Which Specialist Manages Sjögren's Syndrome
Patients with Sjögren's syndrome should be managed by a rheumatologist or at centers of expertise in close collaboration with rheumatology, following a multidisciplinary approach. 1
Primary Management
Rheumatologists serve as the primary specialists for managing Sjögren's syndrome due to the systemic autoimmune nature of the disease and the need for immunosuppressive therapy oversight. 1, 2
Co-management with a rheumatologist is essential for all patients with Sjögren's syndrome, whether primary or secondary, owing to the many possible comorbid systemic conditions including potentially life-threatening vasculitic or lymphoproliferative disorders. 1, 3
The European League Against Rheumatism explicitly recommends that patients with Sjögren's syndrome should be managed at, or in close collaboration with, centers of expertise following a multidisciplinary approach. 1
Multidisciplinary Team Members
While rheumatology leads management, several specialists play critical collaborative roles:
Ophthalmology
- Ophthalmologists manage ocular manifestations including dry eye disease, keratoconjunctivitis sicca, and complications such as scleritis, sterile keratitis, and uveitis. 1, 4
- Eye care clinicians are often the first point of medical contact given that dry eye is typically an early presenting complaint, and they should maintain a high index of suspicion for Sjögren's syndrome with a low threshold for serological workup. 3, 4
Oral Health/Dentistry
- Dental professionals and oral health specialists manage xerostomia, salivary gland dysfunction, and oral complications including dental caries and gingivitis. 1, 4
- These providers are also frequently first-contact clinicians given that dry mouth is a hallmark early symptom. 5
Other Specialists (As Needed)
- Internal medicine physicians may be involved in overall coordination of care. 1
- Gynecologists for management of vaginal dryness. 1
- Dermatologists for cutaneous manifestations. 1
- Otorhinolaryngologists for upper airway and ear involvement. 6
Critical Management Considerations
Approximately 5% of patients develop lymphoma, making regular monitoring by rheumatology essential, particularly in those with decreased C4 levels at diagnosis. 3, 4, 7
Systemic manifestations require immunosuppressive therapy (glucocorticoids, immunosuppressive agents, biologics) that must be managed by rheumatology. 1, 2
The disease requires interdisciplinary management depending on the clinical picture, but rheumatology remains the coordinating specialty. 6