Find out how much you know about one of the most difficult chronic autoimmune disorders to manage.
Reference:1. Carsons SE, Vivino FB, Parke A, et al. Treatment guidelines for rheumatologic manifestations of SjÃ¶gren’s syndrome: use of biologic agents, management of fatigue, and inflammatory musculoskeletal pain. Arthritis Care Res. 2017;69:517-527.
Treatment guidelines for systemic SjÃ¶gren syndrome from the SjÃ¶gren’s Syndrome Foundation focus on the appropriate use of biologic agents and the management of fatigue and inflammatory musculoskeletal pain.1 The recommendations are intended to alleviate symptoms, improve quality of life, and prevent further damage.
In honor of SjÃ¶gren’s Awareness Month in April, we offer this true/false quiz based on the treatment guidelines. Test your knowledge of what the guideline authors describe as one of the most difficult chronic autoimmune rheumatic disorders to manage.
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True or false? Tumor necrosis factor (TNF) inhibitors are recommended for the treatment of sicca symptoms in patients with primary SjÃ¶gren syndrome.
FALSE: TNF inhibitors should not be used to treat sicca symptoms in patients with primary SjÃ¶gren syndrome. This recommendation is based on a small controlled trial and a multicenter trial that showed little to no improvement in these patients. However, the authors caution that this recommendation should not be interpreted to discourage use of TNF inhibitors in settings where there is overlap of SjÃ¶gren syndrome with rheumatoid arthritis or other conditions for which TNF inhibition therapy is indicated.
True or false? Dehydroepiandrosterone (DHEA) is not recommended for the treatment of fatigue in SjÃ¶gren syndrome.
TRUE: DHEA is not recommended for the treatment of fatigue in patients with SjÃ¶gren syndrome. This recommendation is based on the results of clinical trials in which patients experienced no improvement.
True or false? The only strong therapeutic recommendation for fatigue in SjÃ¶gren syndrome is exercise.
TRUE: Fatigue is one of the most difficult symptoms to manage in SjÃ¶gren syndrome, and exercise is the only strongly recommended intervention.
True or false? The first line of treatment for inflammatory musculoskeletal pain in primary SjÃ¶gren syndrome should be corticosteroids.
FALSE: The guidelines outline recommendations for inflammatory musculoskeletal pain in primary SjÃ¶gren syndrome as a decision tree, with the first-line treatment as hydroxychloroquine (HCQ). If HCQ is not effective, methotrexate may be considered first as monotherapy and then in combination with HCQ. If combination therapy is ineffective, the next option is a shortâterm corticosteroid regimen.
True or false? Rituximab may be considered as a therapeutic option for xerostomia in patients with primary SjÃ¶gren syndrome who have evidence of residual salivary production and significant evidence of oral damage, for whom conventional therapies (eg, topical moisturizers and secretagogues) have been inadequate.
TRUE: Rituximab may be considered for xerostomia in patients with primary SjÃ¶gren syndrome who have residual salivary production and significant oral damage, for whom conventional therapies have proved inadequate. This recommendation is based on data from an analysis of secondary outcome measures and a small randomized controlled trial. However, rituximab may be associated with significant risks (eg, infectious complications), and clinicians are advised to monitor patients closely.