Clinical practice guideline for Sjögren’s syndrome 2017

Sumida, Takayuki; Azuma, Naoto; Moriyama, Masafumi; Takahashi, Hiroyuki; Asashima, Hiromitsu; Honda, Fumika; Abe, Saori; Ono, Yuko; Hirota, Tomoya; Hirata, Shintaro; Tanaka, Yoshiya; Shimizu, Toshimasa; Nakamura, Hideki; Kawakami, Atsushi; Sano, Hajime; Ogawa, Yoko; Ohta, Michio; Ryo, Koufuchi; Saito, Ichiro; Tanaka, Akihiko; Nakamura, Seiji; Takamura, Etsuko; Tanaka, Masao; Suzuki, Katsuya; Takeuchi, Tsutomu; Yamakawa, Naoyuki; Mimori, Tsuneyo; Ohta, Akio; Nishiyama, Susumu; Yoshihara, Toshio; Suzuki, Yasunori; Kawano, Mitsuhiro; Tomiita, Minako; Tsuboi, Hiroto

doi:10.1080/14397595.2018.1438093

Cited by 44 publications

(30 citation statements)

References 146 publications

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“…In SjS, we are very far from the ‘disease modification’ concept as the mainstay of treatment (as used in other diseases such as RA, a concept that allows the use of the term disease modifying antirheumatic drugs for many drugs that have demonstrated the ability to prevent structural damage progression in RA). A rapid overview of the LoE that support each statement (table 1) shows that all recommendations for managing oral and ocular dryness are principally supported by evidence extrapolated from Cochrane SLRs that evaluated their management in mixed aetiological populations; on the management/prevention of dryness-related complications (oral ulcers, candidiasis, caries/dental complications, ocular infections), the management of dryness other than oral or ocular, or the role of non-therapeutic interventions in dryness, there was a very limited number of studies carried out in 2002 primary SjS patients, and we recommend following published guidelines 9–11 37 94. With respect to the most frequently used synthetic drugs (GCs and immunosuppressive agents), the available evidence came from isolated uncontrolled studies.…”

Section: Discussionmentioning

confidence: 99%

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EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies

et al. 2019

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The therapeutic management of Sjögren syndrome (SjS) has not changed substantially in recent decades: treatment decisions remain challenging in clinical practice, without a specific therapeutic target beyond the relief of symptoms as the most important goal. In view of this scenario, the European League Against Rheumatism (EULAR) promoted and supported an international collaborative study (EULAR SS Task Force) aimed at developing the first EULAR evidence and consensus-based recommendations for the management of patients with 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. Evidence was collected from studies including primary SjS patients fulfilling the 2002/2016 criteria; when no evidence was available, evidence from studies including associated SjS or patients fulfilling previous sets of criteria was considered and extrapolated. 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 systemic disease. The recommendations address the use of topical oral (saliva substitutes) and ocular (artificial tear drops, topical non-steroidal anti-inflammatory drugs, topical corticosteroids, topical CyA, serum tear drops) therapies, oral muscarinic agonists (pilocarpine, cevimeline), hydroxychloroquine, oral glucocorticoids, synthetic immunosuppressive agents (cyclophosphamide, azathioprine, methotrexate, leflunomide and mycophenolate), and biological therapies (rituximab, abatacept and belimumab). For each recommendation, levels of evidence (mostly modest) and TF agreement (mostly very high) are provided. The 2019 EULAR recommendations are based on the evidence collected in the last 16 years in the management of primary 2002 SjS patients and on discussions between a large and broadly international TF. The recommendations synthesise current thinking on SjS treatment in a set of overarching principles and recommendations. We hope that the current recommendations will be broadly applied in clinical practice and/or serve as a template for national societies to develop local recommendations.

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Section: Discussionmentioning

confidence: 99%

“…Treatment decisions remain challenging in clinical practice, without a specific therapeutic target beyond the relief of symptoms as the most important goal. Therefore there is growing interest in the proposal of clinical guidelines by national scientific societies 8–11…”

Section: Introductionmentioning

confidence: 99%

EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies

et al. 2019

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“…Diagnosis of NEAD. The diagnosis of each single NEAD concurrent with HT was based on the clinical, serological, and histological examination obtained by biopsy when appropriate (22,23) and/or according to the criteria approved by specific Guidelines or even Consensus Conferences (22)(23)(24)(25)(26)(27)(28). A patient with additional autoimmune disorder has been included in the study only when the diagnosis of each chronic autoimmune disease was confirmed by specialists (i.e., gastroenterologists, rheumatologists, dermatologists) who verified the diagnosis.…”

Section: Methodsmentioning

confidence: 99%

Recurrent Pregnancy Loss in Women with Hashimoto's Thyroiditis with Concurrent Non-Endocrine Autoimmune Disorders

Cellini

Santaguida

Stramazzo

et al. 2020

Thyroid

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Background: An increased rate of recurrent miscarriage has been described in patients with autoimmune thyroid disease. However, there is a lack of studies that assess the rate of recurrent pregnancy loss (RPL) in patients with Hashimoto's thyroiditis (HT) isolated or with concurrent non-endocrine autoimmune disorders (NEAD). The objective of the study was to assess the rate of RPL in patients with HT isolated or accompanied with non-endocrine autoimmune diseases. Methods: This is a retrospective observational cohort study with a systematic review of the NEAD with concurrent HT in an outpatient Endocrinology Unit at a University Hospital. Among the 3480 consecutively examined women with HT, 87 patients met the criteria of RPL and represented the study group. Sixty-five of them had isolated HT and 22 women had HT+NEAD. Results: The rate of RPL in women with HT was 2.1% versus 5.64% observed in women with HT+NEAD (odds ratio = 2.78 [95% confidence interval 1.70-4.57]; p < 0.0001). On subdivision, this difference was still evident in euthyroid patients (p < 0.0001), while it disappeared in hypothyroid women (p = 0.21). The RPL did not correlate with the autoantibody concentrations nor in women with isolated HT nor in those with HT+NEAD. The presence of antiphospholipid syndrome (APS) explained RPL in 3 out of 22 (14%) patients with HT+NEAD, the remaining being related to different autoimmune disorders. Interestingly, even subtracting the patients with APS, RPL was more frequent in patients with poly-autoimmunity than in patients with isolated HT (p = 0.0013). Conclusions: The co-presence of NEAD is correlated with a higher risk of RPL in women with HT. The association with APS may explain only a fraction of RPL rate in patients with poly-autoimmunity.

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“…[32][33][34][35] Rebamipide, known as a mucosal protective and anti-inflammatory agent, is also recommended for SS dry eye. [36][37][38] The SS clinical practice guidelines in Japan (released by the Sumida group in 2017) 39 provided evidence for the treatment of SS-related dry eye by diquafosol, 31 rebamipide, 39 and hyaluronic acid. 40 According to Japanese SS clinical practice guidelines, 39 systemic corticosteroid is not recommended for SS dry eye and dry mouth as exocrinopathy.…”

Section: Treatmentmentioning

confidence: 99%

“…7 Both may improve SS dry eye and are recommended as biological reagents for systemic treatment according to SS clinical practice guidelines. 7,39 Other biological reagents are not recommended for treating SS dry eye, according to Japanese SS guidelines.…”

Section: Treatmentmentioning

confidence: 99%

Sjögren's Syndrome, Non-Sjögren's Syndrome, and Graft-Versus-Host Disease Related Dry Eye

Ogawa

2018

Invest. Ophthalmol. Vis. Sci.

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I have reviewed available literature on dry eye related to Sjögren's syndrome (SS), non-Sjögren's syndrome (non-SS), and graft-versus-host disease (GVHD) to examine aqueous tear deficient dry eye as a subtype of dry eye. This section will focus on clinical studies regarding those subtypes of dry eye. I searched the PubMed database from 1990-2017 for discussion of clinical features, diagnostic criteria, and risk factors of SS, non-SS, and GVHD-related dry eye. In addition, therapeutic options for each subtype of dry eye are described. Although the clinical presentations of SS and chronic graft-versus-host disease (cGVHD) are similar, ocular surface fibrotic changes are characteristic of ocular GVHD but not SS-or non-SS-related dry eye. Recently, diagnostic criteria for each disease have been proposed and include the American College of Rheumatology/European League Against Rheumatism (ACR-EULAR) for SS and the International Chronic Ocular GVHD consensus criteria. Although there has been gradual progress, there are currently no specific therapies and few approved treatment options for these intractable diseases, including SS and GVHD. As judged by the findings, these subtypes of dry eye are different clinical entities from simple dry eye. Therefore, novel therapies, specific to these subtypes of dry eye, may be required in the future.

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Clinical practice guideline for Sjögren’s syndrome 2017

Abstract: The CPG for SS 2017 should contribute to improvement and standardization of diagnosis and treatment of SS.

Cited by 44 publications

References 146 publications

EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies

EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies

Recurrent Pregnancy Loss in Women with Hashimoto's Thyroiditis with Concurrent Non-Endocrine Autoimmune Disorders

Sjögren's Syndrome, Non-Sjögren's Syndrome, and Graft-Versus-Host Disease Related Dry Eye

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