The quality of evidence for the use of rituximab was low, but the consensus was also based on the use of rituximab for other rheumatologic conditions and expert opinion.
Use of DMARDs for Musculoskeletal Pain
A decision tree was developed to aid clinicians in prescribing DMARDs to treat inflammatory musculoskeletal pain, which includes symptoms related to non-erosive synovitis, polyarthritis and inflammatory myositis, in patients with primary Sjögren’s syndrome. The first-line treatment recommendation is hydroxychloroquine (HCQ). (Note: The guideline also recommends the use of HCQ to treat fatigue in selected situations.)
However, the authors note in their discussion that the topic review group “was unable to find high-quality evidence to support the use of DMARDs for this indication. … Thus, recommendations were formulated largely based on expert opinion.”
If HCQ is ineffective, clinicians may consider treatment with methotrexate alone. The guidelines also outline further treatment options if both monotherapies fail, including the use of HCQ plus methotrexate and short- or long-term corticosteroid use.
Carsons SE, Vivino FB, Parke A, et al. Treatment guidelines for rheumatologic manifestations of Sjögren’s syndrome: Use of biologic agents, management of fatigue and inflammatory musculoskeletal pain. Arthritis Care Res (Hoboken). 69(4):517–527. doi: 10.1002/acr.22968.
