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., 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 use o...