Pharmacotherapy for managing extraglandular symptoms of primary Sjogren's syndrome

Introduction: Primary Sjogren's syndrome (pSS) is a systemic autoimmune disease, characterized by impaired function of the exocrine glands. Many pSS patients also experience extraglandular symptoms. Effective therapeutic interventions for pSS patients are not yet approved. However, advances in understanding of the disease process have led to the development of promising therapeutic targets.

Areas covered: This review provides an overview of current and presumed future strategies for the treatment of extraglandular symptoms in pSS patients, in relation to pathogenesis of the disease. In addition, future approaches for the evaluation of these symptoms in clinical trials will be discussed.

Expert opinion: Of all clinical trials that have been conducted in pSS, only few evaluated the effect of treatment on extraglandular symptoms. This lack of data can be partially explained by: i) heterogeneity of extraglandular symptoms; ii) inclusion of patients with low systemic disease activity in clinical trials; and iii) the former lack of a validated outcome measure to evaluate the systemic disease activity. These methodological issues should be addressed in future clinical trials. The ultimate goal in the management of pSS is evidence-based and personalized treatment of the broad range of symptoms experienced by patients suffering from this disease, including extraglandular symptoms.