What is your approach to immunomodulatory treatment in patients with Sjogren's syndrome who have active serologies (i.e. elevated ESR, hypergammaglobulinemia, hypocomplementemia) but minimal symptoms?

Hypergammaglobulinemia and hypocomplementemia are risk factors for lymphoma in the setting of Sjogren's Disease (SjD), as well as cryo, IgM kappa, lymphopenia/neutropenia, RF+, asymmetric parotid swelling and disease activity (Nocturne et al., PMID 26606524). Therefore, even with "minimal symptoms" ...

I agree with Dr. @Dr. First Last. I offer hydroxychloroquine to nearly all Sjogrens patients with systemic features whether clinical and/or biochemical. I tell them the evidence behind this may not be strong but for some subset of patients, it can be quite helpful. Many patients worry about potentia...

I treat these patients. In the past, many Sjogren's patients didn't seek medical care or weren't referred by other providers until quite end-stage sicca symptoms. Now we are getting better at recognizing Sjogren's many early symptoms, not just sicca, and instead of the stereotypical middle-aged woma...

I try and recommend hydroxychloroquine for more than six months. This medication is too slow to be active in this kind of patients

This reference may be helpful: Gottenberg et al., PMID 25027140