Executive summary: British Society for Rheumatology guideline on management of adult and juvenile onset Sjögren disease

Background and rationale for guideline developmentSj€ ogren disease (SD) is a chronic, auto-immune disease of unknown aetiology with significant impact on quality of life (QoL) [1].Although dryness (sicca) of the eyes and mouth are the classically described features, dryness of other mucosal surfaces and systemic manifestations are common.The key management aim should be to empower the individuals to manage their condition; conserving, replacing and stimulating secretions; preventing damage and suppressing systemic disease activity.This guideline builds on, and widens the recommendations developed for the first guideline published in 2017 [2].We have included advice on the management of children and adolescents where appropriate to provide a comprehensive guideline for UK-based rheumatology teams. Guideline developmentThis guideline was developed in line with the British Society for Rheumatology (BSR) Creating Guidelines protocol.The working group agreed the guideline scope and identified 19 key questions [3].Using these key questions, a literature search was undertaken (Supplementary Data S1, available at Rheumatology online), eligible papers were reviewed, draft recommendations developed and the GRADE process followed to summarize the quality of evidence as high (A), moderate (B) or low/very low (C) [4].The content, wording, strength of recommendation (strong ¼ 1, conditional ¼ 2) and Strength of Agreement (SoA) were determined by the working group responses.Only recommendations with a SoA >80% were included.