Peripheral Neuropathy Common Among Patients with Sjögren’s Disease

Dr. Hal Scofield

CHICAGO—Neuropathies in patients with Sjögren’s disease are common, but also difficult to diagnose, and no single test for them is available. Sjögren’s disease does not yet have an effective disease-modifying anti-rheumatic drug, although that could change in the future, according to R. Hal Scofield, MD, professor in the Arthritis and Clinical Immunology Research Program at the Oklahoma Medical Research Foundation, Oklahoma City.

In the meantime, both neurologists and rheumatologists must collaborate to identify and treat neuropathies, which are common among patients with Sjögren’s disease.

Dr. Scofield and Arun Varadhachary, MD, PhD, professor of neurology and section chief in the neurohospitalist section, Washington University in St. Louis, brought together their respective specialty expertise during the ACR Convergence 2025 session Tackling the Burning Question of Peripheral Neuropathies in Sjögren’s Disease: New Guidelines.

Dr. Arun Varadhachary

In collaboration with the Sjögren’s Foundation, Dr. Scofield and Dr. Varadhachary have worked with colleagues to publish common nomenclature for peripheral nervous system disorders that affect both rheumatology and neurology.¹ A paper with specific guidelines for this topic is in press.²

Peripheral nervous system involvement with Sjögren’s disease can have several manifestations, including mononeuropathy, polyneuropathy and autonomic neuropathy, the presenters noted.

Although rheumatologists may stick to what they know best when treating patients with Sjögren’s disease, an understanding of the basics with peripheral neuropathy can be useful.

One pearl the presenters shared: The location of symptoms is the key for a neurological diagnosis, and history and physical exams localize the problem the majority of the time. However, electrodiagnostics can further assist with localization.

Mononeuropathy & Sjögren’s

Mononeuropathy involving the facial and trigeminal nerve is one potential type of neuropathy in Sjögren’s patients, with findings usually consistent with fifth or seventh cranial nerve dysfunction. Symptoms may include facial pain and motor function problems in the lower part of the face, such as trouble with biting and chewing. Physicians can offer a contrast-enhanced brain magnetic resonance imaging scan and also consider electrophysiological testing, including a blink reflex.

For dysfunction of the seventh cranial nerve, a 10-day or longer course of glucocorticoid treatment as well as the possible addition of valacyclovir should be considered. For dysfunction of the fifth cranial nerve, treatments may differ for trigeminal neuralgia vs. trigeminal neuropathy. Trigeminal neuralgia can be treated with carbamazepine or oxcarbazepine, along with alternatives or adjuncts, such as gabapentin or pregabalin, Dr. Varadhachary said. For trigeminal neuropathy, specialists can offer a short course of oral glucocorticoids for suspected acute inflammatory etiology.