For clinicians

Sjogren's syndrome

Sjogren's, sicca syndrome

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Bottom lineBottom line: primary Sjogren's without significant systemic involvement generally has good pregnancy outcomes. The dominant reproductive consideration is the high frequency of anti-Ro/SSA (and anti-La/SSB) antibodies, which drives neonatal lupus and congenital heart block surveillance. Hydroxychloroquine is commonly continued.

By domain

The main issue: anti-Ro/SSA antibodies ●●●○moderate evidencestrong

Anti-Ro/SSA positivity is common in Sjogren's and triggers the congenital heart block pathway: hydroxychloroquine and serial fetal echocardiography (approx weeks 16-26). See the anti-Ro atom.[1, 3]

Pregnancy outcomes ●●○○low evidenceconditional

Primary Sjogren's without significant systemic disease generally carries favourable outcomes; risk rises with systemic involvement or overlap disease.[1]

Managing dryness in pregnancy ●●○○low evidenceconditional

Sicca management (ocular lubricants, oral care) is compatible with pregnancy; dental vigilance given caries risk.[1]

Medicines ●●●○moderate evidenceconditional

Continue hydroxychloroquine; additional immunosuppression per systemic involvement using compatible agents.[1, 2]

Key points

PointEvidence
Anti-Ro/SSA status determines the neonatal-lupus surveillance pathway in Sjogren's pregnancies.[3]●●●○moderate evidencestrong

References

  1. Sammaritano LR, et al. 2020 ACR Guideline for the Management of Reproductive Health in RMD. Arthritis Rheumatol. 2020;72(3):529-556. https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/art.41191
  2. Ruegg L, et al. EULAR recommendations for antirheumatic drugs in reproduction, pregnancy, and lactation: 2024 update. Ann Rheum Dis. 2025;84(6):910-926. https://ard.eular.org/article/S0003-4967(25)00818-0/fulltext
  3. Izmirly P, et al. Hydroxychloroquine to Prevent Recurrent Congenital Heart Block in Fetuses of Anti-SSA/Ro-Positive Mothers (PATCH). J Am Coll Cardiol. 2020;76(3):292-302. https://www.jacc.org/doi/10.1016/j.jacc.2020.05.045