r e v b r a s r e u m a t o l . 2015;55(5):396–397
w w w . r e u m a t o l o g i a . c o m . b r
REVISTA
BRASILEIRA
DE
REUMATOLOGIA
Editorial
Evaluation
and
treatment
of
Sjögren’s
syndrome
in
focus
Avaliac¸ão
e
tratamento
da
síndrome
de
Sjögren
em
foco
Sjögren’s syndrome is little known, despite the fact that it is one of the most common chronic rheumatic inflam-matory diseases, approximately as common as systemic lupus erythematosus.1 It is estimated that almost 400,000 Brazilian people suffers from the disease, most of those did not yet get the diagnosis.2 In the last decade the number of articles about Sjögren’s syndrome was 5times and 10 times less than systemic lupus erythematosus and rheumatoid arthritis, respectively. Also, in the last decade,biological therapeutichasrevolutionized the treat-ment of rheumatic disease. Now the time has come for finding and testing newtargets for treatment of Sjögren’s syndrome.
Thereisaglobalefforttoorganizelargecohortsand reg-istries, to validate new classification criteria and tools to evaluatediseaseactivityandsymptoms,todevelopnew tar-gets and to test new treatments for Sjögren’s syndrome. Recently, new findings in the pathogenesis, diagnosis and treatment were discussed among 260 participants of the 13thInternationalSymposiumonSjögren’ssyndrome(ISSS), in Bergen, Norway.1 There, the proposed new ACR-EULAR classification criteria were presented. In spite of not yet beingincluded ultrasoundofsalivaryglands,thenew con-sensusconsidersallsystemicmanifestationincludedinthe EULAR-Sjögren’s syndrome disease activity index (ESSDAI) whenscreeningSjögren’ssyndrome.Thedefinitionofdisease activitystatesandclinicallymeaningfulimprovementin pri-marySjögren’ssyndromewithESSDAIand patient-reported indexes(ESSPRI) were essential todesignfuture studies of treatment.3,4 Biologic agentstargeting B cells (such as rit-uximab and belimumab) and T cell stimulation inhibition haveshown promising results.Modulation orinhibition of othertargetssuchasIFN,IL-6andToll-likereceptorarealso currentlybeinginvestigated.Morethan newtargets,inthe future,personalizedandcell-basedtreatmentcanbringbetter results.
Thecurrentevidencefortreatingandtheurgentneedto standardize the treatment forthis disease motivate medi-calandpatientorganizationstocreateguidelinesfortreating Sjögren’ssyndrome.Atthe13thISSS,Recommendationsfrom Brazilian SocietyofRheumatology andfrom Sjögren’s Syn-dromeFoundation(SSF)werepresented.Sincelastyearthe EULAR-TaskForceispreparingafullguideline.1
Thecurrent issueofthe BrazilianJournal of Rheumato-logybringstwoarticlesaboutSjögren’ssyndrome.Oneisthe evaluationofpsychometricpropertiesofESSPRIinaBrazilian population.Currentlytherearefourvalidatedtoolsusefulfor studyingSjógren’ssyndromeinBrazil(ESSDAI,ESSPRI, PRO-FADandFACIT).5,6
The second article is the Recommendations of Brazil-ianSocietyfortreatmentofSjögren’ssyndromebasedona systematic review,including 127 articles. Thetreatmentof glandularinvolvementwasbasedonahighlevelofevidence, butmostrecommendationsforsystemicmanifestationswere basedoncasereports.Especiallywhengoodevidenceisnot available, the recommendations elaborated by a multidis-ciplinary panelofspecialists is animportant referencefor treatingseveremanifestations.
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1.MeetingAbstractsfromThe13thInternationalSymposiumon Sjögren’sSyndromeBergen,Norway,May19–22,2015.ScandJ Immunol.2015;81:328–450.
2.ValimV,ZandonadeE,PereiraAM,deBritoFilhoOH,Serrano EV,MussoC,etal.PrimarySjögren’ssyndromeprevalenceina majormetropolitanareainBrazil.RevBrasReumatol. 2013;53:24–34.
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4.SerorR,BootsmaH,SarauxA,BowmanSJ,TheanderE,Brun JG,onbehalfoftheEULARSjögren’sTaskForce.Defining diseaseactivitystatesandclinicallymeaningfulimprovement inprimarySjögren’ssyndromewithEULARprimarySjögren’s syndromediseaseactivity(ESSDAI)andpatient-reported indexes(ESSPRI).AnnRheumDis.2014,pii:
annrheumdis-2014-206008.
5.SerranoEV,ValimV,MiyamotoST,GiovelliRA,PaganottiMA, CadêNV.Transculturaladaptationofthe“EULARSjögren’s SyndromeDiseaseActivityIndex(ESSDAI)”intoBrazilian Portuguese.RevBrasReumatol.2013;53:483–93.
6.MiyamotoST,PaganottiMA,SerranoÉV,GiovelliRA,ValimV. AssessmentoffatigueanddrynessinprimarySjögren’s syndrome:Brazilianversionof“ProfileofFatigueand Discomfort–SiccaSymptomsInventory(shortform) (PROFAD-SSI-SF)”.RevBrasReumatol.2015;55: 113–22.
ValériaValima,b,∗,RolandJonssonc
aUniversidadeFederaldoEspíritoSanto,Vitória,ES,Brazil
bPresidentofBrazilianCommitteeonSjögren’sSyndrome,
SociedadeBrasileiradeReumatologia,Brazil cTheBroegelmannChairinImmunology,BroegelmannResearch
Laboratory,DepartmentofClinicalScience,UniversityofBergen, Bergen,Norway
∗Correspondingauthor.
E-mail:val.valim@gmail.com(V.Valim).
2255-5021/$–seefrontmatter ©2015ElsevierEditoraLtda.Allrightsreserved.
