ESSDAI and Lab Monitoring Can Sharpen Sjögren’s Care

As targeted therapies near approval for Sjögren’s disease, a more structured approach to assessment may help rheumatologists identify patients most likely to benefit.

In this Special Report series, Nehad Soloman, MD, FACR, of Arizona Arthritis and Rheumatology Associates, spoke with Teja Kapoor, MD, director of the Columbia Sjögren’s Center, about practical takeaways for clinical practice.

Years of failed trials have still yielded insight, chiefly the recognition of how heterogeneous the disease is. Clinicians need not complete formal ESSDAI training to benefit from the index, which can serve as a teaching guide to manifestations beyond dryness.

Reviewing its domains and weighting can function as a review of systems for each patient, reducing the chance of missing extraglandular disease.¹ Incorporating salivary gland ultrasound and referencing the classification criteria as guidance can add further structure to management.²

Laboratory surveillance adds another layer. Checking quantitative immunoglobulins and complement levels roughly every 6 months, along with cryoglobulins, can uncover systemic activity not apparent on examination.

Clinicians should also follow emerging data on repurposed combinations, such as hydroxychloroquine with mycophenolate or leflunomide.³ Together, these steps position practices to match patients with systemic disease to new agents as they become available.

References

1. Seror R, Ravaud P, Bowman SJ, et al. EULAR Sjogren’s syndrome disease activity index: development of a consensus systemic disease activity index for primary Sjogren’s syndrome. Ann Rheum Dis. 2010;69(6):1103-1109. doi:10.1136/ard.2009.110619

2. Shiboski CH, Shiboski SC, Seror R, et al. 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren’s syndrome: a consensus and data-driven methodology involving three international patient cohorts. Arthritis Rheumatol. 2017;69(1):35-45. doi:10.1002/art.39859

3. Yang M, Lu Y, Wang S, Lin S. Efficacy and safety of pharmacological treatment for Sjögren’s disease: a network meta-analysis. Z Rheumatol. 2026;85(8):632-641. doi:10.1007/s00393-026-01824-2