Sjogren's syndrome management: EULAR Guidelines

The European League Against Rheumatism (EULAR) has released its 2019 guidelines for therapeutic management of Sjögren syndrome (SjS) with topical and systemic medications. The aim was to develop a rational therapeutic approach to SjS patients useful for healthcare professionals, physicians undergoing specialist training, medical students, the pharmaceutical industry and drug regulatory organisations following the 2014 EULAR standardised operating procedures. The Task Force (TF) included specialists in rheumatology, internal medicine, oral health, ophthalmology, gynaecology, dermatology and epidemiology, statisticians, general practitioners, nurses and patient representatives from 30 countries of the 5 continents. The TF endorsed the presentation of general principles for the management of patients with SjS as three overarching, general consensus-based recommendations and 12 specific recommendations that form a logical sequence, starting with the management of the central triplet of symptoms (dryness, fatigue and pain) followed by the management of a systemic disease.

Following are the major recommendations:

A. Patients with SjS should be managed at, or in close collaboration with, centres of expertise following a multidisciplinary approach

B. The first therapeutic approach for dryness should be symptomatic relief using topical therapies

C. Systemic therapies may be considered for the treatment of active systemic disease

• Baseline evaluation of salivary gland function is recommended before starting treatment for oral dryness


• The preferred first therapeutic approach for oral dryness according to salivary gland function may be:

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  • Non-pharmacological stimulation for mild dysfunction
  
  
  • Pharmacological stimulation* for moderate dysfunction
  
  
  • Saliva substitution for severe dysfunction
  
  
  
  

• The first-line therapeutic approach to ocular dryness includes the use of artificial tears and ocular gels/ointments


• Refractory/severe ocular dryness may be managed using topical immunosuppressive-containing drops* and autologous serum eye drops


• Concomitant diseases should be evaluated in patients presenting with fatigue/pain, whose severity should be scored using specific tools


• Consider analgesics or other pain-modifying agents for musculoskeletal pain, considering the balance between potential benefits and side-effects


• Treatment of systemic disease should be tailored to organ-specific severity using the ESSDAI definitions


• Glucocorticoids should be used at the minimum dose and length of time necessary to control active systemic disease


• Immunosuppressive agents should be mainly used as GC-sparing agents, with no evidence supporting the choice of one agent over another


• B-cell targeted therapies may be considered in patients with severe, refractory systemic disease


• The systemic organ-specific therapeutic approach may follow, as a general rule, the sequential (or combined) use of GCs, immunosuppressive agents and biologics


• Treatment of B-cell lymphoma should be individualised according to the specific histological subtype and disease stage

For more details click on the link: http://dx.doi.org/10.1136/annrheumdis-2019-216114