Treatment Guidelines for Rheumatologic Manifestations of Sjögren's Syndrome: Use of Biologic Agents, Management of Fatigue, and Inflammatory Musculoskeletal Pain

Steven E. Carsons, Frederick B. Vivino, Ann Parke, Nancy Carteron, Vidya Sankar, Richard Brasington, Michael T. Brennan, William Ehlers, Robert Fox, Hal Scofield, Katherine M. Hammitt, Julius Birnbaum, Stuart Kassan, Steven Mandel

Research output: Contribution to journalArticle

Abstract

Objective: The Sjögren's Syndrome Foundation clinical practice guidelines (CPGs) are designed to improve quality and consistency of care in Sjögren's syndrome by offering recommendations for management. Methods: Management questions for the systemic manifestations of Sjögren's syndrome were posed by the CPG committee with input from patients and rheumatologists. Clinical questions were assigned to a topic review group that performed systematic reviews and data extraction and drafted guidelines. Quality of evidence and strength of recommendation were rated using the American Society of Clinical Oncology's modification of the Grading of Recommendations Assessment, Development, and Evaluation. Guideline recommendations were reviewed by a consensus expert panel (CEP) composed of 30–40 clinicians from academia and community practices, as well as registered nurses and patients, using a modified Delphi process. A CEP agreement level of 75% was set as a minimum for adoption of a guideline recommendation. Results: Consensus was achieved for 19 recommendations; for 11 additional modules, available data were insufficient to allow a recommendation to be formulated. Of the 19 recommendations, 15 required 1 Delphi round, 2 required 2 rounds, and 2 required 3 rounds. Conclusion: Key recommendations include a decision tree for the use of oral disease-modifying antirheumatic drugs for inflammatory musculoskeletal pain, use of self-care measures and advice regarding exercise to reduce fatigue, and the use of rituximab in selected clinical settings for oral and ocular dryness and for certain extraglandular manifestations, including vasculitis, severe parotid swelling, inflammatory arthritis, pulmonary disease, and mononeuritis multiplex. The CPG committee strongly discouraged the use of tumor necrosis factor inhibitors for sicca symptoms and for the majority of clinical contexts in primary Sjögren's syndrome.

Original languageEnglish (US)
Pages (from-to)517-527
Number of pages11
JournalArthritis Care and Research
Volume69
Issue number4
DOIs
StatePublished - Apr 1 2017

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Musculoskeletal Pain
Biological Factors
Fatigue
Practice Guidelines
Guidelines
Consensus
Mouth Diseases
Mononeuropathies
Xerostomia
Decision Trees
Antirheumatic Agents
Medical Oncology
Quality of Health Care
Therapeutics
Self Care
Vasculitis
Lung Diseases
Arthritis
Tumor Necrosis Factor-alpha
Nurses

ASJC Scopus subject areas

  • Rheumatology

Cite this

Treatment Guidelines for Rheumatologic Manifestations of Sjögren's Syndrome : Use of Biologic Agents, Management of Fatigue, and Inflammatory Musculoskeletal Pain. / Carsons, Steven E.; Vivino, Frederick B.; Parke, Ann; Carteron, Nancy; Sankar, Vidya; Brasington, Richard; Brennan, Michael T.; Ehlers, William; Fox, Robert; Scofield, Hal; Hammitt, Katherine M.; Birnbaum, Julius; Kassan, Stuart; Mandel, Steven.

In: Arthritis Care and Research, Vol. 69, No. 4, 01.04.2017, p. 517-527.

Research output: Contribution to journalArticle

Carsons, SE, Vivino, FB, Parke, A, Carteron, N, Sankar, V, Brasington, R, Brennan, MT, Ehlers, W, Fox, R, Scofield, H, Hammitt, KM, Birnbaum, J, Kassan, S & Mandel, S 2017, 'Treatment Guidelines for Rheumatologic Manifestations of Sjögren's Syndrome: Use of Biologic Agents, Management of Fatigue, and Inflammatory Musculoskeletal Pain', Arthritis Care and Research, vol. 69, no. 4, pp. 517-527. https://doi.org/10.1002/acr.22968
Carsons, Steven E. ; Vivino, Frederick B. ; Parke, Ann ; Carteron, Nancy ; Sankar, Vidya ; Brasington, Richard ; Brennan, Michael T. ; Ehlers, William ; Fox, Robert ; Scofield, Hal ; Hammitt, Katherine M. ; Birnbaum, Julius ; Kassan, Stuart ; Mandel, Steven. / Treatment Guidelines for Rheumatologic Manifestations of Sjögren's Syndrome : Use of Biologic Agents, Management of Fatigue, and Inflammatory Musculoskeletal Pain. In: Arthritis Care and Research. 2017 ; Vol. 69, No. 4. pp. 517-527.
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AU - Parke, Ann

AU - Carteron, Nancy

AU - Sankar, Vidya

AU - Brasington, Richard

AU - Brennan, Michael T.

AU - Ehlers, William

AU - Fox, Robert

AU - Scofield, Hal

AU - Hammitt, Katherine M.

AU - Birnbaum, Julius

AU - Kassan, Stuart

AU - Mandel, Steven

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