomia in patients with primary Sjögren syndrome who have residual salivary production and significant oral damage, for whom conventional therapies have proved inadequate. This recommendation is based on data from an analysis of secondary outcome measures and a small randomized controlled trial. However, rituximab may be associated with significant risks (eg, infectious complications), and clinicians are advised to monitor patients closely.
Treatment guidelines for systemic Sjögren syndrome from the Sjögren’s Syndrome Foundation focus on the appropriate use of biologic agents and the management of fatigue and inflammatory musculoskeletal pain.1 The recommendations are intended to alleviate symptoms, improve quality of life, and prevent further damage.
Reference:
1. Carsons SE, Vivino FB, Parke A, et al. Treatment guidelines for rheumatologic manifestations of Sjögren’s syndrome: use of biologic agents, management of fatigue, and inflammatory musculoskeletal pain. Arthritis Care Res. 2017;69:517-527.
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