Rheumatology Section, Ospedale San Giovanni Bosco, Naples, Italy.
Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK.
Lancet Rheumatol. 2024 Sep;6(9):e636-e647. doi: 10.1016/S2665-9913(24)00039-0. Epub 2024 May 6.
Sjögren's disease is a clinically and pathophysiologically heterogeneous disease to which precision medicine, on the basis of clinical and biological heterogeneity, has been not always applicable. In patients with Sjögren's disease, the relationship between dysregulated biological pathways and symptoms such as fatigue and pain or clinical manifestations is often difficult to establish. This clinical and biological dissociation also poses challenges when defining appropriate clinical endpoints for clinical trials. In the last few years, however, research efforts have been focused on gaining a better understanding of the considerable heterogeneity of Sjögren's disease by developing stratification models aimed at clustering patients with this condition into homogenous subgroups characterised by distinctive molecular signatures, biomarkers, clinical features, and outcomes. In this Review, we discuss current evidence regarding clinical, laboratory, histological, and biomolecular stratification in Sjögren's disease and examine how available stratification data can guide precision medicine and inform the design of future clinical trials.
干燥综合征是一种临床表现和病理生理学异质性的疾病，精准医学基于临床和生物学的异质性，并不总是适用。在干燥综合征患者中，失调的生物学途径与疲劳和疼痛等症状或临床表现之间的关系往往难以确定。这种临床和生物学的分离在确定临床试验的适当临床终点时也带来了挑战。然而，在过去的几年中，研究工作集中于通过开发分层模型来更好地理解干燥综合征的显著异质性，这些模型旨在将患有这种疾病的患者聚类为具有独特分子特征、生物标志物、临床特征和结局的同质亚组。在这篇综述中，我们讨论了干燥综合征的临床、实验室、组织学和生物分子分层的现有证据，并探讨了现有的分层数据如何指导精准医学和为未来临床试验的设计提供信息。
