#2-25E. Precision Medicine in Primary Sjögren Syndrome: Targeted Therapies and Pathophysiology (Nat Rev Rheumatol, 2024)

When managing Primary Sjögren Syndrome (pSS), do we remain confined to symptomatic treatments, or are targeted disease-modifying therapies finally within reach? This review summarizes the significant progress made in understanding pSS, a complex chronic autoimmune epithelitis characterized by lymphocytic infiltration of exocrine glands, leading to xerostomia, xerophthalmia, systemic manifestations, and lymphoma risk. While current treatments are largely symptomatic with limited efficacy in preventing glandular damage, the accelerating knowledge of pathophysiology is paving the way for targeted approaches. The core clinical takeaway is the surge of randomized controlled trials targeting specific molecular pathways, such as the interferon pathway, B cell activation, and T/B cell co-stimulation, underscoring the imminent shift toward personalized medicine. However, clinicians must critically note that many current trials predominantly include specific patient cohorts with extraglandular systemic activity, limiting the generalizability of results to the majority of patients whose primary burden is often high subjective symptoms like fatigue and pain. This comprehensive update is crucial for physicians, providing the latest knowledge on potential targeted therapies and emphasizing the critical need for patient stratification to optimize future treatment strategies beyond current symptomatic care.

Citation: Baldini, C., Fulvio, G., La Rocca, G., & Ferro, F. Update on the pathophysiology and treatment of primary Sjögren syndrome. nature reviews rheumatology. 2024. DOI: 10.1038/s41584-024-01135-3.

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