Thanda Aung
Sjögren's disease (SjD) is a chronic, systemic autoimmune disease characterized by lymphocytic infiltration of exocrine glands and substantial extraglandular involvement. It is widely recognized as one of the most prevalent systemic rheumatic autoimmune diseases; however, patients experience a diagnostic delay averaging roughly five to six years from symptom onset, during which irreversible glandular and systemic damage may accumulate. No disease-modifying therapy is currently approved for SjD, and management remains largely symptomatic, centered on artificial tears, sialogogues, and hydroxychloroquine, none of which reliably arrest systemic immunopathology. This review synthesizes unmet needs across the diagnostic, symptomatic, and therapeutic domains of SjD, with particular attention to the persistent burden of fatigue, cognitive dysfunction, chronic pain, and lymphoproliferative risk. It examines the clinimetric utility of the European Alliance of Associations for Rheumatology (EULAR) Sjögren's Syndrome Disease Activity Index (ESSDAI) and the EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) as complementary tools that capture systemic organ-based activity and patient-reported symptom burden, respectively. Their growing role as primary endpoints in modern clinical trials is also discussed. Finally, emerging therapeutic strategies are highlighted, including B-cell/BAFF-receptor-targeted ianalumab, the FcRn blocker nipocalimab, and the CD40-CD40L pathway inhibitor dazodalibep, which have demonstrated promising efficacy signals in randomized controlled trials. Improving outcomes in SjD will require earlier recognition, more consistent application of validated outcome measures in routine practice, and rational adoption of emerging immunoselective therapies guided by biomarker-based patient stratification.