COMMENTARY

Advances in Understanding, Diagnosing, and Treating Sjogren Syndrome

Robert I. Fox, MD, PhD

Disclosures

July 31, 2015

In This Article

In Summary

There is now agreement on new diagnostic criteria from ACR-EULAR. These criteria will be particularly helpful in studying new treatments (and restudying old treatments) for SS. Early identification of SS patients is important, but clinicians need to recognize the previously discussed limitations of specific biomarkers and diagnostic methods used. SGUS is a promising tool for diagnosis; however, significant variation in its sensitivity and specificity in reports by centers with excellence in ultrasound indicate caution for the rheumatologist who wants to introduce this method into their clinical practice.

Traditional therapy remains divided into topical treatment for dry eyes and dry mouth and treatment for fatigue. Although these symptoms have been described as "benign" features of SS, they are the cause of the greatest patient-reported disability. The greatest unmet need remains fatigue and cognitive dysfunction and will be the "Holy Grail" for the next decade of research where rheumatologists need to collaborate with neuroscientists and learn from studies in multiple sclerosis where these symptoms (as well as sicca) are frequently present.

Based on pathogenesis, targets such as homing receptors and chemokines seem like rational targets for drug development. Biologic therapies work best on extraglandular manifestations of SS, and future studies will need to identify patients who may be misdiagnosed with SLE or RA for their inclusion into SS trials. Advances in genetics and epigenetics (eg, gene methylation and microRNA) may suggest additional new therapeutic targets in SS.

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