AB0533 Recommendations of Brazilian Society of Rheumatology for the Treatment of SjÖGren's Syndrome

Abstract

ObjectivesRecommendations of Brazilian Society of Rheumatology for the treatment of Sjögren's syndrome (SS) were developed to guide management of SS considering the Brazilian social and economic context.MethodsIt was based on specialist's opinion and systematic review on MEDLINE (PubMed) and Cochrane database until October 2014, including 127 articles classified according Oxford & Grade.ResultsForty-four recommendations were organized in 3 main topics: Part 1. General recommendations and patient education: The management of SS should be conducted by multidisciplinary team. Systemic treatment should be according disease severity measured by EULAR Sjögren's Syndrome Disease Activity (ESSDAI). Patients should avoid caffeine, tobacco, alcohol, toothpaste with abrasive, and mouthrinses with alcohol. Patient should be educated about preventive measures for oral health and hydration. Aerobic exercise improves fatigue and quality of life. Immunization to influenza and pneumococo are indicated. Serum levels of vitamin D should be evaluated and supplemented if it is necessary. Part 2. Symptomatic treatment of dryness: Topical treatment for dry mouth includes saliva substitutes, sugar-free candies and gums. Topical treatments for dry eye are lubricants (glucanes or carboximethylcelulose), cyclosporine 0.05%, and punctual occlusion. Topical glucocorticoids may be used for severe dry eye for short time avoiding complications. Pilocarpine and cevimeline should be used for dry mouth and for severe dry eye. N-acetylcysteine may be used for dryness symptoms, including patients showing intolerance for muscarinic agonists. Omega-3 supplementation may be used to dry eye. Part 3. Systemic treatment: Immunosupressant and/or biological therapy are not indicated to dryness treatment. Hydroxichloroquine, glucocorticoid, and immunossupressants (azathioprine, mycophenolate mofetil, cyclophosphamide, cyclosporine) should be indicated according severity of systemic involvement. Rituximab is indicated to treat systemic manifestations without improvement with immunosuppressive therapy. Abatacept and belimumab may be considered in patients not responding to rituximab and with high level of disease activity.AcknowledgementsSociedade Brasileira de Reumatologia (SBR)Disclosure of InterestNone declared

Seropositive juvenile rheumatoid arthritis with Sjo gren's syndrome: features of diagnosis and treatment choice (a case report)

“…Однако у пациентов с ЮРА в сочетании с СШ их применение нежелательно в связи с повышенным риском онкологической патологии [10,16], а также с учетом ранее опубликованных сообщений о недостаточной эффективности указанного лечения при СШ [17]. При выборе ГИБП мы в первую очередь учитывали наличие высокоактивного СШ и данные литературы об эффективности РТМ именно при этой нозологии, хотя формально у РТМ нет официально зарегистрированных показаний для СШ, особенно первичного [18,19].…”