Sjogren’s Syndrome: Strategies for Treatment

Authors

  • Arthur A.M. Bookman, MD, FRCPC Associate Professor of Medicine University of Toronto, Toronto, ON Coordinator, Multidisciplinary Sjogrens Clinic, University Health Network, Toronto, ON Chair, Medical Advisory Committee, Sjogrens Society of Canada

Abstract

Sjogren’s syndrome, characterized by dry eyes, dry mouth, and immunological hyperactivity, has been one of the most difficult rheumatic diseases to differentiate and define. After many hours of consensus group development, studies on large cohorts/registries of over 1500 patients in totality and following national, European, American, and finally consensus iterations, criteria have been agreed upon for the classification of this disease. In the final analysis, these criteria are objective and accessible for measurement, and a number of them can be documented in clinical practice. To treat Sjogren’s syndrome effectively, it is important to rely upon objective evidence with respect to the diagnosis of this disease, as well as the specific component of the condition that one is attempting to manage. 

Author Biography

Arthur A.M. Bookman, MD, FRCPC, Associate Professor of Medicine University of Toronto, Toronto, ON Coordinator, Multidisciplinary Sjogrens Clinic, University Health Network, Toronto, ON Chair, Medical Advisory Committee, Sjogrens Society of Canada

Associate Professor Medicine, University of Toronto and Coordinator, Multidisciplinary Sjogren’s Clinic, University Health Network. Senior Staff Physician at the Toronto Western Hospital. Dr. Bookman has been honoured as a Master by the Canadian Rheumatology Association where he has been the recipient of the ‘Distinguished Rheumatologist’ Award. He was recognized as Rheumatologist of the Year, by the Ontario Rheumatology Association. He has received the “Award of Distinction” from The Arthritis Society. Dr. Bookman is a former President of the Canadian Rheumatology Association and has served as Chair, Board of Directors, The Journal of Rheumatology. He has been the Division Director, Tri-Hospital Rheumatic Disease Unit, and Program Director, Division of Rheumatology, University of Toronto. He has been inducted into the University of Toronto Academy of Master Clinicians. He has 53 peer reviewed publications with a special interest in the clinical aspects of Sjogren’s Syndrome. He holds multiple teaching awards and has lectured nationally and internationally. He has Chaired the Sjogren’s Abstract Committee of the American College of Rheumatology and the International Sjogren’s Conference. 

References

Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, 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

Ripsman DA, Bookman AAM. Correlation between subjective and objective severity of oral and ocular dryness in primary Sjögren syndrome. J Rheumatol. 2021;48(8):1290-1294. doi:10.3899/jrheum.200907

Meng Z, Chu X, Zhang C, Liu H, Yang R, Huang Y, et al. Efficacy and safety evaluation of a single thermal pulsation system treatment (Lipiflow(®)) on meibomian gland dysfunction: a randomized controlled clinical trial. Int Ophthalmol. 2023;43(4):1175-1184. doi:10.1007/s10792-022-02516-x

Moshirfar M, Pierson K, Hanamaikai K, Santiago-Caban L, Muthappan V, Passi SF. Artificial tears potpourri: a literature review. Clin Ophthalmol. 2014;8:1419-1433. doi:10.2147/opth.S65263

Sall K, Stevenson OD, Mundorf TK, Reis BL. Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. CsA Phase 3 Study Group. Ophthalmology. 2000;107(4):631-639.doi:10.1016/s0161-6420(99)00176-1

Sheppard JD, Torkildsen GL, Lonsdale JD, D’Ambrosio FA, Jr., McLaurin EB, Eiferman RA, et al. Lifitegrast ophthalmic solution 5.0% for treatment of dry eye disease: results of the OPUS-1 phase 3 study. Ophthalmology. 2014;121(2):475-483. doi:10.1016/j.ophtha.2013.09.015

Bashrahil B, Taher N, Alzahrani Z, Alnabihi A, Aldahlawi A, Alkhathlan M, et al. The efficacy and safety of varenicline nasal spray for the management of dry eye signs: a systematic review and meta-analysis. BMC Ophthalmol. 2023;23(1):319. doi:10.1186/s12886-023-03069-y

Noble BA, Loh RS, MacLennan S, Pesudovs K, Reynolds A, Bridges LR, et al. Comparison of autologous serum eye drops with conventional therapy in a randomised controlled crossover trial for ocular surface disease. Sjogren’s Syndrome: Strategies for Treatment Br J Ophthalmol. 2004;88(5):647-652. doi:10.1136/bjo.2003.026211

García-Conca V, Abad-Collado M, Hueso-Abancens JR, Mengual-Verdú E, Piñero DP, Aguirre-Balsalobre F, et al. Efficacy and safety of treatment of hyposecretory dry eye with platelet-rich plasma. Acta Ophthalmol. 2019;97(2):e170-e178. doi:10.1111/aos.13907

Vivino FB, Al-Hashimi I, Khan Z, LeVeque FG, Salisbury PL, 3rd, Tran-Johnson TK, et al. Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with Sjögren syndrome: a randomized, placebo-controlled, fixed-dose, multicenter trial. P92-01 Study Group. Arch Intern Med. 1999;159(2):174-181. doi:10.1001/archinte.159.2.174

Petrone D, Condemi JJ, Fife R, Gluck O, Cohen S, Dalgin P. A double-blind, randomized, placebo-controlled study of cevimeline in Sjögren’s syndrome patients with xerostomia and keratoconjunctivitis sicca. Arthritis Rheum. 2002;46(3):748-754. doi:10.1002/art.510

Xin W, Leung KC, Lo EC, Mok MY, Leung MH. A randomized, double-blind, placebo-controlled clinical trial of fluoride varnish in preventing dental caries of Sjögren’s syndrome patients. BMC Oral Health. 2016;16(1):102. doi:10.1186/s12903-016-0296-7

Chrcanovic BR, Kisch J, Wennerberg A. Dental implants in patients with Sjögren’s syndrome: a case series and a systematic review. Int J Oral Maxillofac Surg. 2019;48(9):1250-1259. doi:10.1016/j.ijom.2019.02.005

Fisher BA, Szántó A, Ng W-F, Bombardieri M, Posch MG, Papas AS, et al. Assessment of the anti-CD40 antibody iscalimab in patients with primary Sjögren’s syndrome: a multicentre, randomised, double-blind, placebo-controlled, proof-of-concept study. Lancet. 2020;2(3):E142 E152. doi:10.1016/s2665-9913(19)30135-3

Bowman SJ, Fox R, Dörner T, Mariette X, Papas A, Grader-Beck T, et al. Safety and efficacy of subcutaneous ianalumab (VAY736) in patients with primary Sjögren’s syndrome: a randomised, double-blind, placebo-controlled, phase 2b dose-finding trial. Lancet. 2022;399(10320):161-171. doi:10.1016/s0140-6736(21)02251-0

St Clair EW, Wang L, Alevizos I, Rees W, Baer A, Ng WF, et al. OP0143 Efficacy and safety of dazodalibep (vib4920/hzn4920) in subjects with Sjögren’s syndrome: a phase 2, randomized, double-blind, placebo-controlled, proof of concept study. Annals of the Rheumatic Diseases. 2023;82(Suppl 1):95-95. doi:10.1136/annrheumdis-2023-eular.234

Jensen LT, Attfield KE, Feldmann M, Fugger L. Allosteric TYK2 inhibition: redefining autoimmune disease therapy beyond JAK1-3 inhibitors. EBioMedicine. 2023;97:104840. doi:10.1016/j.ebiom.2023.104840

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Published

2024-04-23

How to Cite

1.
Bookman AA. Sjogren’s Syndrome: Strategies for Treatment. Can Rheumatol Today [Internet]. 2024 Apr. 23 [cited 2024 Jun. 24];1(1):11–18. Available from: https://canadianrheumatologytoday.com/article/view/1-1-Bookman

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