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.

Sjögren syndrome is a systemic autoimmune disease causing secretory gland dysfunction. This leads to dryness of the main mucosal surfaces such as the mouth, eyes, nose, pharynx, larynx, and vagina.1 Sjögren syndrome may be a serious disease, with excess mortality caused by haematological cancer.2 The cause of Sjögren syndrome is unknown, but factors postulated to play a role are both genetic and environmental.1 The disease overwhelmingly affects middle aged women but may also affect children, men, and elderly people. When sicca symptoms appear in a previously healthy person, the syndrome is classified as primary Sjögren syndrome. Sjögren syndrome associated with another underlying systemic autoimmune disorder, such as systemic lupus erythematosus, rheumatoid arthritis, or scleroderma is known as secondary or, increasingly, associated Sjögren syndrome. Sicca symptoms (dry mouth and eyes) are among the most common oral and ocular complaints seen by general practitioners, but even so the disease is often underdiagnosed or misdiagnosed.3 4 Although incidence data in primary care are scarce, preliminary reports suggest it may be around two per 1000 patients per year,5 with an overall prevalence in Europe of nearly 0.1%.6 7 Patients with Sjögren syndrome require a health spend double that of the mean for primary care patients and similar to that for patients with rheumatoid arthritis.8 9 #### Methods We searched Medline for English language articles published between 1 January 1986 and 31 August 2011 for studies in adult humans using the MeSH term “Sjögren’s syndrome.” Duplicate publications, case reports, experimental studies, and uncontrolled series with fewer than 10 patients were excluded. We also manually searched the reference list of relevant articles retrieved. Study designs were considered in the following order (listed from highest to lowest evidence quality): controlled trials, prospective cohort studies, case-control studies, retrospective studies, and case series. There …

Review from JAMA — Treatment of Primary Sjögren Syndrome — A Systematic Review

Long COVID-19 may be defined as patients who, four weeks after the diagnosis of SARS-Cov-2 infection, continue to have signs and symptoms not explainable by other causes. The estimated frequency is around 10% and signs and symptoms may last for months. The main long-term manifestations observed in other coronaviruses (Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS)) are very similar to and have clear clinical parallels with SARS-CoV-2: mainly respiratory, musculoskeletal, and neuropsychiatric. The growing number of patients worldwide will have an impact on health systems. Therefore, the main objective of these clinical practice guidelines is to identify patients with signs and symptoms of long COVID-19 in primary care through a protocolized diagnostic process that studies possible etiologies and establishes an accurate differential diagnosis. The guidelines have been developed pragmatically by compiling the few studies published so far on long COVID-19, editorials and expert opinions, press releases, and the authors’ clinical experience. Patients with long COVID-19 should be managed using structured primary care visits based on the time from diagnosis of SARS-CoV-2 infection. Based on the current limited evidence, disease management of long COVID-19 signs and symptoms will require a holistic, longitudinal follow up in primary care, multidisciplinary rehabilitation services, and the empowerment of affected patient groups.