Sjögren's Syndrome Management and Treatment

Initial Diagnostic Workup

• The American College of Rheumatology recommends serologic testing for anti-SSA/Ro and anti-SSB/La antibodies, ANA, and RF, combined with objective assessment of lacrimal and salivary gland function for all patients with suspected Sjögren's syndrome 1
• The European League Against Rheumatism (EULAR) suggests that patients with suspected Sjögren's syndrome should undergo baseline chest radiography and complete pulmonary function tests (PFTs) to identify subclinical disease 2

Management of Sicca Symptoms

• The American Academy of Ophthalmology recommends first-line therapy consisting of artificial tears containing methylcellulose or hyaluronate at least twice daily for ocular dryness 4
• The American Dental Association recommends sugar-free gum and frequent sips of water for mild salivary dysfunction, and pharmacological stimulation with muscarinic agonists for moderate dysfunction 4

Management of Airway Disease

• The American Thoracic Society recommends a systematic evaluation for chronic cough, including assessment of common causes and Sjögren's-specific complications 5
• The European Respiratory Society suggests that patients with xerotrachea should receive empirical humidification and trial of secretagogue and/or guaifenesin 5

Management of Interstitial Lung Disease (ILD)

• The American Thoracic Society recommends HRCT with expiratory views, oximetry testing, and baseline PFTs for diagnostic workup of suspected ILD 3
• The European Respiratory Society suggests that patients with ILD should receive vaccination, pulmonary rehabilitation, and long-term oxygen therapy as needed 3

Management of Systemic Disease

• The European League Against Rheumatism (EULAR) recommends that systemic therapies should be restricted to patients with active systemic disease, with treatment tailored to organ-specific severity using the ESSDAI 4
• The American College of Rheumatology suggests that patients with moderate to severe systemic disease should receive glucocorticoids, immunosuppressive agents, and B-cell targeted therapies as needed 4

Monitoring and Follow-up

• The European League Against Rheumatism (EULAR) recommends using ESSDAI to measure systemic activity and ESSPRI to evaluate severity of dryness, fatigue, and pain 4
• The American Thoracic Society suggests that patients with pulmonary involvement should receive repeat PFTs every 6-12 months 4