The heterogeneous nature of Sjögren's disease calls for regular, comprehensive assessments1
Sjögren's disease progression is unpredictable2
Progression is highly variable—it may be slow in some patients whose disease remains relatively stable, while others may experience worsening symptoms or develop new systemic manifestations of disease. A subset of patients may develop severe symptoms and/or lymphoma.2,3
When examining patients with Sjögren's disease (SjD), it’s important to recognize that not all signs of disease activity will appear during the physical exam. Critical indicators of disease can lie beneath the surface, requiring deeper, more comprehensive assessment.1,4,5
Factors that may increase the risk associated with systemic disease activity
Reducing disease activity is an essential goal for your patients with SjD. Biomarkers and clinical factors can help you better understand the extent of a patient’s systemic disease activity and signs of disease progression.5-7
Biomarker or clinical factor | Risks associated with systemic disease activity |
Prolonged inflammation in the salivary glands |
|
Moderate or high disease activity (ESSDAI ≥5) |
|
Consistently high IgG levels over a |
|
Cytopenias |
|
Skin involvement, especially palpable purpura; Cryoglobulinemia; Lymphopenia; Low complement levels, especially C4 |
|
Ways to assess underlying disease activity
Experts recommend monitoring patients with low systemic disease activity every 6 to 12 months, and more frequently in patients with high systemic disease activity.1
Laboratory testing
Blood testing for biomarkers can help you determine if a patient has subclinical systemic disease activity.7
SjD biomarkers | Abnormal levels‡ that may identify subclinical systemic disease activity |
IgG level | ≥16 g/L, or a recent decrease of IgG level (<5 g/L)7 |
Blood cell counts | Neutropenia (<1500/mm3)7 |
Cryoglobulins | Presence of cryoglobulins7 |
Complement levels | Hypocomplementemia (C4 or C3)7 |
Most of these biomarkers are captured in the biological and hematological domains of the ESSDAI score, and you can track them in your practice today.7
Consider ordering a blood panel to assess for underlying disease activity and progression
Clinical assessment
An increased risk of lymphoma has been associated with certain clinical factors.13,15
 Swollen salivary glands13,15 |  Cutaneous involvement13 |  Swollen lymph nodes13,15 |
For interstitial lung disease, some clinical tests might require a visit to the pulmonologist for further workup, including pulmonary function tests and high-resolution computed tomography16,17
Could your patients be at risk of progression?
Dr Brian Porter speaks with Paula, a patient with Sjögren's disease, on the challenges of disease progression and symptomatic care.
See ESSDAI-based clinical questions that can help reveal disease activity
†Based on the ESSDAI score measured at the most recent visit.10
‡Lab values may vary.
C3, complement component 3; C4, complement component 4; ESSDAI, EULAR Sjögren's syndrome disease activity index; EULAR, European Alliance of Associations for Rheumatology; IgG, immunoglobulin G.
References: 1. Ramos-Casals M et al. Ann Rheum Dis. 2020;79:3-18. 2. Parisis D et al. J Clin Med. 2020:9(7):2299. 3. Brito-Zerón P et al. Nat Rev Dis Primers. 2016;2:16047. 4. McCoy SS et al. Arthritis Rheum. 2022;74(9):1569-1579. 5. Both T et al. Int J Med Sci. 2017;14(3):191-200. 6. Ma D et al. Front Immunol. 2024;15:1421436. 7. Seror R et al. RMD Open. 2015;1:e000022. 8. Kassan SS, Moutsopoulos HM. Arch Intern Med. 2004;164(12):1275-1284. 9. Goules AV et al. Lancet Rheumatol. 2024;6:e693-e702. 10. Bohman BR et al. Clin Rheumatol. 2024;43:1093-1101. 11. Li Y, Chen S, Guo L, et al. Clin Exp Med. 2025;25:174. 12. Retamozo S et al. Lupus. 2019;28(8):923-936. 13. Nocturne G, Mariette X. Br J Haematol. 2015;168:317-327. 14. Ramos-Casals M et al. BMJ. 2012;314:e3821. 15. Price EJ et al. Rheumatology. 2025;64:409-439. 16. Nambiar AM et al. Ther Adv Respir Dis. 2021;15:1-13. 17. Lee AS et al. CHEST. 2021;159(2):683-698.