Alan Baer, MD, from Johns Hopkins University School of Medicine, Baltimore, who studies Sjögren’s, tells Reuters Health by email, “Sjögren’s is a disease with a high symptom burden for many patients and potentially serious complications for a minority. There should be an emphasis on accuracy of diagnosis, comprehensive evaluation and evidence-based approaches to treatment.”
Although he agrees that patients can benefit from management at expert centers, he notes that “such centers are rare in the U.S., and specialists with the requisite expertise are few in number. Thus, it may prove impractical to have all Sjögren’s patients managed in specialty centers.”
Dr. Baer adds, “The recommendations are hindered by the need to rely on data from limited clinical trials. The results of such trials may not capture impressive anecdotal data. As an example, many of my patients with severe dry eye gain dramatic relief from autologous serum tears. Similarly, I would expect many ophthalmologists would argue that punctal plug insertion is beneficial and should be tried earlier in the therapeutic algorithm (i.e., before the use of expensive autologous serum tears).”
Dr. Ramos-Casals did not respond to a request for comments.
- Ramos-Casals M, Brito-Zerón P2, Bombardieri S et al. EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies. Ann Rheum Dis. 2019 Oct 31. pii: annrheumdis-2019-216114. [Epub ahead of print]