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EULAR recommendations for the management of Sjögren's syndrome with topical and systemic therapies
- Source :
- UPCommons. Portal del coneixement obert de la UPC, Universitat Politècnica de Catalunya (UPC), Annals of the Rheumatic Diseases, Annals of the Rheumatic Diseases, 2019, 79 (1), pp.3-18. ⟨10.1136/annrheumdis-2019-216114⟩, Annals of the Rheumatic Diseases, BMJ Publishing Group, 2019, 79 (1), pp.3-18. ⟨10.1136/annrheumdis-2019-216114⟩
- Publication Year :
- 2019
-
Abstract
- International audience; The therapeutic management of Sjögren syndrome (SjS) has not changed substantially in recent decades: treatment decisions remain challenging in clinical practice, without a specific therapeutic target beyond the relief of symptoms as the most important goal. In view of this scenario, the European League Against Rheumatism (EULAR) promoted and supported an international collaborative study (EULAR SS Task Force) aimed at developing the first EULAR evidence and consensus-based recommendations for the management of patients with SjS with topical and systemic medications. The aim was to develop a rational therapeutic approach to SjS patients useful for healthcare professionals, physicians undergoing specialist training, medical students, the pharmaceutical industry and drug regulatory organisations following the 2014 EULAR standardised operating procedures. The Task Force (TF) included specialists in rheumatology, internal medicine, oral health, ophthalmology, gynaecology, dermatology and epidemiology, statisticians, general practitioners, nurses and patient representatives from 30 countries of the 5 continents. Evidence was collected from studies including primary SjS patients fulfilling the 2002/2016 criteria; when no evidence was available, evidence from studies including associated SjS or patients fulfilling previous sets of criteria was considered and extrapolated. The TF endorsed the presentation of general principles for the management of patients with SjS as three overarching, general consensus-based recommendations and 12 specific recommendations that form a logical sequence, starting with the management of the central triplet of symptoms (dryness, fatigue and pain) followed by the management of systemic disease. The recommendations address the use of topical oral (saliva substitutes) and ocular (artificial tear drops, topical non-steroidal anti-inflammatory drugs, topical corticosteroids, topical CyA, serum tear drops) therapies, oral muscarinic agonists (pilocarpine, cevimeline), hydroxychloroquine, oral glucocorticoids, synthetic immunosuppressive agents (cyclophosphamide, azathioprine, methotrexate, leflunomide and mycophenolate), and biological therapies (rituximab, abatacept and belimumab). For each recommendation, levels of evidence (mostly modest) and TF agreement (mostly very high) are provided. The 2019 EULAR recommendations are based on the evidence collected in the last 16 years in the management of primary 2002 SjS patients and on discussions between a large and broadly international TF. The recommendations synthesise current thinking on SjS treatment in a set of overarching principles and recommendations. We hope that the current recommendations will be broadly applied in clinical practice and/or serve as a template for national societies to develop local recommendations.
- Subjects :
- MESH: Antirheumatic Agents
Autoimmune diseases
MESH: Hydroxychloroquine
Matemàtiques i estadística::Matemàtica aplicada a les ciències [Àrees temàtiques de la UPC]
Azathioprine
Administration, Ophthalmic
MESH: Cyclosporine
0302 clinical medicine
Adrenal Cortex Hormones
MESH: Muscarinic Agonists
Epidemiology
Immunology and Allergy
030212 general & internal medicine
[SDV.MHEP.RSOA] Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system
treatment
Anti-Inflammatory Agents, Non-Steroidal
92 Biology and other natural sciences::92B Mathematical biology in general [Classificació AMS]
[SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences
MESH: Anti-Inflammatory Agents, Non-Steroidal
MESH: Administration, Ophthalmic
3. Good health
[SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences
Sjogren's Syndrome
[SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system
Antirheumatic Agents
Cyclosporine
Rituximab
MESH: Immunosuppressive Agents
MESH: Lubricant Eye Drops
sjøgren's syndrome
MESH: Saliva, Artificial
autoimmune diseases
Immunosuppressive Agents
medicine.drug
Hydroxychloroquine
medicine.medical_specialty
Biomatemàtica
Immunology
Muscarinic Agonists
General Biochemistry, Genetics and Molecular Biology
Lubricant Eye Drops
MESH: Adrenal Cortex Hormones
03 medical and health sciences
Therapeutic approach
Rheumatology
medicine
Humans
Intensive care medicine
Glucocorticoids
Sjøgren's syndrome
Biomathematics
030203 arthritis & rheumatology
MESH: Humans
business.industry
Abatacept
Saliva, Artificial
Evidence-based medicine
medicine.disease
Belimumab
Treatment
stomatognathic diseases
MESH: Sjogren's Syndrome
MESH: Glucocorticoids
business
Rheumatism
Subjects
Details
- ISSN :
- 14682060 and 00034967
- Volume :
- 79
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Annals of the rheumatic diseases
- Accession number :
- edsair.doi.dedup.....39d7e3abfd1ac58830ee8b114a47a6a5
- Full Text :
- https://doi.org/10.1136/annrheumdis-2019-216114⟩