Turkish Society for Rheumatology recommendations for topical and systemic treatments in Sjögren's disease.

Abstract

Objectives: The aim of this work was to develop standardised recommendations for the treatment of Sjögren's disease (SjD) based on existing evidence and expert opinion.

Methods: The task force (TF) consisted of Turkish specialists in rheumatology, ophthalmology and dentistry with an interest in SjD. The group used the Population, Intervention, Comparison and Outcome (PICO) format to frame its clinical questions. A systematic literature review on the therapeutic management of SjD was subsequently conducted in accordance with PRISMA guidelines. Levels of evidence (LoE) were assigned according to the 2011 Oxford Centre for Evidence-Based Medicine (CEBM) standards.

Results: The recommendations are categorised under the following headings: general recommendations, management of ocular and oral dryness, and management of systemic organ involvements. Management of sicca symptoms benefits from a wealth of high-level evidence, highlighting topical therapies as the gold standard. Conversely, the treatment of systemic involvement relies heavily on case series and clinical experience. Here, glucocorticoids, hydroxychloroquine, and immunosuppressive agents remain cornerstone therapies. Overall, biologic therapies have demonstrated limited efficacy in SjD; however, they may be beneficial in selected patient subgroups and can be considered in cases of refractory systemic involvement.

Conclusions: The recommendations on SjD treatment, derived from a systematic literature review and clinical experience, will guide clinicians in the management of patients, based on a set of overarching principles.