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Turkish Society for Rheumatology recommendations for topical and systemic treatments in Sjögren's disease
V. Yazısız1, B. Armağan2, N. İnanç3, C. Bes4, A. Doğru5, G. Sargin6, M.E. Yayla7, M. Ekici8, G. Mumcu9, G. Karabulut10, E. Gönüllü11, H. Emmungil12, N. Erdik13, C.A. Yaşar14, D. Kerim15, E.A. Şener16, A. Avcu17, E. Alpöz18, H. Çankaya19, M. Palamar20, S.A. Turhan21, Y. Kabasakal22
- Department of Internal Medicine, Division of Rheumatology, Akdeniz University, Faculty of Medicine, Antalya, Turkey. drvyazisiz@yahoo.com.tr
- Clinic of Rheumatology, Ankara Bilkent City Hospital, Ankara, Turkey.
- Department of Internal Medicine, Division of Rheumatology, Marmara University, Faculty of Medicine, Istanbul, Turkey.
- Sağlık Bilimleri University, Başakşehir Çam And Sakura Cıty Hospıtal, Istanbul, Turkey.
- Department of Internal Medicine, Division of Rheumatology, Süleyman Demirel University, Faculty of Medicine, Isparta, Turkey.
- Department of Internal Medicine, Division of Rheumatology, Aydın Adnan Menderes University, Faculty of Medicine, Aydın, Turkey.
- Department of Internal Medicine, Division of Rheumatology, Ankara University, Faculty of Medicine, Ankara, Turkey.
- Clinic of Rheumatology, Ankara Bilkent City Hospital, Ankara, Turkey.
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul Okan University, Istanbul, Turkey.
- Department of Internal Medicine, Division of Rheumatology, Ege University, Faculty of Medicine, İzmir, Turkey.
- Department of Internal Medicine, Division of Rheumatology, Sakarya University, Faculty of Medicine, Sakarya, Turkey.
- Department of Internal Medicine, Division of Rheumatology, Trakya University, Faculty of Medicine, Edirne, Turkey.
- Sakarya Training and Research Hospital, Sakarya, Turkey.
- Kocaeli City Hospital, Kocaeli, Turkey.
- Department of Internal Medicine, Division of Rheumatology, Ege University, Faculty of Medicine, İzmir, Turkey.
- Clinic of Rheumatology, Ankara Bilkent City Hospital, Ankara, Turkey.
- Department of Internal Medicine, Division of Rheumatology, Marmara University, Faculty of Medicine, Istanbul, Turkey.
- Department of Oral and Maxillofacial Radiology, Ege University Faculty of Dentistry, Izmir, Turkey.
- Department of Oral and Maxillofacial Radiology, Ege University Faculty of Dentistry, Izmir, Turkey.
- Department of Ophthalmology, Ege University, Faculty of Medicine, Izmir, Turkey.
- Department of Ophthalmology, Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Istanbul, Turkey.
- Department of Internal Medicine, Division of Rheumatology, Ege University, Faculty of Medicine, İzmir, Turkey.
CER19670
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PMID: 42814613 [PubMed]
Received: 07/01/2026
Accepted : 10/02/2026
In Press: 22/09/2026
Abstract
OBJECTIVES:
The aim of this work was to develop standardised recommendations for the treatment of Sjögren’s disease (SjD) based on existing evidence and expert opinion.
METHODS:
The task force (TF) consisted of Turkish specialists in rheumatology, ophthalmology and dentistry with an interest in SjD. The group used the Population, Intervention, Comparison and Outcome (PICO) format to frame its clinical questions. A systematic literature review on the therapeutic management of SjD was subsequently conducted in accordance with PRISMA guidelines. Levels of evidence (LoE) were assigned according to the 2011 Oxford Centre for Evidence-Based Medicine (CEBM) standards.
RESULTS:
The recommendations are categorised under the following headings: general recommendations, management of ocular and oral dryness, and management of systemic organ involvements. Management of sicca symptoms benefits from a wealth of high-level evidence, highlighting topical therapies as the gold standard. Conversely, the treatment of systemic involvement relies heavily on case series and clinical experience. Here, glucocorticoids, hydroxychloroquine, and immunosuppressive agents remain cornerstone therapies. Overall, biologic therapies have demonstrated limited efficacy in SjD; however, they may be beneficial in selected patient subgroups and can be considered in cases of refractory systemic involvement.
CONCLUSIONS:
The recommendations on SjD treatment, derived from a systematic literature review and clinical experience, will guide clinicians in the management of patients, based on a set of overarching principles.
