How do you approach the management of inflammatory arthritis in a patient with Sjogren’s disease who is unable to tolerate or take methotrexate, leflunomide, or hydroxychloroquine?

Would consider a B-cell targeted agent. Currently, rituximab, which was included in the 2017 MSK and biologic guidelines (Carsons et al. AC&R PMID: 27390247) for SjD inflammatory arthritis.

Serum level of BAFF is elevated in SjD, so an anti-BAFF agent, like belimumab, could be considered.

Have avoided...