#2-81E. Navigating Sjögren’s Neuropathy: A Comprehensive Guideline for PNS Management (ACR, 2025)

Sjögren's disease (SjD) often involves challenging and frequently under-recognized peripheral nervous system (PNS) manifestations, including mononeuropathies, polyneuropathies, and autonomic dysfunction, which significantly impair patient quality of life. How should clinicians effectively evaluate and manage this complex spectrum of SjD-related neuropathies? This new clinical practice guideline, developed by a multidisciplinary team of experts, provides a rigorous, consensus-based resource for the assessment, diagnosis, and treatment of PNS manifestations in SjD patients. It establishes unified terminology, details 31 good evaluation practices, and presents 20 treatment recommendations, facilitating interdisciplinary collaboration. Crucially, the guideline offers specific therapeutic direction, notably recommending immediate initiation of high-dose systemic glucocorticoids combined with rituximab as the first-line therapy for suspected vasculitic neuropathy due to the high risk of irreversible axonal loss. However, clinicians must be mindful that a significant limitation is the scarcity of high-level evidence, as most recommendations are primarily derived from expert consensus informed by case series and observational data. This resource is vital for rheumatologists, neurologists, and primary care providers, offering a structured framework to facilitate timely diagnosis, support shared decision-making, and promote the multidisciplinary care essential for improving patient outcomes.

Citation: Deboo, A. et al. Clinical Practice Guideline for Evaluation and Management of Peripheral Nervous System Manifestations in Sjögren’s Disease. Arthritis Care & Research. 2025. DOI: 10.1002/acr.70004

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