Algorithm of glandular function assessment and therapeutic approach in patients with primary SjS presenting with oral dryness. SjS, Sjögren syndrome; SWSF, stimulated whole salivary flows; UWSF, unstimulated whole salivary flows.

Table adapted from: Ramos-Casals M, Brito-Zerón P, Bombardieri S On behalf of the EULAR-Sjögren Syndrome Task Force Group, et al. “EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies.” Annals of the Rheumatic Diseases 2020;79:3-18.

Algorithm of glandular function assessment and therapeutic approach in patients with primary SjS presenting with ocular dryness. *Consider neuropathic pain if OSS≤1. **Additional criteria for severity: (1) impaired visual function (photophobia, visual acuity modification or low contrast sensitivity); (2) blepharospasm (secondary to ocular inflammation); (3) severe meibomian gland disease or eyelid inflammation. ***For short-term indications (2–4 weeks). CyA, ciclosporin A; GC, glucocorticoid; OSS, ocular staining score (Whitcher¹⁰⁷ JP, et al. Am J Ophthalmol. 2010;149:405–15). OSDI, ocular surface disease index (adapted from Baudouin C,¹⁰⁸ et al. Br J Ophthalmol 2014;98:1168–1176); SjS, Sjögren syndrome.

Table adapted from: Ramos-Casals M, Brito-Zerón P, Bombardieri S On behalf of the EULAR-Sjögren Syndrome Task Force Group, et al. “EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies.” Annals of the Rheumatic Diseases 2020;79:3-18.

A to I) Algorithm for the therapeutic approach to patients with primary SjS presenting with organ-specific systemic involvements. NSAIDs: no longer than 7–10 days. HCQ: hydroxychloroquine 200 mg/day. GC (recommended dose in mg/kg/day); short-term course whenever possible; consider methylprednisolone pulses in severe cases. ID: immunosuppressive agents, no head-to-head comparisons. CyC: cyclophosphamide pulses 0.5 g/15 day (maximum six pulses). Rituximab: rituximab 1 g/15 days (x2). BLM: belimumab; 10 mg/kg (0, 2 and 4 weeks and then every 4 weeks). ABA: abatacept 0, 2, 4 weeks and every 4 weeks. IVIg: intravenous immunoglobulins 0.4–2 g/kg 5 days. PEX: plasma exchanges. CyA, ciclosporin A; EULAR, European League Against Rheumatism; ESSDAI, EULAR Sjögren”s syndrome disease activity index; GC, glucocorticoid; LoE, levels of evidence; NSAIDs, non-steroidal anti-inflammatory drugs; RA, rheumatoid arthritis; SjS, Sjögren syndrome.

Table adapted from: Ramos-Casals M, Brito-Zerón P, Bombardieri S On behalf of the EULAR-Sjögren Syndrome Task Force Group, et al. “EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies.” Annals of the Rheumatic Diseases 2020;79:3-18.