Clinical Practice Guideline for Evaluation and Management of Peripheral Nervous System Manifestations in Sjögren's Disease
Year: 2025
Type: article
Abstract: OBJECTIVE: Sjögren's disease is an autoimmune disorder that can impact multiple organ systems, including the peripheral nervous system (PNS). PNS manifestations, which can exist concurrently, include mononeuropathies, polyneuropathies, and autonomic nervous system neuropathies. To help patients and providers in the decision-making process, we developed an evidence-based clinical practice guideline for the evaluation and management of PNS manifestations in patients with Sjögren's disease. METHODS: A Topic Review Group, comprising experts in rheumatology, neurology, and guideline methodology, developed Patient, Intervention, Comparison, and Outcome questions and conducted a systematic review to identify the current best evidence on management of PNS manifestations of Sjögren's disease. PubMed and Embase were searched for evidence published up to July 22, 2025. Literature screening, data extraction, and critical appraisal were performed in duplicate. Six case series, one retrospective cohort, and two prospective cohort studies lacking a comparison group met the inclusion criteria. RESULTS: We developed an aligned nomenclature of PNS terms that can be used across disciplines, 31 good practices for evaluation of suspected PNS manifestations, and 20 evidence-based treatment recommendations, the latter of which were rated as conditional or strong based on the Grading of Recommendations Assessment, Development, and Evaluation methodology. Because of the scarcity of high-level evidence, this guideline predominantly derives from expert opinion. CONCLUSION: This clinical practice guideline on PNS manifestations of Sjögren's disease provides clinicians a rigorous, evidence-based resource, developed through an expert consensus-based process, for the assessment, diagnosis, and treatment of peripheral neuropathy in patients with Sjögren's disease. Recommendations were rated as strong when the benefits significantly outweighed potential harms, creating a scenario in which most patients would prefer the advised action.
Source: Arthritis Care & Research
DOI: 10.1002/acr.70004
Authors: Anahita Deboo, Robert Fox, Katherine M. Hammitt, Julie Frantsve‐Hawley, Matthew C. Baker, Stamatina Danielides, Eduardo De Sousa, Brent P. Goodman, Jennifer K. King, Steven Mandel, Ghaith Noaiseh, Pantelis P. Pavlakis, George Sarka, R. Hal Scofield, Arun Varadhachary, Daniel J. Wallace, Matt Makara, Nancy Carteron, Steven Carsons
Institutions: Temple University, Scripps Memorial Hospital, Sjögren’s Foundation, Stanford University, Inova Health System, University of Virginia, Mercy Hospital, HonorHealth, University of California, Los Angeles, Hofstra University, New York Medical College, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, University of Kansas, Athens Medical Center, Cedars-Sinai Medical Center, California State University, Northridge, Saddleback Memorial Medical Center, Oklahoma Medical Research Foundation, Oklahoma City VA Medical Center, University of Oklahoma Health Sciences Center, Washington University in St. Louis, University of California, San Francisco, University of California, Berkeley, NYU Grossman Long Island School of Medicine, New York University
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,640
Funder: Sjögren's Foundation
OpenAlex ID: W4416895307