Hal Scofield has done a remarkable job in assembling a timely, up-to-date, and thoughtful review of Sjogren syndrome (SS). It does appear that the science is catching up to the phenomenology that has always characterized this disease. Great strides have been made, and Hal has captured their impact.
Nocturne and colleagues review the data from biologic trials in SS; B-cell targeting has not matched the hopes for its success. However, progress in understanding SS pathogenesis has identified new targets, and trials are underway. Fayyaz and colleagues review the role of autoantibodies attributed to the pathogenesis of SS and attempt to define their exact mechanism of action. Reksten and coworkers discuss the genes associated with SS and the possible role that genetic dysregulation of the NF-kB pathway plays in the pathogenesis of the disease. Katsiougiannis and Wong focus on saliva proteomics in an attempt to validate salivary biomarkers for diagnosis, classification, and prognosis. Anaya and colleagues discuss polyautoimmunity in SS from the standpoint of potential environmental triggers, and Campos and colleagues examine pathologic studies as a key factor in understanding disease establishment and progression. Spijkervet and associates make a strong case for using carefully done parotid gland biopsies as a substitute for the use of minor salivary gland biopsies, and Jonsson and Baldini discuss the emerging role of salivary gland ultrasonography in the diagnosis and management of SS. Bob Fox, with a lifetime of experience in diagnosing and managing patients with SS, provides his insights into why trials have failed by not focusing on what matters most to the patient. Finally, Vivino and colleagues review the state-of-the-art of comprehensive management of patients with SS.