New Guidance on Managing Sjogren's Rheumatologic Problems

[Jasper]

Medscape Medical News:   New Guidance on Managing Sjogren's Rheumatologic Problems, August 02, 2016

"The first US clinical practice guidelines for management of primary Sjogren's system were published online July 7 in Arthritis Care & Research and include a decision tree for the use of oral disease-modifying antirheumatic drugs (DMARDs) for inflammatory musculoskeletal (MSK) pain, guidance on patient self-care and exercise to reduce fatigue, and recommendations for uses of rituximab in Sjogren's. The Clinical Practice Guidelines Committee discouraged the use of tumor necrosis factor-α (TNFα) inhibitors for patients with Sjogren's who lack other indications for those agents, including patients with sicca symptoms. ..........

Hydroxychloroquine (HCQ) "remains the first line therapy for inflammatory musculoskeletal pain in Sjogren's ..........

The guideline provides a decision-tree table beginning with HCQ and progressing to methotrexate (MTX), then HCQ plus MTX, then short-term corticosteroids, then long-term (>1 month) corticosteroids.

The panel recommended that clinicians not use TNFα inhibitors to treat sicca symptoms in patients with primary Sjogren's, but consider them in patients who also have rheumatoid arthritis (RA) or related conditions. The authors also note there is "no evidence that the subset of RA patients with Sjogren's who have been treated with anti-TNF-α agents have an increased incidence of lymphoma. Therefore, this recommendation should not be interpreted to discourage use of TNF inhibitors in situations where there is overlap with RA or where TNFα inhibition therapy is indicated for the treatment of inflammatory arthritis."

The group recommended that clinicians consider rituximab for treating keratoconjunctivitis sicca in patients with primary Sjogren's inadequately controlled by conventional therapies including topical moisturizers, secretagogues, anti-inflammatory agents, immunomodulators, and punctual occlusion. They also recommended consideration of rituximab for xerostomia in patients with primary Sjogren's who have some residual salivary production and significant evidence of oral damage inadequately controlled by conventional therapies, including topical moisturizers and secretagogues.

The authors also recommend rituximab as a possible option for adults with primary Sjogren's and a variety of other systemic manifestations including vasculitis with or without cryoglobulinemia, severe parotid swelling, inflammatory arthritis, pulmonary disease, or peripheral neuropathy (especially mononeuritis multiplex). .........."

To read entire article, go to Medscape. You may need to register but it is free. Either go to the Rheunmatology section or type in the title of the article in the search box.

[warmwaters]

Thanks Jasper, I've been waiting for this. I'm going to see if my local library can provide access to the the Arthritis Research Journal where the full guidelines occur.  Kind of crazy that treatment guidelines are not available public, but hey, journals wanna make money, too.

Or maybe Sjogrens.org will have it.

hmm....

[warmwaters]

Here's a link to the actual guidelines
https://www.sjogrens.org/files/research/RheumatologyCPG.pdf

[Jasper]

Thanks for that link, Warmwaters.

I tried to access the original article (and guidelines) in Arthritis Care & Research but it would not allow access without paying. I am thrilled that you were able to find the original guidelines via another route.

I, too, have been waiting for this. I think it needs further refinement as more well designed studies are completed, but this is a really good start since, prior to this set of guidelines, we had nothing.

I noticed in the guidelines that Sjogren's is referred to as Sjogren's Disease (not Sjogren's Syndrome). This, in itself, is a big step towards gaining acceptance that Sjogren's Disease is more than just a bunch of annoying symptoms.

I look forward to the completion of some of the studies that are in progress. I hope we will soon have more treatments available to us and that the treatments will finally be used to treat us.

Fortunately, I have an excellent Rheumatologist who is current on all of the research regarding Sjogren's Disease and is willing to treat me with the available drugs, including biologics. Many people, maybe most people, with Sjogren's Disease have doctors who know very little about Sjogren's Disease and consequently do not treat their patients with the currently available drugs.

Again, thanks for that link to the actual guidelines.

[Anastasia]

Thanks so much for the information!
Anastasia.

[Tharrell]

Oh wow! Just in time! This is coming with me on Monday to my rheumatologist appointment! Thank you very much!

[Anastasia]

This is also promising in terms of research:

www.washingtonpost.com/business/economy/high-prices-make-once-neglected-orphan-drugs-a-booming-business/2016/08/04/539d0968-1e10-11e6-9c81-4be1c14fb8c8_story.html