{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:22:21Z","timestamp":1792002141627,"version":"4.4.0"},"reference-count":59,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Seoul St. Mary\u2019s Hospital, The Catholic University of Korea"},{"id":[{"id":"https:\/\/ror.org\/01fpnj063","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Mol. Sci.","IJMS"],"abstract":"<jats:p>Sj\u00f6gren\u2019s disease (SjD) is a chronic autoimmune disease characterized by lymphocytic infiltration and dysfunction of the exocrine glands, with manifestations extending beyond glandular sicca symptoms to multiple extraglandular systems. Although the pathogenesis of SjD remains incompletely understood, growing evidence indicates that a complex cytokine network involving both innate and adaptive immune pathways plays a central role in disease development. This narrative review summarizes recent updates on cytokine signaling in SjD across three clinically relevant domains. In glandular inflammation, activation of salivary gland epithelial cells through Toll-like receptor pathways triggers type I interferon (IFN) signaling via plasmacytoid dendritic cells, while IFN-\u03b3, Th17-related cytokines (IL-6, IL-17, IL-22), BAFF\/APRIL, and chemokines (CXCL10, CXCL12, CXCL13) collectively sustain local inflammation and ectopic lymphoid organization. The BAFF\/APRIL axis, a systemic type I IFN signature, and IL-21\u2013follicular helper T cell\u2013B cell interactions primarily drive systemic immune activation, which together underlie autoantibody production, hypergammaglobulinemia, and a lymphoma-prone phenotype. In contrast, constitutional symptoms such as fatigue, pain, and dryness frequently dissociate from classical inflammatory activity and are better explained by neuroimmune\u2013metabolic mechanisms, including the IFN-\u03b3\u2013IDO\u2013kynurenine pathway and symptom-associated proteomic signatures. Collectively, these findings underscore the heterogeneous nature of SjD, in which glandular inflammation, systemic immune activation, and constitutional symptoms are driven by distinct yet partially overlapping cytokine pathways. Recognizing this heterogeneity has direct implications for cytokine-targeted therapy, suggesting that future trials should stratify patients by disease phenotype (IFN-high, B cell-dominant, and symptom-dominant) rather than treating SjD as a uniform population.<\/jats:p>","DOI":"10.3390\/ijms27156638","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T09:47:41Z","timestamp":1785145661000},"page":"6638","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cytokine Networks and Clinical Heterogeneity in Sj\u00f6gren\u2019s Disease: From Glandular Inflammation to Therapeutic Stratification"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6818-6444","authenticated-orcid":false,"given":"Eui-Jong","family":"Kwon","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Bucheon St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Bucheon 14647, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bong-Woo","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1381-5466","authenticated-orcid":false,"given":"Ji","family":"Ju","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1002\/art.39859","article-title":"2016 American College of Rheumatology\/European League Against Rheumatism Classification Criteria for Primary Sj\u00f6gren\u2019s Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts","volume":"69","author":"Shiboski","year":"2017","journal-title":"Arthritis Rheumatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s10238-021-00728-6","article-title":"Sj\u00f6gren\u2019s syndrome: A systemic autoimmune disease","volume":"22","author":"Negrini","year":"2022","journal-title":"Clin. Exp. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1038\/s41584-025-01268-z","article-title":"2023 International Rome consensus for the nomenclature of Sj\u00f6gren disease","volume":"21","author":"Baer","year":"2025","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1038\/s41584-023-00932-6","article-title":"Genetics and epigenetics of primary Sj\u00f6gren syndrome: Implications for future therapies","volume":"19","author":"Thorlacius","year":"2023","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1038\/ng.2792","article-title":"Variants at multiple loci implicated in both innate and adaptive immune responses are associated with Sj\u00f6gren\u2019s syndrome","volume":"45","author":"Lessard","year":"2013","journal-title":"Nat. Genet."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Maslinska, M., and Kostyra-Grabczak, K. (2022). The role of virus infections in Sj\u00f6gren\u2019s syndrome. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.823659"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1038\/s41584-021-00605-2","article-title":"Epithelial-immune cell interplay in primary Sj\u00f6gren syndrome salivary gland pathogenesis","volume":"17","author":"Verstappen","year":"2021","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Dong, Y., Wang, T., and Wu, H. (2024). The role of cytokines from salivary gland epithelial cells in the immunopathology of Sj\u00f6gren\u2019s syndrome. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1443455"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/cei.13242","article-title":"Activation of Toll-like receptor 7 signaling in labial salivary glands of primary Sj\u00f6gren\u2019s syndrome patients","volume":"196","author":"Shimizu","year":"2019","journal-title":"Clin. Exp. Immunol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1111\/j.1365-2249.2006.03311.x","article-title":"Expression of functional Toll-like receptors by salivary gland epithelial cells: Increased mRNA expression in cells derived from patients with primary Sj\u00f6gren\u2019s syndrome","volume":"147","author":"Spachidou","year":"2007","journal-title":"Clin. Exp. Immunol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1136\/annrheumdis-2019-216114","article-title":"EULAR recommendations for the management of Sj\u00f6gren\u2019s syndrome with topical and systemic therapies","volume":"79","author":"Bombardieri","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1038\/s41591-024-03009-3","article-title":"CD40 ligand antagonist dazodalibep in Sj\u00f6gren\u2019s disease: A randomized, double-blinded, placebo-controlled, phase 2 trial","volume":"30","author":"Baer","year":"2024","journal-title":"Nat. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1093\/rheumatology\/kead265","article-title":"Efficacy and safety of telitacicept in primary Sj\u00f6gren\u2019s syndrome: A randomized, double-blind, placebo-controlled, phase 2 trial","volume":"63","author":"Xu","year":"2024","journal-title":"Rheumatology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1136\/annrheumdis-2020-218467","article-title":"Interleukin 6 receptor inhibition in primary Sj\u00f6gren syndrome: A multicentre double-blind randomised placebo-controlled trial","volume":"80","author":"Felten","year":"2021","journal-title":"Ann. Rheum. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s13063-023-07087-5","article-title":"A multi-center, open-label, randomized study to explore efficacy and safety of baricitinib in active primary Sjogren\u2019s syndrome patients","volume":"24","author":"Bai","year":"2023","journal-title":"Trials"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/S0140-6736(21)02251-0","article-title":"Safety and efficacy of subcutaneous ianalumab (VAY736) in patients with primary Sj\u00f6gren\u2019s syndrome: A randomised, double-blind, placebo-controlled, phase 2b dose-finding trial","volume":"399","author":"Bowman","year":"2022","journal-title":"Lancet"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1002\/art.22458","article-title":"Aberrant expression of BAFF by B lymphocytes infiltrating the salivary glands of patients with primary Sj\u00f6gren\u2019s syndrome","volume":"56","author":"Daridon","year":"2007","journal-title":"Arthritis Rheum."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"R51","DOI":"10.1186\/ar1912","article-title":"B cell-activating factor of the tumor necrosis factor family (BAFF) is expressed under stimulation by interferon in salivary gland epithelial cells in primary Sj\u00f6gren\u2019s syndrome","volume":"8","author":"Ittah","year":"2006","journal-title":"Arthritis Res. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3072","DOI":"10.1093\/rheumatology\/key438","article-title":"Emerging roles for chemokines and cytokines as orchestrators of immunopathology in Sj\u00f6gren\u2019s syndrome","volume":"60","author":"Blokland","year":"2021","journal-title":"Rheumatology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1136\/annrheumdis-2019-216588","article-title":"Salivary gland epithelial cells from patients with Sj\u00f6gren\u2019s syndrome induce B-lymphocyte survival and activation","volume":"79","author":"Pascaud","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"131","DOI":"10.55563\/clinexprheumatol\/fp741f","article-title":"Serum CXCL13, BAFF, IL-21 and IL-22 levels are related to disease activity and lymphocyte profile in primary Sj\u00f6gren\u2019s syndrome","volume":"39","author":"Palacio","year":"2021","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1093\/rheumatology\/kex490","article-title":"Systemic interferon type I and type II signatures in primary Sj\u00f6gren\u2019s syndrome reveal differences in biological disease activity","volume":"57","author":"Bodewes","year":"2018","journal-title":"Rheumatology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"243723","DOI":"10.1155\/2015\/243723","article-title":"T Regulatory and T Helper 17 Cells in Primary Sj\u00f6gren\u2019s Syndrome: Facts and Perspectives","volume":"2015","author":"Alunno","year":"2015","journal-title":"Mediat. Inflamm."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Xin, X., Wang, Q., Qing, J., Song, W., Gui, Y., Li, X., and Li, Y. (2022). Th17 cells in primary Sj\u00f6gren\u2019s syndrome negatively correlate with increased Roseburia and Coprococcus. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.974648"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Cano-Ortiz, A., Laborda-Illanes, A., Plaza-Andrades, I., Membrillo Del Pozo, A., Villarrubia Cuadrado, A., Rodr\u00edguez Calvo de Mora, M., Leiva-Gea, I., Sanchez-Alcoholado, L., and Queipo-Ortu\u00f1o, M.I. (2020). Connection between the Gut Microbiome, Systemic Inflammation, Gut Permeability and FOXP3 Expression in Patients with Primary Sj\u00f6gren\u2019s Syndrome. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21228733"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.4110\/in.2024.24.e8","article-title":"Cytokines in Follicular Helper T Cell Biology in Physiologic and Pathologic Conditions","volume":"24","author":"Choi","year":"2024","journal-title":"Immune Netw."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1002\/art.27362","article-title":"Disruption of tight junction structure in salivary glands from Sj\u00f6gren\u2019s syndrome patients is linked to proinflammatory cytokine exposure","volume":"62","author":"Ewert","year":"2010","journal-title":"Arthritis Rheum."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1038\/nrrheum.2018.1","article-title":"B cells in the pathogenesis of primary Sj\u00f6gren syndrome","volume":"14","author":"Nocturne","year":"2018","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.1136\/annrheumdis-2020-217646","article-title":"Unique expansion of IL-21+ Tfh and Tph cells under control of ICOS identifies Sj\u00f6gren\u2019s syndrome with ectopic germinal centres and MALT lymphoma","volume":"79","author":"Pontarini","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1136\/ard.2010.143743","article-title":"EULAR Sjogren\u2019s Syndrome Patient Reported Index (ESSPRI): Development of a consensus patient index for primary Sjogren\u2019s syndrome","volume":"70","author":"Seror","year":"2011","journal-title":"Ann. Rheum. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1177\/0022034516634647","article-title":"Interleukin-17 Impairs Salivary Tight Junction Integrity in Sj\u00f6gren\u2019s Syndrome","volume":"95","author":"Zhang","year":"2016","journal-title":"J. Dent. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1136\/annrheumdis-2012-201511","article-title":"IL-17-producing CD4-CD8- T cells are expanded in the peripheral blood, infiltrate salivary glands and are resistant to corticosteroids in patients with primary Sjogren\u2019s syndrome","volume":"72","author":"Alunno","year":"2013","journal-title":"Ann. Rheum. Dis."},{"key":"ref_33","first-page":"2363","article-title":"Kynurenine pathway can be a potential biomarker of fatigue in primary Sj\u00f6gren\u2019s syndrome","volume":"41","author":"Park","year":"2023","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.jaut.2017.11.003","article-title":"Th17 cells in primary Sj\u00f6gren\u2019s syndrome: Pathogenicity and plasticity","volume":"87","author":"Verstappen","year":"2018","journal-title":"J. Autoimmun."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1136\/ard-2023-224842","article-title":"Inhibition of JAK-STAT pathway corrects salivary gland inflammation and interferon driven immune activation in Sj\u00f6gren\u2019s disease","volume":"83","author":"Gupta","year":"2024","journal-title":"Ann. Rheum. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Verstappen, G.M., Gao, L., Pringle, S., Haacke, E.A., van der Vegt, B., Liefers, S.C., Patel, V., Hu, Y., Mukherjee, S., and Carman, J. (2021). The Transcriptome of Paired Major and Minor Salivary Gland Tissue in Patients with Primary Sj\u00f6gren\u2019s Syndrome. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.681941"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"100248","DOI":"10.1016\/j.jtauto.2024.100248","article-title":"Single-cell transcriptomic analysis uncovers heterogeneity in the labial gland microenvironment of primary Sj\u00f6gren\u2019s syndrome","volume":"9","author":"Huang","year":"2024","journal-title":"J. Transl. Autoimmun."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1093\/rheumatology\/kez335","article-title":"Unique Sj\u00f6gren\u2019s syndrome patient subsets defined by molecular features","volume":"59","author":"James","year":"2020","journal-title":"Rheumatology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1186\/s13075-017-1446-2","article-title":"Severe intestinal dysbiosis is prevalent in primary Sj\u00f6gren\u2019s syndrome and is associated with systemic disease activity","volume":"19","author":"Mandl","year":"2017","journal-title":"Arthritis Res. Ther."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1136\/annrheumdis-2013-204584","article-title":"Th17 cells play a critical role in the development of experimental Sj\u00f6gren\u2019s syndrome","volume":"74","author":"Lin","year":"2015","journal-title":"Ann. Rheum. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s42358-024-00354-2","article-title":"Inflammatory cytokines and their potential role in Sjogren\u2019s syndrome risk: Insights from a mendelian randomization study","volume":"64","author":"Shi","year":"2024","journal-title":"Adv. Rheumatol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1136\/annrheumdis-2013-204615","article-title":"Validation of EULAR primary Sj\u00f6gren\u2019s syndrome disease activity (ESSDAI) and patient indexes (ESSPRI)","volume":"74","author":"Seror","year":"2015","journal-title":"Ann. Rheum. Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e002119","DOI":"10.1136\/rmdopen-2021-002119","article-title":"Sj\u00f6gren\u2019s and non-Sj\u00f6gren\u2019s sicca share a similar symptom burden but with a distinct symptom-associated proteomic signature","volume":"8","author":"Pucino","year":"2022","journal-title":"RMD Open"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e000282","DOI":"10.1136\/rmdopen-2016-000282","article-title":"Fatigue in primary Sj\u00f6gren\u2019s syndrome is associated with lower levels of proinflammatory cytokines","volume":"2","author":"Tarn","year":"2016","journal-title":"RMD Open"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"49","DOI":"10.3109\/03009742.2016.1153142","article-title":"Pain, xerostomia, and younger age are major determinants of fatigue in Korean patients with primary Sj\u00f6gren\u2019s syndrome: A cohort study","volume":"46","author":"Koh","year":"2017","journal-title":"Scand. J. Rheumatol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Ture, H.Y., Kim, N.R., and Nam, E.J. (2023). EULAR Sjogren\u2019s Syndrome Patient Reported Index (ESSPRI) and Other Patient-Reported Outcomes in the Assessment of Glandular Dysfunction in Primary Sj\u00f6gren\u2019s Syndrome. Life, 13.","DOI":"10.3390\/life13101991"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e85","DOI":"10.1016\/S2665-9913(19)30042-6","article-title":"Symptom-based stratification of patients with primary Sj\u00f6gren\u2019s syndrome: Multi-dimensional characterisation of international observational cohorts and reanalyses of randomised clinical trials","volume":"1","author":"Tarn","year":"2019","journal-title":"Lancet Rheumatol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Li, Z., Mu, Y., Guo, C., You, X., Liu, X., Li, Q., and Sun, W. (2022). Analysis of the saliva metabolic signature in patients with primary Sjogren\u2019s syndrome. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0269275"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Fineide, F., Chen, X., Bjellaas, T., Vitelli, V., Utheim, T.P., Jensen, J.L., and Galtung, H.K. (2021). Characterization of Lipids in Saliva, Tears and Minor Salivary Glands of Sjogren\u2019s Syndrome Patients Using an HPLC\/MS-Based Approach. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22168997"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Urbanski, G., Chabrun, F., Delattre, E., Lacout, C., Davidson, B., Blanchet, O., Chao de la Barca, J.M., Simard, G., Lavigne, C., and Reynier, P. (2023). An immuno-lipidomic signature revealed by metabolomic and machine-learning approaches in labial salivary gland to diagnose primary Sjogren\u2019s syndrome. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1205616"},{"key":"ref_51","first-page":"1","article-title":"Impaired kynurenine metabolism in patients with primary Sjogren\u2019s syndrome","volume":"114","author":"Tezcan","year":"2023","journal-title":"Clin. Biochem."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1002\/art.39629","article-title":"Association of Increased Treg Cell Levels with Elevated Indoleamine 2,3-Dioxygenase Activity and an Imbalanced Kynurenine Pathway in Interferon-Positive Primary Sj\u00f6gren\u2019s Syndrome","volume":"68","author":"Maria","year":"2016","journal-title":"Arthritis Rheumatol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/j.1365-2249.2005.02889.x","article-title":"Mechanisms dependent on tryptophan catabolism regulate immune responses in primary Sj\u00f6gren\u2019s syndrome","volume":"142","author":"Pertovaara","year":"2005","journal-title":"Clin. Exp. Immunol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e553","DOI":"10.1016\/S2665-9913(21)00122-3","article-title":"Composite of Relevant Endpoints for Sj\u00f6gren\u2019s Syndrome (CRESS): Development and validation of a novel outcome measure","volume":"3","author":"Arends","year":"2021","journal-title":"Lancet Rheumatol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1136\/ard-2022-223356","article-title":"EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update","volume":"82","author":"Smolen","year":"2023","journal-title":"Ann. Rheum. Dis."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1136\/ard-2024-226429","article-title":"EULAR recommendations for the treatment of systemic sclerosis: 2023 update","volume":"84","author":"Lescoat","year":"2025","journal-title":"Ann. Rheum. Dis."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1136\/ard-2023-224762","article-title":"EULAR recommendations for the management of systemic lupus erythematosus: 2023 update","volume":"83","author":"Fanouriakis","year":"2024","journal-title":"Ann. Rheum. Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"3715","DOI":"10.1093\/rheumatology\/kead096","article-title":"Identification of new candidate drugs for primary Sjogren\u2019s syndrome using a drug repurposing transcriptomic approach","volume":"62","author":"Felten","year":"2023","journal-title":"Rheumatology"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1089\/omi.2022.0138","article-title":"Drug Repositioning Identifies Six Drug Candidates for Systemic Autoimmune Diseases by Integrative Analyses of Transcriptomes from Scleroderma, Systemic Lupus Erythematosus, and Sjogren\u2019s Syndrome","volume":"26","author":"Oktem","year":"2022","journal-title":"OMICS"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/15\/6638\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:47:30Z","timestamp":1787572050000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/15\/6638"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,25]]},"references-count":59,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["ijms27156638"],"URL":"https:\/\/doi.org\/10.3390\/ijms27156638","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,25]]}}}