Early Immunosuppressive Therapy for Sjogren's Syndrome - Pros and Cons

Primary Sjogren's syndrome (pSS) is a chronic inflammatory autoimmune disease which is characterised by a lymphocytic infiltration of the exocrine glands leading to keratoconjunctivitis sicca and xerostomia. Apart from that, several extraglandular manifestations may occur. Currently available medical therapy is mainly aimed to treat the sicca symptoms of the eyes and the mouth. The data on several disease-modifying anti-rheumatic drugs (DMARD) are inconclusive. In addition, the optimal time for the initiation of a DMARD therapy remains unclear in pSS. Recently, the efficacy of rituximab (RTX) has been demonstrated, especially in patients with a shorter disease duration. A reduction of histological changes in the salivary glands has been shown. Also progression of the salivary function could be demonstrated in pSS patients who received RTX. Thus, an early therapy could be justified in certain cases. The new EULAR disease Activity Index could be helpful in evaluating the efficacy of potential new therapeutic strategies. This index estimates the systemic manifestations of the disease. Further studies are needed to prove potential advantages of an early therapy.