Conclusions

SjD remains a significant unmet medical need spanning diagnostic, symptomatic, and therapeutic domains. Persistent diagnostic delay, an underrecognized burden of fatigue, cognitive dysfunction, and pain, and the historical absence of approved disease-modifying therapies have collectively limited the quality of care available to patients. The complementary application of ESSDAI and ESSPRI provides a validated framework for distinguishing objective systemic disease activity from patient-reported symptom burden, informing both clinical trial design and individualized management decisions. The recent positive phase 2 and phase 3 results for ianalumab, nipocalimab, and dazodalibep represent a potential inflection point, offering the prospect of the first approved, mechanistically targeted disease-modifying therapies for SjD. Practicing rheumatologists should incorporate validated disease activity and patient-reported outcome measures into routine longitudinal assessment in preparation for an era of biomarker-guided, immunoselective therapies that may become part of standard SjD management.