علاج متلازمة شوغرن مع التهاب المفاصل والمرض الجهازي النشط

References

DOI: 10.1136/annrheumdis-2019-216114

• Arthritis is clinically diagnosed on the basis of objective inflammation of >=1 joints (heat, redness and swelling in the physical examination of the affected joint) supported by ultrasound studies when in doubt, and the ESSDAI score classifies the severity of arthritis according to the number of joints involved (moderate <5 joints, high >5).
• GCs should be used at the minimum dose and length of time necessary to control active systemic disease, administering pulses of methylprednisolone followed by doses of 0.5 mg/kg/d or lower as induction therapy in severe presentations, and doses <0.5 mg/kg/d in moderate/less-severe presentations, with a final target of withdrawing GCs in inactive patients as soon as possible or at least trying to target a maintenance dose of 5 mg/daily or less with the aid of GC-sparing immunosuppressive agents.
• GC (recommended dose in mg/kg/day); short-term course whenever possible; consider methylprednisolone pulses in severe cases.
• With respect to the definition of the therapeutic response in systemic SjS, the TF recommends using a reduction of >=3 points in the global ESSDAI score.