Management of Neuropathy in Sjögren's Syndrome

Rationale for Multidisciplinary Management

The European League Against Rheumatism (EULAR) recommendations state that a multidisciplinary approach involving various health professionals is essential for Sjögren's syndrome management, with specialists in autoimmune diseases acting as coordinators of the healthcare process 1, 3
Both rheumatologists and neurologists should be involved in treating neuropathy caused by Sjögren's syndrome, with the rheumatologist managing the underlying autoimmune disease and the neurologist addressing the specific neuropathic manifestations 1, 2

Electrodiagnostic studies (nerve conduction studies and electromyography) are essential for evaluating polyneuropathy, and additional testing may include MRI of the spine/brain, lumbar puncture, and autoimmune panels 4

Treatment of systemic disease should be tailored to organ-specific severity using the ESSDAI definitions, and for neuropathies associated with Sjögren's syndrome, treatment follows a sequential approach starting with glucocorticoids at the minimum dose and duration necessary to control active systemic disease 5
Immunosuppressive agents (cyclophosphamide, azathioprine, methotrexate, leflunomide, mycophenolate) can be used as glucocorticoid-sparing agents, and B-cell targeted therapies (rituximab) may be considered in patients with severe, refractory systemic disease 5, 6

Symptomatic treatment of neuropathic pain with agents such as pregabalin, gabapentin, or duloxetine is recommended 4