Sjögren's Syndrome: Epidemiology, Classification Criteria, Molecular Pathogenesis, Diagnosis, and Treatment

Ying Hu , Bin Wen , Yunfei Zhang , Xiaocui Wang , Xuemei Duan , Haonan Li , Yufeng Fan , Huifeng Shang , Yukai Jing

MedComm ›› 2025, Vol. 6 ›› Issue (7) : e70297

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MedComm ›› 2025, Vol. 6 ›› Issue (7) : e70297 DOI: 10.1002/mco2.70297
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Sjögren's Syndrome: Epidemiology, Classification Criteria, Molecular Pathogenesis, Diagnosis, and Treatment

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Abstract

Sjögren's syndrome (SS) is a chronic autoimmune disorder characterized by T-cell-mediated B-cell hyperactivity and cytokine production, clinically manifesting, dry mouth and eyes, accompanied by pain and fatigue. The disease may progress from asymptomatic glandular involvement to systemic manifestations or even lymphoma. The pathogenesis of SS is intricate, involving a multifaceted interplay of genetic, environmental, and immunological factors. There is still uncertainty regarding the effectiveness of SS-targeted treatments, due to the significant diversity in disease phenotypes and potentially varying responses to immunomodulatory therapies, stringent enrollment criteria and adoption of outcome metrics in clinical trials may partially explain the failure of many trials to achieve their primary outcomes. Despite the current lack of effective treatments, recent advancements have been made in epidemiology, the development of classification criteria, and the establishment of systems for assessing disease activity. Notably, enhanced insights into the pathogenesis have paved the way for the potential development of targeted therapies. This review aims to systematically synthesize the latest research advancements in the epidemiological characteristics, diagnostic criteria, molecular mechanisms, and clinical manifestations of SS, thereby providing a scientific foundation for the development of future therapeutic strategies.

Keywords

classification criteria / diagnosis / epidemiology / molecular pathogenesis / Sjögren's syndrome / treatment

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Ying Hu, Bin Wen, Yunfei Zhang, Xiaocui Wang, Xuemei Duan, Haonan Li, Yufeng Fan, Huifeng Shang, Yukai Jing. Sjögren's Syndrome: Epidemiology, Classification Criteria, Molecular Pathogenesis, Diagnosis, and Treatment. MedComm, 2025, 6(7): e70297 DOI:10.1002/mco2.70297

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References

[1]

S. J. Bowman, R. Fox, T. Dörner, et al., “Safety and Efficacy of Subcutaneous Ianalumab (VAY736) in Patients With Primary Sjögren's Syndrome: A Randomised, Double-Blind, Placebo-Controlled, Phase 2b Dose-Finding Trial,” Lancet 399, no. 10320 (2022): 161-171.

[2]

R. Felten, A. Meyer, and J. E. Gottenberg, “Non-Primary Sjogren's Syndrome: Secondary or Associated?,” Joint, Bone, Spine 90, no. 2 (2023): 105502.

[3]

B. Qin, J. Wang, Z. Yang, et al., “Epidemiology of Primary Sjögren's Syndrome: A Systematic Review and Meta-Analysis,” Annals of the Rheumatic Diseases 74, no. 11 (2015): 1983-1989.

[4]

X. Li, B. Xu, Y. Ma, et al., “Clinical and Laboratory Profiles of Primary Sjogren's Syndrome in a Chinese Population: A Retrospective Analysis of 315 Patients,” International Journal of Rheumatic Diseases 18, no. 4 (2015): 439-446.

[5]

P. Brito-Zerón, N. Acar-Denizli, W. F. Ng, et al., “How Immunological Profile Drives Clinical Phenotype of Primary Sjögren's Syndrome at Diagnosis: Analysis of 10,500 Patients (Sjögren Big Data Project),” Clinical and Experimental Rheumatology 36, no. 3 suppl 112 (2018): 102-112.

[6]

J. E. Gottenberg, R. Seror, C. Miceli-Richard, et al., “Serum Levels of Beta2-Microglobulin and Free Light Chains of Immunoglobulins Are Associated With Systemic Disease Activity in Primary Sjögren's Syndrome. Data at Enrollment in the Prospective ASSESS Cohort,” PLoS ONE 8, no. 5 (2013): e59868.

[7]

M. Beydon, S. McCoy, Y. Nguyen, T. Sumida, X. Mariette, and R. Seror, “Epidemiology of Sjögren Syndrome,” Nature Reviews Rheumatology 20, no. 3 (2024): 158-169.

[8]

A. K. Johansson, A. Johansson, L. Unell, G. Ekbäck, S. Ordell, and G. E. Carlsson, “Self-Reported Dry Mouth in Swedish Population Samples Aged 50, 65 and 75 Years,” Gerodontology 29, no. 2 (2012): e107-115.

[9]

D. A. Schaumberg, D. A. Sullivan, J. E. Buring, and M. R. Dana, “Prevalence of Dry Eye Syndrome Among US Women,” American Journal of Ophthalmology 136, no. 2 (2003): 318-326.

[10]

H. Tsuboi, S. Hagiwara, H. Asashima, et al., “Comparison of Performance of the 2016 ACR-EULAR Classification Criteria for Primary Sjögren's Syndrome With Other Sets of Criteria in Japanese Patients,” Annals of the Rheumatic Diseases 76, no. 12 (2017): 1980-1985.

[11]

C. Vitali, S. Bombardieri, R. Jonsson, et al., “Classification Criteria for Sjögren's Syndrome: A Revised Version of the European Criteria Proposed by the American-European Consensus Group,” Annals of the Rheumatic Diseases 61, no. 6 (2002): 554-558.

[12]

M. Le Goff, D. Cornec, and S. Jousse-Joulin, “Comparison of 2002 AECG and 2016 ACR/EULAR Classification Criteria and Added Value of Salivary Gland Ultrasonography in a Patient Cohort With Suspected Primary Sjögren's Syndrome,” Arthritis Research & Therapy 19, no. 1 (2017): 269.

[13]

Y. J. Xiang and S. M. Dai, “Prevalence of Rheumatic Diseases and Disability in China,” Rheumatology International 29, no. 5 (2009): 481-490.

[14]

L. C. See, C. F. Kuo, I. J. Chou, M. J. Chiou, and K. H. Yu, “Sex- and Age-Specific Incidence of Autoimmune Rheumatic Diseases in the Chinese Population: A Taiwan Population-Based Study,” Seminars in Arthritis and Rheumatism 43, no. 3 (2013): 381-386.

[15]

R. Seror, L. Chiche, M. Beydon, et al., “Estimated Prevalence, Incidence and Healthcare Costs of Sjögren's Syndrome in France: A National Claims-Based Study,” RMD Open 10, no. 1 (2024): e003591.

[16]

G. Maciel, C. S. Crowson, E. L. Matteson, and D. Cornec, “Prevalence of Primary Sjögren's Syndrome in a US Population-Based Cohort,” Arthritis Care Research (Hoboken) 69, no. 10 (2017): 1612-1616.

[17]

G. Nocturne, R. Seror, X. Mariette, V. Devauchelle-Pensec, A. Saraux, and L. Chiche, “Primary Sjögren's Syndrome Prevalence: What If Sjögren Was Right After All? Comment on the Article by Maciel Et Al,” Arthritis Care Research (Hoboken) 70, no. 6 (2018): 951-953.

[18]

P. Brito-Zerón, N. Acar-Denizli, M. Zeher, et al., “Influence of Geolocation and Ethnicity on the Phenotypic Expression of Primary Sjögren's Syndrome at Diagnosis in 8310 Patients: A Cross-Sectional Study From the Big Data Sjögren Project Consortium,” Annals of the Rheumatic Diseases 76, no. 6 (2017): 1042-1050.

[19]

S. Retamozo, N. Acar-Denizli, I. F. Horváth, et al., “Influence of the Age at Diagnosis in the Disease Expression of Primary Sjögren Syndrome. Analysis of 12,753 Patients From the Sjögren Big Data Consortium,” Clinical and Experimental Rheumatology 39, no. 6 suppl 133 (2021): 166-174.

[20]

P. Brito-Zerón, N. Acar-Denizli, W. F. Ng, et al., “Epidemiological Profile and North-South Gradient Driving Baseline Systemic Involvement of Primary Sjögren's Syndrome,” Rheumatology 59, no. 9 (2020): 2350-2359.

[21]

T. Flament, A. Bigot, B. Chaigne, H. Henique, E. Diot, and S. Marchand-Adam, “Pulmonary Manifestations of Sjögren's Syndrome,” European Respiratory Review 25, no. 140 (2016): 110-123.

[22]

J. I. Ramírez Sepúlveda, M. Kvarnström, S. Brauner, C. Baldini, and M. Wahren-Herlenius, “Difference in Clinical Presentation Between Women and Men in Incident Primary Sjögren's Syndrome,” Biology of Sex Differences 8 (2017): 16.

[23]

J. D. Crawford, H. Wang, D. Trejo-Zambrano, et al., “The XIST lncRNA Is a Sex-Specific Reservoir of TLR7 Ligands in SLE,” JCI Insight 8, no. 20 (2023): e169344.

[24]

M. Souyris, C. Cenac, P. Azar, et al., “TLR7 Escapes X Chromosome Inactivation in Immune Cells,” Science Immunology 3, no. 19 (2018): eaap8855.

[25]

V. M. Harris, I. T. W. Harley, B. T. Kurien, K. A. Koelsch, and R. H. Scofield, “Lysosomal pH Is Regulated in a Sex Dependent Manner in Immune Cells Expressing CXorf21,” Frontiers in Immunology 10 (2019): 578.

[26]

L. Jin, M. Dai, C. Li, J. Wang, and B. Wu, “Risk Factors for Primary Sjögren's Syndrome: A Systematic Review and Meta-Analysis,” Clinical Rheumatology 42, no. 2 (2023): 327-338.

[27]

J. Mofors, A. Björk, E. Richardsdotter Andersson, et al., “Cigarette Smoking Patterns Preceding Primary Sjögren's Syndrome,” RMD Open 6, no. 3 (2020): e001402.

[28]

H. Ben-Eli, D. J. Aframian, E. Ben-Chetrit, et al., “Shared Medical and Environmental Risk Factors in Dry Eye Syndrome, Sjogren's Syndrome, and B-Cell Non-Hodgkin Lymphoma: A Case-Control Study,” Journal of Immunology Research 2019 (2019): 9060842.

[29]

P. Olsson, C. Turesson, T. Mandl, L. Jacobsson, and E. Theander, “Cigarette Smoking and the Risk of Primary Sjögren's Syndrome: A Nested Case Control Study,” Arthritis Research & Therapy 19, no. 1 (2017): 50.

[30]

R. Priori, E. Medda, F. Conti, et al., “Risk Factors for Sjögren's Syndrome: A Case-Control Study,” Clinical and Experimental Rheumatology 25, no. 3 (2007): 378-384.

[31]

D. Karaiskos, C. P. Mavragani, M. H. Sinno, et al., “Psychopathological and Personality Features in Primary Sjogren's Syndrome—Associations With Autoantibodies to Neuropeptides,” Rheumatology 49, no. 9 (2010): 1762-1769.

[32]

F. Meng, S. Ren, Y. Meng, N. Tao, and J. Zhang, “Association Between Stressful Life Events and Female Primary Sjogren's Syndrome and Their Role in Disease Activity: A Retrospective Case-Control Study in China,” Neuropsychiatric Disease and Treatment 17 (2021): 213-220.

[33]

A. Machowicz, I. Hall, P. de Pablo, et al., “Mediterranean Diet and Risk of Sjögren's Syndrome,” Clinical and Experimental Rheumatology 38, no. 4 suppl 126 (2020): 216-221.

[34]

C. Salliot, Y. Nguyen, G. Gusto, et al., “Female Hormonal Exposures and Risk of Rheumatoid Arthritis in the French E3N-EPIC Cohort Study,” Rheumatology 60, no. 10 (2021): 4790-4800.

[35]

S. Kovats, “Estrogen Receptors Regulate Innate Immune Cells and Signaling Pathways,” Cellular Immunology 294, no. 2 (2015): 63-69.

[36]

S. S. McCoy, E. Sampene, and A. N. Baer, “Association of Sjögren's Syndrome with Reduced Lifetime Sex Hormone Exposure: A Case-Control Study,” Arthritis Care Research (Hoboken) 72, no. 9 (2020): 1315-1322.

[37]

Y. Xuan, X. Zhang, and H. Wu, “Impact of Sex Differences on the Clinical Presentation, Pathogenesis, Treatment and Prognosis of Sjögren's Syndrome,” Immunology 171, no. 4 (2024): 513-524.

[38]

N. Ishimaru, K. Saegusa, K. Yanagi, N. Haneji, I. Saito, and Y. Hayashi, “Estrogen Deficiency Accelerates Autoimmune Exocrinopathy in murine Sjögren's Syndrome Through Fas-Mediated Apoptosis,” American Journal of Pathology 155, no. 1 (1999): 173-181.

[39]

Y. M. Da, K. Y. Niu, S. Y. Liu, et al., “Does Cimicifuga racemosa Have the Effects Like Estrogen on the Sublingual Gland in Ovariectomized Rats?,” Biological Research 50, no. 1 (2017): 11.

[40]

M. N. Manoussakis, M. Tsinti, E. K. Kapsogeorgou, and H. M. Moutsopoulos, “The Salivary Gland Epithelial Cells of Patients With Primary Sjögren's Syndrome Manifest Significantly Reduced Responsiveness to 17β-Estradiol,” Journal of Autoimmunity 39, no. 1-2 (2012): 64-68.

[41]

D. A. Schaumberg, J. E. Buring, D. A. Sullivan, and M. R. Dana, “Hormone Replacement Therapy and Dry Eye Syndrome,” JAMA 286, no. 17 (2001): 2114-2119.

[42]

E. O. Johnson, M. Kostandi, and H. M. Moutsopoulos, “Hypothalamic-Pituitary-Adrenal Axis Function in Sjögren's Syndrome: Mechanisms of Neuroendocrine and Immune System Homeostasis,” Annals of the New York Academy of Sciences 1088 (2006): 41-51.

[43]

L. Yang, W. Wei, X. He, Y. Xie, M. A. Kamal, and J. Li, “Influence of Hormones on Sjögren's Syndrome,” Current Pharmaceutical Design 24, no. 35 (2018): 4167-4176.

[44]

C. P. Mavragani, G. E. Fragoulis, and H. M. Moutsopoulos, “Endocrine Alterations in Primary Sjogren's Syndrome: An Overview,” Journal of Autoimmunity 39, no. 4 (2012): 354-358.

[45]

Z. Liu and A. Chu, “Sjögren's Syndrome and Viral Infections,” Rheumatology and Therapy 8, no. 3 (2021): 1051-1059.

[46]

K. Otsuka, M. Sato, T. Tsunematsu, and N. Ishimaru, “Virus Infections Play Crucial Roles in the Pathogenesis of Sjögren's Syndrome,” Viruses 14, no. 7 (2022): 1474.

[47]

M. Maślińska, “The Role of Epstein-Barr Virus Infection in Primary Sjögren's Syndrome,” Current Opinion in Rheumatology 31, no. 5 (2019): 475-483.

[48]

H. Nakamura, Y. Horai, A. Tokuyama, et al., “HTLV-I Virological and Histopathological Analysis in Two Cases of Anti-Centromere-Antibody-Seropositive Sjögren's Syndrome,” Modern Rheumatology 23, no. 1 (2013): 133-139.

[49]

S. J. Lee, J. S. Lee, M. G. Shin, et al., “Detection of HTLV-1 in the Labial Salivary Glands of Patients With Sjögren's Syndrome: A Distinct Clinical Subgroup?,” Journal of Rheumatology 39, no. 4 (2012): 809-815.

[50]

A. Flores-Chávez, J. A. Carrion, X. Forns, and M. Ramos-Casals, “Extrahepatic Manifestations Associated With Chronic Hepatitis C Virus Infection,” Revista Española de Sanidad Penitenciaria 19, no. 3 (2017): 87-97.

[51]

M. Ramos-Casals, P. Brito-Zerón, and J. Font, “Lessons From Diseases Mimicking Sjögren's Syndrome,” Clinical Reviews in Allergy & Immunology 32, no. 3 (2007): 275-283.

[52]

Y. Wang, H. Dou, G. Liu, et al., “Hepatitis C Virus Infection and the Risk of Sjögren or Sicca Syndrome: A Meta-Analysis,” Microbiology and Immunology 58, no. 12 (2014): 675-687.

[53]

J. J. Arrieta, E. Rodríguez-Iñigo, N. Ortiz-Movilla, et al., “In Situ Detection of Hepatitis C Virus RNA in Salivary Glands,” American Journal of Pathology 158, no. 1 (2001): 259-264.

[54]

M. Ramos-Casals, M. García-Carrasco, R. Cervera, et al., “Th1/Th2 Cytokine Imbalance in Patients With Sjögren Syndrome Secondary to Hepatitis C Virus Infection,” Seminars in Arthritis and Rheumatism 32, no. 1 (2002): 56-63.

[55]

J. K. Amaral, J. B. Bilsborrow, and R. T. Schoen, “Chronic Chikungunya Arthritis and Rheumatoid Arthritis: What They Have in Common,” American Journal of Medicine 133, no. 3 (2020): e91-e97.

[56]

R. Kumar, M. K. Sharma, S. K. Jain, S. K. Yadav, and A. K. Singhal, “Cutaneous Manifestations of Chikungunya Fever: Observations From an Outbreak at a Tertiary Care Hospital in Southeast Rajasthan, India,” Indian Dermatology Online Journal 8, no. 5 (2017): 336-342.

[57]

J. F. de Carvalho, D. Kanduc, F. F. da Silva, A. Tanay, A. Lucchese, and Y. Shoenfeld, “Sjögren's Syndrome Associated With Chikungunya Infection: A Case Report,” Rheumatology and Therapy 8, no. 1 (2021): 631-637.

[58]

I. Ates, U. Terzi, S. Suzen, and L. M. Irham, “An Overview on Sjögren's Syndrome and Systemic Lupus Erythematosus' Genetics,” Toxicology Research (Cambridge) 14, no. 1 (2025): tfae194.

[59]

J. Imgenberg-Kreuz, A. Rasmussen, K. Sivils, and G. Nordmark, “Genetics and Epigenetics in Primary Sjögren's Syndrome,” Rheumatology 60, no. 5 (2021): 2085-2098.

[60]

L. Ortíz-Fernández, J. Martín, and M. E. Alarcón-Riquelme, “A Summary on the Genetics of Systemic Lupus Erythematosus, Rheumatoid Arthritis, Systemic Sclerosis, and Sjögren's Syndrome,” Clinical Reviews in Allergy & Immunology 64, no. 3 (2023): 392-411.

[61]

C. Perricone, L. Bruno, G. Cafaro, et al., “Sjogren's Syndrome: Everything You Always Wanted to Know About Genetic and Epigenetic Factors,” Autoimmunity Reviews 23, no. 12 (2024): 103673.

[62]

X. Hong, S. Meng, D. Tang, et al., “Single-Cell RNA Sequencing Reveals the Expansion of Cytotoxic CD4(+) T Lymphocytes and a Landscape of Immune Cells in Primary Sjögren's Syndrome,” Frontiers in Immunology 11 (2020): 594658.

[63]

E. Rivière, J. Pascaud, N. Tchitchek, et al., “Salivary Gland Epithelial Cells From Patients With Sjögren's Syndrome Induce B-Lymphocyte Survival and Activation,” Annals of the Rheumatic Diseases 79, no. 11 (2020): 1468-1477.

[64]

C. Rizzo, G. Grasso, G. M. Destro Castaniti, F. Ciccia, and G. Guggino, “Primary Sjogren Syndrome: Focus on Innate Immune Cells and Inflammation,” Vaccines (Basel) 8, no. 2 (2020): 272.

[65]

C. J. Lessard, H. Li, I. Adrianto, et al., “Variants at Multiple Loci Implicated in Both Innate and Adaptive Immune Responses Are Associated With Sjögren's Syndrome,” Nature Genetics 45, no. 11 (2013): 1284-1292.

[66]

E. F. López-Villalobos, F. J. Carrillo-Ballesteros, J. F. Muñoz-Valle, et al., “Association of CD28 and CTLA4 Haplotypes With Susceptibility to Primary Sjögren's Syndrome in Mexican Population,” Journal of Clinical Laboratory Analysis 33, no. 1 (2019): e22620.

[67]

G. E. Thorlacius, M. Wahren-Herlenius, and L. Rönnblom, “An Update on the Role of Type I Interferons in Systemic Lupus Erythematosus and Sjögren's Syndrome,” Current Opinion in Rheumatology 30, no. 5 (2018): 471-481.

[68]

K. Fang, K. Zhang, and J. Wang, “Network-Assisted Analysis of Primary Sjögren's Syndrome GWAS Data in Han Chinese,” Scientific Reports 5 (2015): 18855.

[69]

J. L. Mougeot, B. D. Noll, and F. K. Bahrani Mougeot, “Sjögren's Syndrome X-Chromosome Dose Effect: An Epigenetic Perspective,” Oral Diseases 25, no. 2 (2019): 372-384.

[70]

K. Liu, B. T. Kurien, S. L. Zimmerman, et al., “X Chromosome Dose and Sex Bias in Autoimmune Diseases: Increased Prevalence of 47,XXX in Systemic Lupus Erythematosus and Sjögren's Syndrome,” Arthritis & Rheumatology 68, no. 5 (2016): 1290-1300.

[71]

R. Sharma, V. M. Harris, J. Cavett, et al., “Rare X Chromosome Abnormalities in Systemic Lupus Erythematosus and Sjögren's Syndrome,” Arthritis & Rheumatology 69, no. 11 (2017): 2187-2192.

[72]

G. Nocturne, E. Pontarini, M. Bombardieri, and X. Mariette, “Lymphomas Complicating Primary Sjögren's Syndrome: From Autoimmunity to Lymphoma,” Rheumatology 60, no. 8 (2021): 3513-3521.

[73]

W. Saleh, M. M. Elashry, N. Winn, M. Mona, J. Katz, and S. Cha, “A Lower Prevalence of Malignant Lymphoma in Sjögren's syndrome Patients: A Cross-Sectional Study,” Oral Diseases 29, no. 8 (2023): 3313-3324.

[74]

E. Treppo, F. Toffolutti, V. Manfrè, et al., “Risk of Cancer in Connective Tissue Diseases in Northeastern Italy Over 15 Years,” Journal of Clinical Medicine 11, no. 15 (2022): 4272.

[75]

H. Zhong, S. Liu, Y. Wang, et al., “Primary Sjögren's Syndrome Is Associated With Increased Risk of Malignancies Besides Lymphoma: A Systematic Review and Meta-Analysis,” Autoimmunity Reviews 21, no. 5 (2022): 103084.

[76]

V. C. Pezoulas, A. Goules, F. Kalatzis, et al., “Addressing the Clinical Unmet Needs in Primary Sjögren's Syndrome Through the Sharing, Harmonization and Federated Analysis of 21 European Cohorts,” Computational and Structural Biotechnology Journal 20 (2022): 471-484.

[77]

S. De Vita, M. Isola, C. Baldini, et al., “Predicting Lymphoma in Sjögren's Syndrome and the Pathogenetic Role of Parotid Microenvironment Through Precise Parotid Swelling Recording,” Rheumatology 62, no. 4 (2023): 1586-1593.

[78]

I. Giovannini, M. Lorenzon, V. Manfrè, et al., “Safety, Patient Acceptance and Diagnostic Accuracy of Ultrasound Core Needle Biopsy of Parotid or Submandibular Glands in Primary Sjögren's Syndrome With Suspected Salivary Gland Lymphoma,” RMD Open 8, no. 1 (2022): e001901.

[79]

G. Hernández-Molina, C. Ávila-Casado, C. Hernández-Hernández, C. Recillas-Gispert, and J. Sánchez-Guerrero, “Performance of the 2016 ACR/EULAR SS Classification Criteria in Patients With Secondary Sjögren's Syndrome,” Clinical and Experimental Rheumatology 38, no. 4 suppl 126 (2020): 130-133.

[80]

A. P. E. Gianordoli, R. Laguardia, M. Santos, et al., “Prevalence of Sjögren's Syndrome According to 2016 ACR-EULAR Classification Criteria in Patients With Systemic Lupus Erythematosus,” Advances in Rheumatology 63, no. 1 (2023): 11.

[81]

A. N. Baer, J. W. Maynard, F. Shaikh, L. S. Magder, and M. Petri, “Secondary Sjogren's Syndrome in Systemic Lupus Erythematosus Defines a Distinct Disease Subset,” Journal of Rheumatology 37, no. 6 (2010): 1143-1149.

[82]

D. Xu, X. Tian, W. Zhang, X. Zhang, B. Liu, and F. Zhang, “Sjogren's Syndrome-Onset Lupus Patients Have Distinctive Clinical Manifestations and Benign Prognosis: A Case-Control Study,” Lupus 19, no. 2 (2010): 197-200.

[83]

L. R. Harrold, Y. Shan, S. Rebello, et al., “Prevalence of Sjögren's Syndrome Associated With Rheumatoid Arthritis in the USA: An Observational Study From the Corrona Registry,” Clinical Rheumatology 39, no. 6 (2020): 1899-1905.

[84]

N. Hassold, R. Seror, X. Mariette, and G. Nocturne, “Characteristics of Sjögren's Syndrome Associated With Rheumatoid Arthritis,” RMD Open 8, no. 1 (2022): e002234.

[85]

M. Hadj Said, J. M. Foletti, N. Graillon, L. Guyot, and C. Chossegros, “Orofacial Manifestations of Scleroderma. A Literature Review,” Revue de Stomatologie, de Chirurgie Maxillo-Faciale et de Chirurgie Orale 117, no. 5 (2016): 322-326.

[86]

S. Kobak, F. Oksel, K. Aksu, and Y. Kabasakal, “The Frequency of Sicca Symptoms and Sjögren's Syndrome in Patients With Systemic Sclerosis,” International Journal of Rheumatic Diseases 16, no. 1 (2013): 88-92.

[87]

C. Baldini, M. Mosca, A. Della Rossa, et al., “Overlap of ACA-Positive Systemic Sclerosis and Sjögren's Syndrome: A Distinct Clinical Entity With Mild Organ Involvement but at High Risk of Lymphoma,” Clinical and Experimental Rheumatology 31, no. 2 (2013): 272-280.

[88]

M. Bautista-Vargas, A. J. Vivas, and G. J. Tobón, “Minor Salivary Gland Biopsy: Its Role in the Classification and Prognosis of Sjögren's Syndrome,” Autoimmunity Reviews 19, no. 12 (2020): 102690.

[89]

A. N. Baer, L. Medrano, M. McAdams-DeMarco, and T. J. Gniadek, “Association of Anticentromere Antibodies with More Severe Exocrine Glandular Dysfunction in Sjögren's Syndrome: Analysis of the Sjögren's International Collaborative Clinical Alliance Cohort,” Arthritis Care Research (Hoboken) 68, no. 10 (2016): 1554-1559.

[90]

S. Negrini, G. Emmi, M. Greco, et al., “Sjögren's Syndrome: A Systemic Autoimmune Disease,” Clinical and Experimental Medicine 22, no. 1 (2022): 9-25.

[91]

C. H. Shiboski, S. C. Shiboski, R. Seror, et al., “2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren's Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts,” Arthritis & Rheumatology 69, no. 1 (2017): 35-45.

[92]

A. Ravelli, F. Minoia, S. Davì, et al., “2016 Classification Criteria for Macrophage Activation Syndrome Complicating Systemic Juvenile Idiopathic Arthritis: A European League Against Rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organisation Collaborative Initiative,” Annals of the Rheumatic Diseases 75, no. 3 (2016): 481-489.

[93]

M. Ramos-Casals, P. Brito-Zerón, S. Bombardieri, et al., “EULAR Recommendations for the Management of Sjögren's Syndrome With Topical and Systemic Therapies,” Annals of the Rheumatic Diseases 79, no. 1 (2020): 3-18.

[94]

L. Kong, C. P. Robinson, A. B. Peck, et al., “Inappropriate Apoptosis of Salivary and Lacrimal Gland Epithelium of Immunodeficient NOD-Scid Mice,” Clinical and Experimental Rheumatology 16, no. 6 (1998): 675-681.

[95]

M. N. Manoussakis and E. K. Kapsogeorgou, “The Role of Intrinsic Epithelial Activation in the Pathogenesis of Sjögren's Syndrome,” Journal of Autoimmunity 35, no. 3 (2010): 219-224.

[96]

Y. Z. Gong, J. Nititham, K. Taylor, et al., “Differentiation of Follicular Helper T Cells by Salivary Gland Epithelial Cells in Primary Sjögren's Syndrome,” Journal of Autoimmunity 51 (2014): 57-66.

[97]

Y. Peng, X. Wu, S. Zhang, et al., “The Potential Roles of Type I Interferon Activated Neutrophils and Neutrophil Extracellular Traps (NETs) in the Pathogenesis of Primary Sjögren's Syndrome,” Arthritis Research & Therapy 24, no. 1 (2022): 170.

[98]

V. Papayannopoulos, “Neutrophil Extracellular Traps in Immunity and Disease,” Nature Reviews Immunology 18, no. 2 (2018): 134-147.

[99]

F. P. Siegal, N. Kadowaki, M. Shodell, et al., “The Nature of the Principal Type 1 Interferon-Producing Cells in Human Blood,” Science 284, no. 5421 (1999): 1835-1837.

[100]

L. Guéry and S. Hugues, “Tolerogenic and Activatory Plasmacytoid Dendritic Cells in Autoimmunity,” Frontiers in Immunology 4 (2013): 59.

[101]

Y. Tian, H. Yang, N. Liu, Y. Li, and J. Chen, “Advances in Pathogenesis of Sjögren's Syndrome,” Journal of Immunology Research 2021 (2021): 5928232.

[102]

W. Chen, F. Yang, G. Xu, J. Ma, and J. Lin, “Follicular Helper T Cells and Follicular Regulatory T Cells in the Immunopathology of Primary Sjögren's Syndrome,” Journal of Leukocyte Biology 109, no. 2 (2021): 437-447.

[103]

A. G. Tzioufas, E. K. Kapsogeorgou, and H. M. Moutsopoulos, “Pathogenesis of Sjögren's Syndrome: What We Know and What We Should Learn,” Journal of Autoimmunity 39, no. 1-2 (2012): 4-8.

[104]

G. M. Verstappen, P. M. Meiners, O. B. J. Corneth, et al., “Attenuation of Follicular Helper T Cell-Dependent B Cell Hyperactivity by Abatacept Treatment in Primary Sjögren's Syndrome,” Arthritis & Rheumatology 69, no. 9 (2017): 1850-1861.

[105]

M. Akiyama, W. Alshehri, K. Yoshimoto, and Y. Kaneko, “T Follicular Helper Cells and T Peripheral Helper Cells in Rheumatic and Musculoskeletal Diseases,” Annals of the Rheumatic Diseases 82, no. 11 (2023): 1371-1381.

[106]

Q. Zhan, J. Zhang, Y. Lin, W. Chen, X. Fan, and D. Zhang, “Pathogenesis and Treatment of Sjogren's Syndrome: Review and Update,” Frontiers in Immunology 14 (2023): 1127417.

[107]

J. A. Woznicki, N. Saini, P. Flood, et al., “TNF-α Synergises With IFN-γ to Induce Caspase-8-JAK1/2-STAT1-Dependent Death of Intestinal Epithelial Cells,” Cell Death & Disease 12, no. 10 (2021): 864.

[108]

M. N. Manoussakis and E. K. Kapsogeorgou, “The Role of Epithelial Cells in the Pathogenesis of Sjögren's Syndrome,” Clinical Reviews in Allergy & Immunology 32, no. 3 (2007): 225-230.

[109]

S. Asam, G. Neag, O. Berardicurti, D. Gardner, and F. Barone, “The Role of Stroma and Epithelial Cells in Primary Sjögren's Syndrome,” Rheumatology 60, no. 8 (2021): 3503-3512.

[110]

A. G. Vakrakou, I. P. Svolaki, K. Evangelou, V. G. Gorgoulis, and M. N. Manoussakis, “Cell-Autonomous Epithelial Activation of AIM2 (Absent in Melanoma-2) Inflammasome by Cytoplasmic DNA Accumulations in Primary Sjögren's Syndrome,” Journal of Autoimmunity 108 (2020): 102381.

[111]

K. Saegusa, N. Ishimaru, K. Yanagi, et al., “Treatment With Anti-CD86 Costimulatory Molecule Prevents the Autoimmune Lesions in Murine Sjögren's Syndrome (SS) Through Up-Regulated Th2 Response,” Clinical and Experimental Immunology 119, no. 2 (2000): 354-360.

[112]

M. P. Spachidou, E. Bourazopoulou, C. I. Maratheftis, et al., “Expression of Functional Toll-Like Receptors by Salivary Gland Epithelial Cells: Increased mRNA Expression in Cells Derived From Patients With Primary Sjögren's Syndrome,” Clinical and Experimental Immunology 147, no. 3 (2007): 497-503.

[113]

H. Nakamura, T. Tanaka, C. Zheng, et al., “Amplified Type I Interferon Response in Sjögren's Disease via Ectopic Toll-Like Receptor 7 Expression in Salivary Gland Epithelial Cells Induced by Lysosome-Associated Membrane Protein 3,” Arthritis & Rheumatology 76, no. 7 (2024): 1109-1119.

[114]

S. V. Walsh, A. M. Hopkins, and A. Nusrat, “Modulation of Tight Junction Structure and Function by Cytokines,” Advanced Drug Delivery Reviews 41, no. 3 (Jun( 2000): 303-313.

[115]

P. Ewert, S. Aguilera, C. Alliende, et al., “Disruption of Tight Junction Structure in Salivary Glands From Sjögren's Syndrome Patients Is Linked to Proinflammatory Cytokine Exposure,” Arthritis and Rheumatism 62, no. 5 (2010): 1280-1289.

[116]

R. F. Abu-Helu, I. D. Dimitriou, E. K. Kapsogeorgou, H. M. Moutsopoulos, and M. N. Manoussakis, “Induction of Salivary Gland Epithelial Cell Injury in Sjogren's Syndrome: In Vitro Assessment of T Cell-Derived Cytokines and Fas Protein Expression,” Journal of Autoimmunity 17, no. 2 (2001): 141-153.

[117]

E. Villanueva, S. Yalavarthi, C. C. Berthier, et al., “Netting Neutrophils Induce Endothelial Damage, Infiltrate Tissues, and Expose Immunostimulatory Molecules in Systemic Lupus Erythematosus,” Journal of Immunology 187, no. 1 (2011): 538-552.

[118]

R. Khandpur, C. Carmona-Rivera, A. Vivekanandan-Giri, et al., “NETs Are a Source of Citrullinated Autoantigens and Stimulate Inflammatory Responses in Rheumatoid Arthritis,” Science Translational Medicine 5, no. 178 (2013): 178ra140.

[119]

D. Söderberg, T. Kurz, A. Motamedi, T. Hellmark, P. Eriksson, and M. Segelmark, “Increased Levels of Neutrophil Extracellular Trap Remnants in the Circulation of Patients With Small Vessel Vasculitis, but an Inverse Correlation to Anti-Neutrophil Cytoplasmic Antibodies During Remission,” Rheumatology 54, no. 11 (2015): 2085-2094.

[120]

L. Zheng, Z. Zhang, C. Yu, L. Tu, L. Zhong, and C. Yang, “Association Between IFN-Alpha and Primary Sjogren's Syndrome,” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics 107, no. 1 (2009): e12-e18.

[121]

D. Azzouz, M. A. Khan, and N. Palaniyar, “ROS Induces NETosis by Oxidizing DNA and Initiating DNA Repair,” Cell Death Discovery 7, no. 1 (2021): 113.

[122]

S. K. Panda, R. Kolbeck, and M. A. Sanjuan, “Plasmacytoid Dendritic Cells in Autoimmunity,” Current Opinion in Immunology 44 (2017): 20-25.

[123]

H. Takagi, K. Arimura, T. Uto, et al., “Plasmacytoid Dendritic Cells Orchestrate TLR7-Mediated Innate and Adaptive Immunity for the Initiation of Autoimmune Inflammation,” Scientific Reports 6 (2016): 24477.

[124]

F. O. Nestle, C. Conrad, A. Tun-Kyi, et al., “Plasmacytoid Predendritic Cells Initiate Psoriasis Through Interferon-Alpha Production,” Journal of Experimental Medicine 202, no. 1 (2005): 135-143.

[125]

J. Zhou, X. Zhang, and Q. Yu, “Plasmacytoid Dendritic Cells Promote the Pathogenesis of Sjögren's Syndrome,” Biochimica et Biophysica Acta - Molecular Basis of Disease 1868, no. 2 (2022): 166302.

[126]

B. Reizis, “Plasmacytoid Dendritic Cells: Development, Regulation, and Function,” Immunity 50, no. 1 (2019): 37-50.

[127]

F. J. Barrat, M. K. Crow, and L. B. Ivashkiv, “Interferon Target-Gene Expression and Epigenomic Signatures in Health and Disease,” Nature Immunology 20, no. 12 (2019): 1574-1583.

[128]

P. Zhou, M. Huang, Y. Hang, et al., “Artesunate Alleviates Sjögren's Syndrome by Inhibiting the Interferon-α Signaling in Plasmacytoid Dendritic Cells via TLR-MyD88-IRF7,” Biomedicine & Pharmacotherapy 177 (2024): 116885.

[129]

R. Lande, D. Ganguly, V. Facchinetti, et al., “Neutrophils Activate Plasmacytoid Dendritic Cells by Releasing Self-DNA-Peptide Complexes in Systemic Lupus Erythematosus,” Science Translational Medicine 3, no. 73 (2011): 73ra19.

[130]

X. Bosch, “Systemic Lupus Erythematosus and the Neutrophil,” New England Journal of Medicine 365, no. 8 (2011): 758-760.

[131]

Y. Yao, Z. Liu, B. Jallal, N. Shen, and L. Rönnblom, “Type I Interferons in Sjögren's Syndrome,” Autoimmunity Reviews 12, no. 5 (2013): 558-566.

[132]

A. Ambrosi and M. Wahren-Herlenius, “Update on the Immunobiology of Sjögren's Syndrome,” Current Opinion in Rheumatology 27, no. 5 (2015): 468-475.

[133]

D. J. Rawlings, M. A. Schwartz, S. W. Jackson, and A. Meyer-Bahlburg, “Integration of B Cell Responses Through Toll-Like Receptors and Antigen Receptors,” Nature Reviews Immunology 12, no. 4 (2012): 282-294.

[134]

M. J. Shlomchik, “Activating Systemic Autoimmunity: B's, T's, and Tolls,” Current Opinion in Immunology 21, no. 6 (2009): 626-633.

[135]

I. B. Bekeredjian-Ding, M. Wagner, V. Hornung, et al., “Plasmacytoid Dendritic Cells Control TLR7 Sensitivity of Naive B Cells via Type I IFN,” Journal of Immunology 174, no. 7 (2005): 4043-4050.

[136]

S. Brauner, L. Folkersen, M. Kvarnström, et al., “H1N1 Vaccination in Sjögren's Syndrome Triggers Polyclonal B Cell Activation and Promotes Autoantibody Production,” Annals of the Rheumatic Diseases 76, no. 10 (2017): 1755-1763.

[137]

V. G. Blinova, V. I. Vasilyev, E. B. Rodionova, and D. D. Zhdanov, “The Role of Regulatory T Cells in the Onset and Progression of Primary Sjögren's Syndrome,” Cells 12, no. 10 (2023): 1359.

[138]

M. Iizuka, H. Tsuboi, N. Matsuo, et al., “A Crucial Role of RORγt in the Development of Spontaneous Sialadenitis-Like Sjögren's Syndrome,” Journal of Immunology 194, no. 1 (2015): 56-67.

[139]

A. Alunno, F. Carubbi, O. Bistoni, et al., “T Regulatory and T Helper 17 Cells in Primary Sjögren's Syndrome: Facts and Perspectives,” Mediators of Inflammation 2015 (2015): 243723.

[140]

F. N. Skopouli, P. C. Fox, V. Galanopoulou, J. C. Atkinson, E. S. Jaffe, and H. M. Moutsopoulos, “T Cell Subpopulations in the Labial Minor Salivary Gland Histopathologic Lesion of Sjögren's Syndrome,” Journal of Rheumatology 18, no. 2 (1991): 210-214.

[141]

C. Y. Gao, Y. Yao, L. Li, et al., “Tissue-Resident Memory CD8+ T Cells Acting as Mediators of Salivary Gland Damage in a Murine Model of Sjögren's Syndrome,” Arthritis & Rheumatology 71, no. 1 (2019): 121-132.

[142]

H. Zhou, J. Yang, J. Tian, and S. Wang, “CD8(+) T Lymphocytes: Crucial Players in Sjögren's Syndrome,” Frontiers in Immunology 11 (2020): 602823.

[143]

S. Wang, H. Shen, B. Bai, J. Wu, and J. Wang, “Increased CD4(+)CD8(+) Double-Positive T Cell in Patients With Primary Sjögren's Syndrome Correlated With Disease Activity,” Journal of Immunology Research 2021 (2021): 6658324.

[144]

M. Kurosawa, R. Arakaki, A. Yamada, et al., “NF-κB2 Controls the Migratory Activity of Memory T Cells by Regulating Expression of CXCR4 in a Mouse Model of Sjögren's Syndrome,” Arthritis & Rheumatology 69, no. 11 (2017): 2193-2202.

[145]

Y. Tanaka, T. Sotome, A. Inoue, et al., “SATB1 Conditional Knockout Results in Sjögren's Syndrome in Mice,” Journal of Immunology 199, no. 12 (2017): 4016-4022.

[146]

R. Fernandez-Ruiz and T. B. Niewold, “Type I Interferons in Autoimmunity,” Journal of Investigative Dermatology 142, no. 3 pt B (2022): 793-803.

[147]

I. L. A. Bodewes, A. Björk, M. A. Versnel, and M. Wahren-Herlenius, “Innate Immunity and Interferons in the Pathogenesis of Sjögren's Syndrome,” Rheumatology 60, no. 6 (2021): 2561-2573.

[148]

S. Y. Nishihata, T. Shimizu, M. Umeda, et al., “The Toll-Like Receptor 7-Mediated Ro52 Antigen-Presenting Pathway in the Salivary Gland Epithelial Cells of Sjögren's Syndrome,” Journal of Clinical Medicine 12, no. 13 (2023): 4423.

[149]

Y. Wang, A. Roussel-Queval, L. Chasson, et al., “TLR7 Signaling Drives the Development of Sjögren's Syndrome,” Frontiers in Immunology 12 (2021): 676010.

[150]

L. Alexopoulou, “Nucleic Acid-Sensing Toll-Like Receptors: Important Players in Sjögren's Syndrome,” Frontiers in Immunology 13 (2022): 980400.

[151]

S. Manou-Stathopoulou and M. J. Lewis, “Diversity of NF-κB Signalling and Inflammatory Heterogeneity in Rheumatic Autoimmune Disease,” Seminars in Immunology 58 (2021): 101649.

[152]

Y. Ren, G. Cui, and Y. Gao, “Research Progress on Inflammatory Mechanism of Primary Sjögren Syndrome,” Zhejiang Da Xue Xue Bao. Yi Xue Ban = Journal of Zhejiang University. Medical Sciences 50, no. 6 (2021): 783-794.

[153]

A. Psarras, P. Emery, and E. M. Vital, “Type I Interferon-Mediated Autoimmune Diseases: Pathogenesis, Diagnosis and Targeted Therapy,” Rheumatology 56, no. 10 (2017): 1662-1675.

[154]

A. Petitdemange, J. Blaess, J. Sibilia, R. Felten, and L. Arnaud, “Shared Development of Targeted Therapies Among Autoimmune and Inflammatory Diseases: A Systematic Repurposing Analysis,” Therapeutic Advances in Musculoskeletal Disease 12 (2020): 1759720×20969261.

[155]

D. Trutschel, P. Bost, X. Mariette, et al., “Variability of Primary Sjögren's Syndrome Is Driven by Interferon-α and Interferon-α Blood Levels Are Associated with the Class II HLA-DQ Locus,” Arthritis & Rheumatology 74, no. 12 (2022): 1991-2002.

[156]

G. Barturen, S. Babaei, F. Català-Moll, et al., “Integrative Analysis Reveals a Molecular Stratification of Systemic Autoimmune Diseases,” Arthritis & Rheumatology 73, no. 6 (2021): 1073-1085.

[157]

A. Mathian, R. Felten, M. E. Alarcon-Riquelme, et al., “Type 1 Interferons: A Target for Immune-Mediated Inflammatory Diseases (IMIDs),” Joint, Bone, Spine 91, no. 2 (2024): 105627.

[158]

A. C. Londe, R. Fernandez-Ruiz, P. R. Julio, S. Appenzeller, and T. B. Niewold, “Type I Interferons in Autoimmunity: Implications in Clinical Phenotypes and Treatment Response,” Journal of Rheumatology 50, no. 9 (2023): 1103-1113.

[159]

S. Pestka, C. D. Krause, and M. R. Walter, “Interferons, Interferon-Like Cytokines, and Their Receptors,” Immunological Reviews 202 (2004): 8-32.

[160]

L. B. Ivashkiv and L. T. Donlin, “Regulation of Type I Interferon Responses,” Nature Reviews Immunology 14, no. 1 (2014): 36-49.

[161]

E. S. Emamian, J. M. Leon, C. J. Lessard, et al., “Peripheral Blood Gene Expression Profiling in Sjögren's Syndrome,” Genes and Immunity 10, no. 4 (2009): 285-296.

[162]

U. Båve, G. Nordmark, T. Lövgren, et al., “Activation of the Type I Interferon System in Primary Sjögren's Syndrome: A Possible Etiopathogenic Mechanism,” Arthritis and Rheumatism 52, no. 4 (2005): 1185-1195.

[163]

G. De Benedittis, C. Ciccacci, A. Latini, L. Novelli, G. Novelli, and P. Borgiani, “Emerging Role of MicroRNAs and Long Non-Coding RNAs in Sjögren's Syndrome,” Genes (Basel) 12, no. 6 (2021): 903.

[164]

D. Jara, P. Carvajal, I. Castro, et al., “Type I Interferon Dependent Hsa-miR-145-5p Downregulation Modulates MUC1 and TLR4 Overexpression in Salivary Glands From Sjögren's Syndrome Patients,” Frontiers in Immunology 12 (2021): 685837.

[165]

T. Duan, Y. Du, C. Xing, H. Y. Wang, and R. F. Wang, “Toll-Like Receptor Signaling and Its Role in Cell-Mediated Immunity,” Frontiers in Immunology 13 (2022): 812774.

[166]

J. Fu, H. Shi, N. Cao, et al., “Toll-Like Receptor 9 Signaling Promotes Autophagy and Apoptosis via Divergent Functions of the p38/JNK Pathway in human Salivary Gland Cells,” Experimental Cell Research 375, no. 2 (2019): 51-59.

[167]

Y. Wang, L. Bao, M. Liu, et al., “The Role of the Toll-Like Receptor Signaling Pathway in Autoimmune Diseases and Treatment With Traditional Chinese Medicine: A Literature Review,” Endocrine, Metabolic & Immune Disorders Drug Targets (2025).

[168]

S. K. Kwok, M. L. Cho, Y. M. Her, et al., “TLR2 Ligation Induces the Production of IL-23/IL-17 via IL-6, STAT3 and NF-kB Pathway in Patients With Primary Sjogren's Syndrome,” Arthritis Research & Therapy 14, no. 2 (2012): R64.

[169]

M. J. Barrera, S. Aguilera, E. Veerman, et al., “Salivary Mucins Induce a Toll-Like Receptor 4-Mediated Pro-Inflammatory Response in Human Submandibular Salivary Cells: Are Mucins Involved in Sjögren's Syndrome?,” Rheumatology 54, no. 8 (2015): 1518-1527.

[170]

J. Ding, W. Zhang, S. Haskett, et al., “BAFF Overexpression Increases Lymphocytic Infiltration in Sjögren's Target Tissue, but Only Inefficiently Promotes Ectopic B-cell Differentiation,” Clinical Immunology 169 (2016): 69-79.

[171]

A. R. Concepcion, M. Vaeth, L. E. Wagner, et al., “Store-Operated Ca2+ Entry Regulates Ca2+-Activated Chloride Channels and Eccrine Sweat Gland Function,” Journal of Clinical Investigation, no. 11 (2016): 4303-4318.

[172]

G. Y. Son, A. Zou, A. Wahl, et al., “Loss of STIM1 and STIM2 in Salivary Glands Disrupts ANO1 Function but Does Not Induce Sjogren's Disease,” Function (Oxford) 6, no. 1 (2025): zqae047.

[173]

S. Zhang, J. Qu, L. Wang, et al., “Activation of Toll-Like Receptor 7 Signaling Pathway in Primary Sjögren's Syndrome-Associated Thrombocytopenia,” Frontiers in Immunology 12 (2021): 637659.

[174]

T. Liu, L. Zhang, D. Joo, and S. C. Sun, “NF-κB Signaling in Inflammation,” Signal Transduction and Targeted Therapy 2 (2017): 17023.

[175]

H. Zhu, J. Zheng, Y. Zhou, T. Wu, and T. Zhu, “PRMT5 Participates in B Cell Overactivation in Patients With Primary Sjogren's Syndrome (pSS) Through RSAD2-Mediated NF-κB Signaling,” Immunity, Inflammation and Disease 11, no. 12 (2023): e1102.

[176]

J. L. Sun, H. Z. Zhang, S. Y. Liu, et al., “Elevated EPSTI1 Promote B Cell Hyperactivation Through NF-κB Signalling in Patients With Primary Sjögren's Syndrome,” Annals of the Rheumatic Diseases 79, no. 4 (2020): 518-524.

[177]

S. Shimoyama, I. Nakagawa, J. J. Jiang, et al., “Sjögren's Syndrome-Associated SNPs Increase GTF2I Expression in Salivary Gland Cells to Enhance Inflammation Development,” International Immunology 33, no. 8 (2021): 423-434.

[178]

J. Fu, H. Shi, T. Zhan, et al., “BST-2/Tetherin Is Involved in BAFF-Enhanced Proliferation and Survival via Canonical NF-κB Signaling in Neoplastic B-Lymphoid Cells,” Experimental Cell Research 398, no. 1 (2021): 112399.

[179]

H. Zhu, J. Zheng, Y. Zhou, T. Wu, and T. Zhu, “Knockdown of RSAD2 Attenuates B Cell Hyperactivity in Patients With Primary Sjögren's Syndrome (pSS) via Suppressing NF-κb Signaling Pathway,” Molecular and Cellular Biochemistry 476, no. 5 (2021): 2029-2037.

[180]

D. Wang, M. Zhou, Y. Wang, and S. Sun, “Suppression of High-Mobility Group Box 1 Ameliorates Xerostomia in a Sjögren Syndrome-Triggered Mouse Model,” Canadian Journal of Physiology and Pharmacology 98, no. 6 (2020): 351-356.

[181]

Y. Cai, Y. Zhang, S. Wang, and E. Changyong, “MiR-23b-3p Alleviates Sjögren's Syndrome by Targeting SOX6 and Inhibiting the NF-κB Signaling,” Molecular Immunology 172 (2024): 68-75.

[182]

X. Qi, R. Wang, and L. Jin, “MiR-223-3p Aggravates Ocular Inflammation in Sjögren's Syndrome,” Endocrine, Metabolic & Immune Disorders - Drug Targets 23, no. 8 (2023): 1087-1095.

[183]

X. Wang, Y. Miao, Z. Cao, S. Zheng, X. Xue, and X. Feng, “Characterization of Molecular Genetics and Clinicopathology in Thymic MALT Lymphoma,” Annals of Hematology 101, no. 1 (2022): 91-97.

[184]

E. K. Oktem and M. Yazar, “Drug Repositioning Identifies Six Drug Candidates for Systemic Autoimmune Diseases by Integrative Analyses of Transcriptomes From Scleroderma, Systemic Lupus Erythematosus, and Sjogren's Syndrome,” Omics 26, no. 12 (2022): 683-693.

[185]

T. Ersahin, N. Tuncbag, and R. Cetin-Atalay, “The PI3K/AKT/mTOR Interactive Pathway,” Molecular Biosystems 11, no. 7 (2015): 1946-1954.

[186]

D. A. Fruman, H. Chiu, B. D. Hopkins, S. Bagrodia, L. C. Cantley, and R. T. Abraham, “The PI3K Pathway in Human Disease,” Cell 170, no. 4 (2017): 605-635.

[187]

Y. Li, W. Zhu, R. Lin, J. Zhao, and Y. Wang, “Vasoactive Intestinal Peptide Exerts Therapeutic Action by Regulating PTEN in a Model of Sjögren's Disease,” Immunity, Inflammation and Disease 11, no. 7 (2023): e936.

[188]

I. E. Stergiou, L. Chatzis, A. Papanikolaou, et al., “Akt Signaling Pathway Is Activated in the Minor Salivary Glands of Patients With Primary Sjögren's Syndrome,” International Journal of Molecular Sciences 22, no. 24 (2021): 13441.

[189]

D. Heras-Sandoval, J. M. Pérez-Rojas, J. Hernández-Damián, and J. Pedraza-Chaverri, “The Role of PI3K/AKT/mTOR Pathway in the Modulation of Autophagy and the Clearance of Protein Aggregates in Neurodegeneration,” Cell Signaling 26, no. 12 (2014): 2694-2701.

[190]

C. H. Shiboski, S. C. Shiboski, R. Seror, et al., “2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren's Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts,” Annals of the Rheumatic Diseases 76, no. 1 (2017): 9-16.

[191]

B. A. Fisher, R. Jonsson, T. Daniels, et al., “Standardisation of Labial Salivary Gland Histopathology in Clinical Trials in Primary Sjögren's Syndrome,” Annals of the Rheumatic Diseases 76, no. 7 (2017): 1161-1168.

[192]

R. Seror, E. Theander, J. G. Brun, et al., “Validation of EULAR Primary Sjögren's Syndrome Disease Activity (ESSDAI) and Patient Indexes (ESSPRI),” Annals of the Rheumatic Diseases 74, no. 5 (2015): 859-866.

[193]

S. Veenbergen, A. Kozmar, P. L. A. van Daele, and M. W. J. Schreurs, “Autoantibodies in Sjögren's Syndrome and Its Classification Criteria,” Journal of Translational Autoimmunity 5 (2022): 100138.

[194]

R. Patel and A. Shahane, “The Epidemiology of Sjögren's Syndrome,” Clinical Epidemiology 6 (2014): 247-255.

[195]

L. Shen and L. Suresh, “Autoantibodies, Detection Methods and Panels for Diagnosis of Sjögren's Syndrome,” Clinical Immunology 182 (2017): 24-29.

[196]

S. F. H. Neys, G. M. Verstappen, H. Bootsma, F. G. M. Kroese, R. W. Hendriks, and O. B. J. Corneth, “Decreased BAFF Receptor Expression and Unaltered B Cell Receptor Signaling in Circulating B Cells From Primary Sjögren's Syndrome Patients at Diagnosis,” International Journal of Molecular Sciences 23, no. 9 (2022): 5101.

[197]

S. Xu, C. Zhu, J. Jiang, et al., “Non-Invasive Diagnosis of Primary Sjögren's Syndrome Using Ultrasonography and Transcriptome Biomarkers,” Clinical Immunology 255 (2023): 109739.

[198]

N. Zehrfeld, T. Witte, and D. Ernst, “[Focus on Sjögren's Syndrome—Diagnosis and Treatment],” Deutsche Medizinische Wochenschrift 149, no. 12 (2024): 734-739.

[199]

D. Rebel, L. de Wolff, K. Delli, et al., “Added Value of the Salivary Gland Ultrasonography OMERACT Score in the ACR/EULAR Classification Criteria for Sjögren's Disease,” Seminars in Arthritis and Rheumatism 67 (2024): 152473.

[200]

M. Killian, F. Colaone, P. Haumont, et al., “Therapeutic Potential of Anti-Interferon α Vaccination on SjS-Related Features in the MRL/Lpr Autoimmune Mouse Model,” Frontiers in Immunology 12 (2021): 666134.

[201]

J. M. Meijer, J. Pijpe, H. Bootsma, A. Vissink, and C. G. Kallenberg, “The Future of Biologic Agents in the Treatment of Sjögren's Syndrome,” Clinical Reviews in Allergy & Immunology 32, no. 3 (2007): 292-297.

[202]

J. Jiang, M. Zhao, C. Chang, H. Wu, and Q. Lu, “Type I Interferons in the Pathogenesis and Treatment of Autoimmune Diseases,” Clinical Reviews in Allergy & Immunology 59, no. 2 (2020): 248-272.

[203]

E. Price, M. Bombardieri, A. Kivitz, et al., “Safety and Efficacy of Filgotinib, Lanraplenib and Tirabrutinib in Sjögren's Syndrome: A Randomized, Phase 2, Double-Blind, Placebo-Controlled Study,” Rheumatology 61, no. 12 (2022): 4797-4808.

[204]

J. Lee, J. Lee, S. K. Kwok, et al., “JAK-1 Inhibition Suppresses Interferon-Induced BAFF Production in Human Salivary Gland: Potential Therapeutic Strategy for Primary Sjögren's Syndrome,” Arthritis & Rheumatology 70, no. 12 (2018): 2057-2066.

[205]

R. Gao, J. Pu, Y. Wang, et al., “Tofacitinib in the Treatment of Primary Sjögren's Syndrome-Associated Interstitial Lung Disease: Study Protocol for a Prospective, Randomized, Controlled and Open-Label Trial,” BMC Pulmonary Medicine 23, no. 1 (2023): 473.

[206]

Y. Yang, Y. Liu, X. Li, Y. Zeng, W. He, and J. Zhou, “Uncovering the Therapeutic Target and Molecular Mechanism of Upadacitinib on Sjogren's Syndrome,” Biomedical Engineering and Computational Biology 15 (2024): 11795972241293519.

[207]

H. Wu, X. Chen, F. Gu, et al., “CP-25 Alleviates Antigen-Induced Experimental Sjögren's Syndrome in Mice by Inhibiting JAK1-STAT1/2-CXCL13 Signaling and Interfering With B-Cell Migration,” Laboratory Investigation 101, no. 8 (2021): 1084-1097.

[208]

A. Charras, P. Arvaniti, and C. Le Dantec, “JAK Inhibitors Suppress Innate Epigenetic Reprogramming: A Promise for Patients With Sjögren's Syndrome,” Clinical Reviews in Allergy & Immunology 58, no. 2 (2020): 182-193.

[209]

E. H. M. van der Heijden, S. L. M. Blokland, M. R. Hillen, et al., “Leflunomide-Hydroxychloroquine Combination Therapy in Patients With Primary Sjögren's Syndrome (RepurpSS-I): A Placebo-Controlled, Double-Blinded, Randomised Clinical Trial,” Lancet Rheumatology 2, no. 5 (2020): e260-e269.

[210]

S. Hamkour, E. H. van der Heijden, A. P. Lopes, et al., “Leflunomide/Hydroxychloroquine Combination Therapy Targets Type I IFN-Associated Proteins in Patients With Sjögren's Syndrome That Show Potential to Predict and Monitor Clinical Response,” RMD Open 9, no. 3 (2023): : e002979.

[211]

A. Marinho, J. Delgado Alves, J. Fortuna, et al., “Biological Therapy in Systemic Lupus Erythematosus, Antiphospholipid Syndrome, and Sjögren's Syndrome: Evidence- and Practice-Based Guidance,” Frontiers in Immunology 14 (2023): 1117699.

[212]

X. Mariette, F. Barone, C. Baldini, et al., “A Randomized, Phase II Study of Sequential Belimumab and Rituximab in Primary Sjögren's Syndrome,” JCI Insight 7, no. 23 (2022): e163030.

[213]

D. Geh and C. Gordon, “Epratuzumab for the Treatment of Systemic Lupus Erythematosus,” Expert Review of Clinical Immunology 14, no. 4 (2018): 245-258.

[214]

J. E. Gottenberg, T. Dörner, H. Bootsma, et al., “Efficacy of Epratuzumab, an Anti-CD22 Monoclonal IgG Antibody, in Systemic Lupus Erythematosus Patients With Associated Sjögren's Syndrome: Post Hoc Analyses From the EMBODY Trials,” Arthritis & Rheumatology 70, no. 5 (2018): 763-773.

[215]

B. A. Fisher, A. Szanto, W. F. Ng, et al., “Assessment of the Anti-CD40 Antibody Iscalimab in Patients With Primary Sjögren's Syndrome: A Multicentre, Randomised, Double-Blind, Placebo-Controlled, Proof-of-Concept Study,” Lancet Rheumatology 2, no. 3 (2020): e142-e152.

[216]

T. Zhan, B. Wang, J. Fu, et al., “Artesunate Inhibits Sjögren's Syndrome-Like Autoimmune Responses and BAFF-Induced B Cell Hyperactivation via TRAF6-Mediated NF-κB Signaling,” Phytomedicine 80 (2021): 153381.

[217]

J. Cai, D. Gao, D. Liu, and Z. Liu, “Telitacicept for Autoimmune Nephropathy,” Frontiers in Immunology 14 (2023): 1169084.

[218]

S. Dhillon, “Telitacicept: First Approval,” Drugs 81, no. 14 (2021): 1671-1675.

[219]

D. Xu, J. Fang, S. Zhang, et al., “Efficacy and Safety of Telitacicept in Primary Sjögren's Syndrome: A Randomized, Double-Blind, Placebo-Controlled, Phase 2 Trial,” Rheumatology 63, no. 3 (2024): 698-705.

[220]

H. Chen, X. Qi, Y. Li, et al., “Iguratimod Treatment Reduces Disease Activity in Early Primary Sjögren's Syndrome: An Open-Label Pilot Study,” Modern Rheumatology 31, no. 2 (2021): 394-398.

[221]

P. Kingston, A. Blauvelt, B. Strober, and A. W. Armstrong, “Deucravacitinib: A Novel TYK2 Inhibitor for the Treatment of Moderate-to-Severe Psoriasis,” Journal of Psoriasis and Psoriatic Arthritis 8, no. 4 (2023): 156-165.

[222]

E. Morand, M. Pike, J. T. Merrill, et al., “Deucravacitinib, a Tyrosine Kinase 2 Inhibitor, in Systemic Lupus Erythematosus: A Phase II, Randomized, Double-Blind, Placebo-Controlled Trial,” Arthritis & Rheumatology 75, no. 2 (2023): 242-252.

[223]

A. Tkachenko, K. Kupcova, and O. Havranek, “B-Cell Receptor Signaling and Beyond: The Role of Igα (CD79a)/Igβ (CD79b) in Normal and Malignant B Cells,” International Journal of Molecular Sciences 25, no. 1 (2023): 10.

[224]

T. Dörner, M. Kaul, A. Szántó, et al., “Efficacy and Safety of Remibrutinib, a Selective Potent Oral BTK Inhibitor, in Sjögren's Syndrome: Results From a Randomised, Double-Blind, Placebo-Controlled Phase 2 Trial,” Annals of the Rheumatic Diseases 83, no. 3 (2024): 360-371.

[225]

M. Juarez, N. Diaz, G. I. Johnston, et al., “A Phase 2 Randomized, Double-Blind, Placebo-Controlled, Proof-of-Concept Study of Oral Seletalisib in Primary Sjögren's Syndrome,” Rheumatology 60, no. 3 (2021): 1364-1375.

[226]

M. D. Scuron, B. L. Fay, A. J. Connell, J. Oliver, and P. A. Smith, “The PI3Kδ Inhibitor Parsaclisib Ameliorates Pathology and Reduces Autoantibody Formation in Preclinical Models of Systemic Lupus Erythematosus and Sjögren's Syndrome,” International Immunopharmacology 98 (2021): 107904.

[227]

K. J. Moise, L. E. Ling, and D. Oepkes, “Nipocalimab in Early-Onset Severe Hemolytic Disease of the Fetus and Newborn,” New England Journal of Medicine 391, no. 6 (2024): 526-537.

[228]

V. Bhandari and V. Bril, “FcRN Receptor Antagonists in the Management of Myasthenia Gravis,” Frontiers in Neurology 14 (2023): 1229112.

[229]

J. He, J. Chen, M. Miao, et al., “Efficacy and Safety of Low-Dose Interleukin 2 for Primary Sjögren Syndrome: A Randomized Clinical Trial,” JAMA Network Open 5, no. 11 (2022): e2241451.

[230]

M. S. Chimenti, M. Talamonti, L. Novelli, et al., “Long-Term Ustekinumab Therapy of Psoriasis in Patients With Coexisting Rheumatoid Arthritis and Sjögren Syndrome. Report of Two Cases and Review of Literature,” Journal of Dermatological Case Reports 9, no. 3 (2015): 71-75.

[231]

A. C. Vendel, J. Calemine-Fenaux, A. Izrael-Tomasevic, V. Chauhan, D. Arnott, and D. L. Eaton, “B and T Lymphocyte Attenuator Regulates B Cell Receptor Signaling by Targeting Syk and BLNK,” Journal of Immunology 182, no. 3 (2009): 1509-1517.

[232]

C. P. Mavragani and H. M. Moutsopoulos, “Sjögren's Syndrome: Old and New Therapeutic Targets,” Journal of Autoimmunity 110 (2020): 102364.

[233]

E. W. St Clair, A. N. Baer, W. F. Ng, et al., “CD40 Ligand Antagonist Dazodalibep in Sjögren's Disease: A Randomized, Double-Blinded, Placebo-Controlled, Phase 2 Trial,” Nature Medicine 30, no. 6 (2024): 1583-1592.

[234]

B. A. Fisher, X. Mariette, and A. Papas, “Safety and Efficacy of Subcutaneous Iscalimab (CFZ533) in Two Distinct Populations of Patients With Sjögren's Disease (TWINSS): Week 24 Results of a Randomised, Double-Blind, Placebo-Controlled, Phase 2b Dose-Ranging Study,” Lancet 404, no. 10452 (2024): 540-553.

[235]

J. F. van Nimwegen, E. Mossel, G. S. van Zuiden, et al., “Abatacept Treatment for Patients With Early Active Primary Sjögren's Syndrome: A Single-Centre, Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial (ASAP-III Study),” Lancet Rheumatology 2, no. 3 (2020): e153-e163.

[236]

L. de Wolff, J. F. van Nimwegen, E. Mossel, et al., “Long-Term Abatacept Treatment for 48 Weeks in Patients With Primary Sjögren's Syndrome: The Open-Label Extension Phase of the ASAP-III Trial,” Seminars in Arthritis and Rheumatism 53 (2022): 151955.

[237]

P. Li, Y. Jin, R. Zhao, Z. Xue, and J. Ji, “Expression of ICOS in the Salivary Glands of Patients With Primary Sjogren's Syndrome and Its Molecular Mechanism,” Molecular Medicine Reports 26, no. 5 (2022): 348.

[238]

J. H. Liao, Q. He, Z. W. Huang, et al., “Network Pharmacology-Based Strategy to Investigate the Mechanisms of Artemisinin in Treating Primary Sjögren's Syndrome,” BMC Immunology [Electronic Resource] 25, no. 1 (2024): 16.

[239]

S. Hawtin, C. André, G. Collignon-Zipfel, et al., “Preclinical Characterization of the Toll-Like Receptor 7/8 Antagonist MHV370 for Lupus Therapy,” Cell Reports Medicine 4, no. 5 (2023): 101036.

[240]

T. Shisha, M. G. Posch, J. Lehmann, et al., “First-in-Human Study of the Safety, Pharmacokinetics, and Pharmacodynamics of MHV370, a Dual Inhibitor of Toll-Like Receptors 7 and 8, in Healthy Adults,” European Journal of Drug Metabolism and Pharmacokinetics 48, no. 5 (2023): 553-566.

[241]

K. Sacre, L. A. Criswell, and J. M. McCune, “Hydroxychloroquine Is Associated With Impaired Interferon-Alpha and Tumor Necrosis Factor-Alpha Production by Plasmacytoid Dendritic Cells in Systemic Lupus Erythematosus,” Arthritis Research & Therapy 14, no. 3 (2012): R155.

[242]

R. Huo, C. Wei, Y. Yang, J. Lin, and X. Huang, “Hydroxychloroquine: A Double‑Edged Sword (Review),” Molecular Medicine Reports 31, no. 4 (2025): 102.

[243]

C. Cenac, M. F. Ducatez, and J. C. Guéry, “Hydroxychloroquine Inhibits Proteolytic Processing of Endogenous TLR7 Protein in Human Primary Plasmacytoid Dendritic Cells,” European Journal of Immunology 52, no. 1 (2022): 54-61.

[244]

I. L. A. Bodewes, J. E. Gottenberg, C. G. van Helden-Meeuwsen, X. Mariette, and M. A. Versnel, “Hydroxychloroquine Treatment Downregulates Systemic Interferon Activation in Primary Sjögren's Syndrome in the JOQUER Randomized Trial,” Rheumatology 59, no. 1 (2020): 107-111.

[245]

H. Arakawa, K. Tanese, R. Tanaka, et al., “Efficacy of Hydroxychloroquine for Treating Annular Erythema Associated With Sjögren's Syndrome,” Journal of Dermatology 48, no. 10 (2021): 1526-1532.

[246]

J. Posada, S. Valadkhan, D. Burge, et al., “Improvement of Severe Fatigue Following Nuclease Therapy in Patients With Primary Sjögren's Syndrome: A Randomized Clinical Trial,” Arthritis & Rheumatology 73, no. 1 (2021): 143-150.

[247]

D. J. Burge, V. P. Werth, S. A. Boackle, and J. Posada, “Evaluation of RNase Therapy in Systemic Lupus Erythematosus: A Randomised Phase 2a Clinical Trial of RSLV-132,” Lupus Science & Medicine 11, no. 1 (2024): e001113.

[248]

J. S. Andrews, J. B. Boonyaratanakornkit, E. Krusinska, S. Allen, and J. A. Posada, “Assessment of the Impact of RNase in Patients With Severe Fatigue Related to Post-Acute Sequelae of SARS-CoV-2 Infection: A Randomized Phase 2 Trial of RSLV-132,” Clinical Infectious Diseases 79, no. 3 (2024): 635-642.

[249]

J. Yu, Y. Yang, Z. Gu, M. Shi, A. La Cava, and A. Liu, “CAR Immunotherapy in Autoimmune Diseases: Promises and Challenges,” Frontiers in Immunology 15 (2024): 1461102.

[250]

S. J. Schuster, J. Svoboda, E. A. Chong, et al., “Chimeric Antigen Receptor T Cells in Refractory B-Cell Lymphomas,” New England Journal of Medicine 377, no. 26 (2017): 2545-2554.

[251]

L. Kattamuri, B. Mohan Lal, and N. Vojjala, “Safety and Efficacy of CAR-T Cell Therapy in Patients With Autoimmune Diseases: A Systematic Review,” Rheumatology International 45, no. 1 (2025): 18.

[252]

J. F. Howard, T. Vu, and T. Mozaffar, “CAR T-Cell Therapy in Autoimmune Disease,” New England Journal of Medicine 390, no. 17 (2024): 1629-1631.

[253]

A. Wilhelm, D. Chambers, F. Müller, et al., “Selective CAR T Cell-Mediated B Cell Depletion Suppresses IFN Signature in SLE,” JCI Insight 9, no. 12 (2024): e179433.

[254]

Q. Guo, J. Li, J. Wang, L. Li, J. Wei, and L. Zhang, “The Advent of Chimeric Antigen Receptor T Cell Therapy in Recalibrating Immune Balance for Rheumatic Autoimmune Disease Treatment,” Frontiers in Pharmacology 15 (2024): 1502298.

[255]

G. Liu, Z. Wang, X. Li, et al., “Total Glucosides of Paeony (TGP) Alleviates Constipation and Intestinal Inflammation in Mice Induced by Sjögren's Syndrome,” Journal of Ethnopharmacology 260 (2020): 113056.

[256]

A. Zhang, S. Chen, and R. Lin, “Combined Use of Total Glucosides of Paeony and Hydroxychloroquine in Primary Sjögren's Syndrome: A Systematic Review,” Immunity, Inflammation and Disease 11, no. 10 (2023): e1044.

[257]

K. Yang, L. Zeng, Z. Long, et al., “Efficacy and Safety of Total Glucosides of Paeony in the Treatment of 5 Types of Inflammatory Arthritis: A Systematic Review and Meta-Analysis,” Pharmacological Research 195 (2023): 106842.

[258]

M. Zhao, N. Peng, Y. Zhou, et al., “The Immunoregulatory Effects of Total Glucosides of Peony in Autoimmune Diseases,” Journal of Leukocyte Biology 117, no. 2 (2025): qiae095.

[259]

N. Bibi, N. Rahman, M. Q. Ali, N. Ahmad, and F. Sarwar, “Nutritional Value and Therapeutic Potential of Moringa oleifera: A Short Overview of Current Research,” Natural Product Research 38, no. 23 (2024): 4261-4279.

[260]

A. J. Susanto, B. Purwanto, A. Mudigdo, and B. Wasita, “Lacrimal Gland Histopathology and Secretory Function in Sjögren's Syndrome Mice Model Treated With Moringa oleifera Lam. Leaf Extract,” Anti-Inflammatory and Anti-Allergy Agents in Medicinal Chemistry 21, no. 3 (2023): 166-172.

[261]

Y. Shao, J. Fu, T. Zhan, L. Ye, and C. Yu, “Fangchinoline Inhibited Proliferation of Neoplastic B-Lymphoid Cells and Alleviated Sjögren's Syndrome-Like Responses in NOD/Ltj Mice via the Akt/mTOR Pathway,” Current Molecular Pharmacology 15, no. 7 (2022): 969-979.

[262]

P. Zeng, Z. Jiang, Z. Huang, et al., “PI3K/AKT/mTOR Signaling Pathway Is Downregulated by Runzaoling (RZL) in Sjögren's Syndrome,” Mediators of Inflammation 2022 (2022): 7236118.

[263]

J. He, M. Xu, and S. Wu, “Rutin Alleviates Sjogren's Syndrome via CaR/NLRP3/NF-κB Signal Pathway,” In Vitro Cellular & Developmental Biology Animal 60, no. 4 (2024): 411-419.

[264]

L. P. Dardin, A. B. A. Garcia, P. A. Minali, A. Pinto, and V. F. M. Trevisani, “The Effects of Resistance Training in Patients With Primary Sjogren's Syndrome,” Clinical Rheumatology 41, no. 4 (2022): 1145-1152.

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