Letters |

Treatment Approaches in Primary Sjögren Syndrome—Reply

Manuel Ramos-Casals, MD, PhD; Athanasios G. Tzioufas, MD; John H. Stone, MD, MPH
JAMA. 2010;304(18):2015-2016. doi:10.1001/jama.2010.1583.
Text Size: A A A
Published online


In Reply: In response to Dr Vissink and colleagues, our review focused on pharmacologic therapy rather than substitutive therapy (artificial tears, salivary substitutes), not because the latter are unimportant components of Sjögren syndrome therapy but rather because of space constraints. Our review of the literature identified 4 articles regarding such therapy,14 all of which had crossover designs and included from 22 to 43 patients. The results of these studies were contradictory and do not permit firm conclusions. Moreover, we are aware of no controlled studies showing that saliva substitutes are more effective than muscarinic agonists in patients with moderate to severe sicca symptoms. Although the existing literature is inconclusive on the issue of saliva substitutes, our opinion is that in clinical practice patients with mild symptoms should be first treated with therapies without adverse effects before drugs with a higher rate of adverse effects are introduced.


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview




November 10, 2010
Arjan Vissink, DMD, MD, PhD; Cees G. M. Kallenberg, MD, PhD; Hendrika Bootsma, MD, PhD
JAMA. 2010;304(18):2015-2016. doi:10.1001/jama.2010.1582.
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.