SSF Clinical Practice Guidelines

The cover story for the latest Sjogren's Quarterly publication entitled SSF Clinical Practice Guidelines for Management of Sjogren's is a very interesting read. It was written by Frederick B Vivino MD, who chairs the SSF Clinical Practice Guidelines committee, is Chief of the Division of Rheumatology Penn Presbyterian Medical Center, and Director of the PENN Sjogren's Syndrome Center.

Dr. Vivino begins his discussion with this:

"In response to patient concerns about medical care and physician inquiries regarding therapeutic dilemmas, the Sjogren's Syndrome Foundation launched an initiative several years ago to develop Clinical Practice Guidelines for the disease. Working groups were formed to concentrate on three major areas including Rheumatologic/systemic manifestations, Ocular and Oral problems. (Bolding mine.) These guidelines are now well underway and recommendations for initial clinical questions are being drafted. "This initiative marks one of the biggest undertakings that the Foundation has ever made! Recognizing the critical need for Clinical Practice Guidelines to improve care for Sjogren's patients and provide consistent, evidence- and/or expert-based guidance to healthcare providers, the SSF Board of Directorss was determined to make this initiative a Foundation priority," says Steven Taylor, SSF CEO."

He goes on to explain that the project is a team effort:

"While specialist in rheumatology, opthalmology, optometry, and oral medicine form the majority of volunteers, representatives from other backgrounds and specialties are involved in specific topics and in the consensus process. These include patients, nurses, neurologists, neuropsychologists, psychiatrists, and oncologists."

Each of the three working groups for each major area of study developed major topics to be addressed.

The Rheumatology/Systemic Manifestations working group chose three topics:

• The effectiveness and use of biologics to treat sicca symptoms
• The use of DMARDs for inflammatory musculoskeletal pain
• Management of fatigue

The Oral Manifestations group topics include:

• Caries Prevention
• Caries Management and Restoration
• Mucosal Management and Symptom Relief

Ocular Management Clinical Topics include:

• Evaluation of Dry Eye Disease
• General Management
• Therapeutic Treatment

Dr. Vivino ends his article with this comment:

"As this article goes to press, the first set of recommendations is undergoing the Consensus Panel process. As recommendations are developed, Guidelines members plan to report on final recommendations at professional meetings, publish in journals representing their respective specialties, and, in the end, compile all recommendations into one publication. Gaps in scientific knowledge will be identified as areas of future study so that unproven treatments and methods of management can be further assessed. Guidelines members recognize that recommendations are a work in progress and will need continual updating as new studies are published. In the future, the Clinical Practice Guidelines committee also hopes to engage colleagues in Europe and Asia for further guidelines development with a more global perspective."

While I realize that the final version of these vitally important clinical practice guidelines are years away from completion, still I feel hopeful simply because they are in process. I appreciate systemic symptoms and fatigue receiving significant examination and focus. I also am impressed that the members of this committee are volunteering their efforts and time toward this gigantic project.

I can envision the day when Sjogren's syndrome patients, rheumatologists, and other health care providers have this valuable tool available for their use.