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Practice Guideline
. 2025 Feb 11;65(1):7.
doi: 10.1186/s42358-025-00438-7.

Recommendations on neurologic, cognitive, and psychiatric manifestations in patients with Sjögren's disease by the Brazilian Society of Rheumatology

Fabiola Reis de Oliveira  1 , Simone Appenzeller  2 , Sandra Gofinet Pasoto  3 , Marilena Leal Mesquita Silvestre Fernandes  4 , Maria Lucia Lemos Lopes  5   6 , Sonia Cristina de Magalhães Souza Fialho  3 , Aysa Cesar Pinheiro  7 , Laura Caldas Dos Santos  8 , Valeria Valim  9   10 , Erica Vieira Serrano  10   11 , Sandra Lucia Euzébio Ribeiro  12 , Tatiana Nayara Libório-Kimura  12 , Danielle Christinne Soares do Egypto  13 , Diego Ustárroz Cantali  14 , Juliana D'Agostino Gennari  15 , Samira Tatiyama Miyamoto  16 , Karina Gatz Capobianco  17 , Alisson Aliel Vigano Pugliesi  18 , Vinicius Tassoni Civile  19 , Ana Carolina Pereira Nunes Pinto  19   20 , César Ramos Rocha-Filho  19 , Aline Pereira da Rocha  19 , Virginia Fernandes Moça Trevisani  19   21
Affiliations
Practice Guideline

Recommendations on neurologic, cognitive, and psychiatric manifestations in patients with Sjögren's disease by the Brazilian Society of Rheumatology

Fabiola Reis de Oliveira et al. Adv Rheumatol. .

Abstract

Background: Neurological and psychiatric manifestations occur in patients with primary Sjogren's disease (SjD) with a wide-ranging clinical presentation, affecting quality of life, social participation, and prognosis. Despite this, neither central nor peripheral neurological symptoms are systematically evaluated in the context of autoimmunity or identified as manifestations of SjD. The EULAR Sjogren's Syndrome Disease Activity Index (ESSDAI) covers only part of them in the neurological domain.

Methods: We performed a systematic review of the diagnosis and prevalence of central, peripheral, and autonomic nervous system manifestations in primary SjD, following the recommendations proposed by the Cochrane Collaboration Handbook. Observational studies were included when their main issue was the diagnosis and the prevalence of the manifestations individually. We employed a generalized linear mixed model (GLMM) method with a random-effects model, and the results were computed using logit transformation, implemented through the 'meta' and 'metafor' packages in the R software (version 3.6.1). To present these recommendations, agreement among experts was investigated using the Delphi method in in-person meetings.

Results: We propose ten recommendations regarding the investigation and management of neurological involvement in SjD that had 100% agreement among participants.

Conclusion: These recommendations add to the literature on the clinical care of patients with SjD.

Keywords: Central nervous system; Cognitive impairments; Neurological manifestations; Peripheral nervous system; Psychiatric disease; Sjögren’s disease.; Sjögren’s syndrome.

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Conflict of interest statement

Declarations. Ethical approval: Not applicable. Consent for publication: All authors consent to publication. Competing interests: The authors declare no competing interests.

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