According to the guidelines, HCQ remains the first-line option for inflammatory musculoskeletal pain; however, other disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate, may be considered in certain situations, including more severe cases when the perceived benefits outweigh the risk of increased toxicity. These situations include:
You Might Also Like
Explore This IssueJune 2017
Also By This Author
- Patients who are HCQ responsive but must discontinue therapy due to toxicity or adverse effects;
- Patients who have inadequate response to HCQ;
- Patients with severe steroid-responsive musculoskeletal pain and persistent symptoms who need another DMARD for steroid-sparing effect; and for
- Patients with objective evidence of synovitis.
The decision tree also states that when HCQ or methotrexate alone or the two in combination are ineffective, ≤15 mg/day of corticosteroids for one month or shorter time frame may be considered. Corticosteroids may be used for more than one month to manage inflammatory musculoskeletal pain, “but efforts should be made to find a steroid-sparing agent as soon as possible.”
According to Dr. Carsons, clinicians who treat Sjögren’s syndrome should also become familiar with the published oral and ocular guidelines because, although some patients display prominent rheumatologic manifestations, nearly all Sjögren’s patients have dry eyes and dry mouth, complicated by ongoing ocular and dental problems.3,4 The guideline committee feels that rheumatologists should be familiar with the basic principles of managing ocular and oral manifestations in order to guide overall patient management, Dr. Carsons says.
“Managing patients with Sjögren’s syndrome involves multiple specialties, not only for treatment but also for diagnosis. You have to have close cooperation among rheumatologists, ophthalmologists and dentists,” Dr. Carsons says.
Sjögren’s syndrome remains one of the most difficult autoimmune rheumatic disorders to manage, and to date, there are no curative or remittive agents. The guidelines state that “therapeutic goals remain symptom palliation, improved quality of life, prevention of damage and appropriate selection of patients for immunosuppressive therapy.”
Supplemental material published online with the current manuscript offers information and observations about future directions for research, including development of improved outcome measures for research studies, additional investigation of B cells as therapeutic targets for Sjögren’s and development of orally administered small molecule immunomodulators for Sjögren’s treatment.
Kathy Holliman, MEd, has been a medical writer and editor since 1997.
Sjögren’s syndrome remains one of the most difficult autoimmune rheumatic disorders to manage, and to date, there are no curative or remittive agents. The clinical practice guidelines from the Sjögren’s Syndrome Foundation are designed to improve quality and consistency of care in Sjögren’s syndrome by offering recommendations for management. Consensus was achieved for 19 recommendations.