Insights into Sjögren’s Disease - A Rheum Survey Save

Key Rheumatologist Takeaways on Sjogren’s Disease:

• All (~99%) rheumatologists manage SjD.
• Antimalarials remain the most commonly used systemic treatment.
• Diagnostic uncertainty is an issue in some (25-37%).
• For new SjD drugs, access issues, safety and guidelines will be a challenge.
• Rheums are favorably included towards B-cell depletion in SjD.
• Expert consensus and disease activity (ESSDAI) outcomes are prime influencers.
• SjD treatment guidelines are a leading educational need.
• SjD is seen in 10-33% of SLE patients.
• There is limited understanding of the pathogenesis of SjD, especially with regard to interferon and TYK2.

In August 2026, RheumNow surveyed rheumatologists about Sjogren’s disease (SjD) - how they approach diagnosis, treatment, and unique challenges; all important as new advances in SjD evolves.

A total of 383 Rheum HCPs respondents responded to this single email (and social media) invite to participate. While this was a worldwide sampling, 54% of respondents were from the United States. Answers were not significantly different between the USA and rest of the world responders.

Over half (55%) are in community/private practice, and roughly 18% were from academic centers or community practices with an academic affiliation. Most also reported seeing Sjögren’s patients regularly: 80% see 1–10 patients per week and 12% see 10–20 SjD patients per week. Only 8 respondents claimed to see >20 SjD patients per week (~2%). Only 7.7% do not see SjD patients.

Nearly 99% of respondents manage SjD.  About three-quarters (~72%) are the primary providers in diagnosing and managing Sjögren’s patients, while the 24-27% co-manage patients with other specialists. Very few (1.8%) refer SjD to other specialists.

Below are their responses to eight multiple choices questions on Sjogren’s.

1. Besides treatment for dryness, which therapies do you most commonly use in SjD patients?

• Antimalarials- 49.6%
• Antimalarials + csDMARDs - 30.4%
• None of the above - 10.4%
• csDMARDs - 4.8%
• Biologics - 4.8%
• Antimalarials remain central to systemic treatment in SjD, either alone or in combination with conventional DMARDs. Biologic use remains uncommon, reflecting the limited advanced treatment options currently available for SjD.

2. What is the main challenge in diagnosing SjD?

• Distinguishing sicca due to other causes - 37%
• Unclear diagnostic criteria or diagnostic testing - 24.7%
• Distinguishing extraglandular symptoms from other diagnoses - 20.1%
• Risk of serious SjD complications - 10.0%
• No challenge - 5.9%
• Other - 2.3%
• Diagnosing SjD and distinguishing SjD from other causes of Sicca remains a challenge for some. One in five are challenged by SjD extraglandular manifestations and other diagnoses. This highlights the complexity of recognizing SjD, particularly when patients present with symptoms that overlap with other rheumatic or systemic diseases.

3. How would you mechanistically treat problematic SjD?

• B-cell depletion - 46.7%
• General immunosuppression - 31.9%
• Unknown - 10%
• Other - 4.3%
• Cytokine inhibition - 3.8%
• T-cell immunomodulation - 3.3%
• Nearly half of respondents favored B-cell depletion. Currently there is no FDA approved B-cell depleting therapy for SjD. Hence, this prevailing opinion suggests rheumatologists view B-cells as an important therapeutic target in SjD. Also not FDA approved, is general immunosuppression, favored by nearly one-third of rheumatologists. One in seven (14.3%) prefer unlisted or uncertain therapies.

4. If a new advanced therapy were FDA-approved for SjD, what would be your (initial) primary concern?

• Insurance/access issues - 37.5%
• Safety concerns - 24%
• Lack of treatment guidelines - 20.7%
• Lack of experience - 9.1%
• Patient preference/hesitancy - 4.8%
• No concern - 3.8%
• As we are in an era of novel drug development for SjD, we asked rheumatologists what their concerns would be if a new agent were to be approved for SjD. Insurance access, safety and treatment guidelines were their dominant concerns The need for treatment guidelines suggests that approval alone may not be enough to drive adoption.

5. What data or information would (most) inform your use of a new advanced therapy for SjD?

• ESSDAI (systemic disease activity) outcomes - 37% (34% USA)
• Expert consensus or real-world experience - 34.4% (40% USA)
• Favorable safety/tolerability profile - 19.8%
• ESSPRI (patient-reported) outcomes - 6.8%
• Route of administration - 2.1%
• Systemic disease activity outcomes and real-world or expert experience were considerably influential. More than safety, patient reported outcomes and route of administration.

6. Which single topic would most improve your confidence in managing SjD?

• Treatment guidelines - 36.2%
• Management of systemic manifestations - 24.6%
• Understanding clinical trial successes, failures, and endpoints - 15.6%
• Diagnostic workup - 13.6%
• SjD reviews by experts - 10.1%
• Treatment guidelines emerged again as an important educational need, as well as an interest in managing systemic manifestations. Together, these findings point toward a need for practical education that helps rheumatologists translate evolving SjD evidence into real-world treatment decisions.

7. What percentage of your systemic lupus erythematosus (SLE) patients have Sjogren’s disease?

• 20% - 39.7%
• 10% - 25.9%
• 33% - 18.5%
• I don’t know - 10.1%.
• 50% or more - 5.8%
• Nearly 85% of Rheumatologists estimate that SjD affects between 10% and 33% of their SLE population, reinforcing the clinical overlap between these autoimmune diseases.

8. How clear is your understanding of the role of the interferon and TYK2 pathways in SjD?

• Not clear — 36.7%
• Somewhat clear — 35.7%
• Mostly clear — 22.2%
• Very clear — 5.3%
• Only a quarter of rheumatologists have confidence in understanding the pathogenic roles for interferon and TYK2 in SjD. Nearly three-quarters described their understanding as either not clear or only somewhat clear. Greater education around disease mechanisms may be needed to help clinicians interpret emerging clinical trial data and understand the rationale for new therapeutic approaches.

Looking ahead, rheumatologists appear receptive to new therapeutic options but will require more than regulatory approval alone. Evidence of improvement in systemic disease activity, expert and real-world experience, clear treatment guidelines, and adequate access will likely be important factors influencing the adoption.