Treatment Guidelines for Rheumatologic Manifestations of Sjogren's Syndrome: Use of Biologic Agents, Management of Fatigue, and Inflammatory Musculoskeletal Pain

被引：99

作者：

Carsons, Steven E. ^{[1
]}

Vivino, Frederick B. ^{[2
]}

Parke, Ann ^{[3
]}

Carteron, Nancy ^{[4
]}

Sankar, Vidya ^{[5
]}

Brasington, Richard ^{[6
]}

Brennan, Michael T. ^{[7
]}

Ehlers, William ^{[3
]}

Fox, Robert ^{[8
]}

Scofield, Hal ^{[9
,10
]}

Hammitt, Katherine M. ^{[11
]}

Birnbaum, Julius ^{[12
]}

Kassan, Stuart ^{[13
]}

Mandel, Steven ^{[14
,15
]}

机构：

[1] SUNY Stony Brook, Winthrop Univ Hosp Campus, Mineola, NY 11794 USA

[2] Univ Penn, Philadelphia, PA 19104 USA

[3] Univ Connecticut, Ctr Hlth, Farmington, CT USA

[4] Univ Calif San Francisco, San Francisco, CA 94143 USA

[5] Univ Texas San Antonio, Sch Dent, San Antonio, TX USA

[6] Washington Univ, St Louis, MO USA

[7] Carolinas Med Ctr, Charlotte, NC 28203 USA

[8] Scripps Mem Hosp Xi Med, La Jolla, CA USA

[9] Univ Oklahoma, Oklahoma Med Res Fdn, Hlth Sci Ctr, Norman, OK 73019 USA

[10] Oklahoma City Dept Vet Affairs Med Ctr, Oklahoma City, OK USA

[11] Sjogrens Syndrome Fdn, Bethesda, MD USA

[12] Johns Hopkins Univ, Baltimore, MD USA

[13] Univ Colorado, Denver, CO 80202 USA

[14] Lenox Hill Hosp, New York, NY 10021 USA

[15] Hofstra Northwell Sch Med, Hempstead, NY USA

来源：

ARTHRITIS CARE & RESEARCH | 2017年 / 69卷 / 04期

关键词：

SYSTEMIC-LUPUS-ERYTHEMATOSUS; CLINICAL-PRACTICE GUIDELINES; RITUXIMAB TREATMENT; DISEASE-ACTIVITY; CONTROLLED-TRIAL; DOUBLE-BLIND; ARTHRITIS; EFFICACY; AUTOIMMUNE; CONSENSUS;

D O I：

10.1002/acr.22968

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective. The Sjogren's Syndrome Foundation clinical practice guidelines (CPGs) are designed to improve quality and consistency of care in Sjogren's syndrome by offering recommendations for management. Methods. Management questions for the systemic manifestations of Sjogren's syndrome were posed by the CPG committee with input from patients and rheumatologists. Clinical questions were assigned to a topic review group that performed systematic reviews and data extraction and drafted guidelines. Quality of evidence and strength of recommendation were rated using the American Society of Clinical Oncology's modification of the Grading of Recommendations Assessment, Development, and Evaluation. Guideline recommendations were reviewed by a consensus expert panel (CEP) composed of 30-40 clinicians from academia and community practices, as well as registered nurses and patients, using a modified Delphi process. A CEP agreement level of 75% was set as a minimum for adoption of a guideline recommendation. Results. Consensus was achieved for 19 recommendations; for 11 additional modules, available data were insufficient to allow a recommendation to be formulated. Of the 19 recommendations, 15 required 1 Delphi round, 2 required 2 rounds, and 2 required 3 rounds. Conclusion. Key recommendations include a decision tree for the use of oral disease-modifying antirheumatic drugs for inflammatory musculoskeletal pain, use of self-care measures and advice regarding exercise to reduce fatigue, and the use of rituximab in selected clinical settings for oral and ocular dryness and for certain extraglandular manifestations, including vasculitis, severe parotid swelling, inflammatory arthritis, pulmonary disease, andmononeuritismultiplex. The CPG committee strongly discouraged the use of tumor necrosis factor inhibitors for sicca symptoms and for the majority of clinical contexts in primary Sjogren's syndrome.

引用

页码：517 / 527

页数：11

共 1 条

[1] Fatigue and widespread pain in systemic lupus erythematosus and Sjogren's syndrome: symptoms of inflammatory disease or associated fibromyalgia?
Iannuccelli, C.
Spinelli, F. R.
Guzzo, M. P.
Priori, R.
Conti, F.
Ceccarelli, F.
Pietropaolo, M.
Olivieri, M.
Minniti, A.
Alessandri, C.
Gattamelata, A.
Valesini, G.
Di Franco, M.
CLINICAL AND EXPERIMENTAL RHEUMATOLOGY, 2012, 30 (06) : S117 - S121

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