Sjögren's Disease as a Dynamical Syndrome: Integrating Glandular Programs, Autonomic–Physiological Drift, Fatigue Dynamics, and Digital Monitoring. Conceptual Note — URM / Dynamic Medicine Series

This Conceptual Note is part of the URM / Dynamic Medicine Series and interprets Sjögren’s disease as a multidomain dynamical syndrome rather than a static sicca-defined condition. The article integrates recent developments in salivary gland transcriptomics, single-cell and spatial profiling, autonomic–physiological regulation, fatigue research, digital monitoring, electronic patient-reported outcomes, and machine-learning-based stratification. It proposes that clinically meaningful states in Sjögren’s disease may be preceded and accompanied by system-level dynamical change across glandular biology, immune activation, activity patterns, fatigue dynamics, and patient-reported fluctuation. Within the Universal Resonance Model, Sjögren’s disease is interpreted as a disorder of coupled subsystems, where glandular immune programs, autonomic regulation, activity–sleep patterns, and symptom expression may interact over time. Fatigue is highlighted as a clinically important downstream expression of impaired buffering, altered recovery capacity, and multidomain system coupling. This work is conceptual and hypothesis-generating. It does not provide clinical treatment recommendations and should not be used to guide individual patient care without appropriate clinical judgment.