Daniel J. Wallace MD, FACP, MACR is a Professor of Medicine at Cedars-Sinai Medical Center and the David Geffen School of Medicine and co-directs the rheumatology fellowship program at Cedars-Sinai. Dr. Wallace has authored or co-authored nearly 450 peer-reviewed publications, and he has had 10 articles in the New England Journal of Medicine, JAMA, the Lancet and Journal of Clinical Investigation. He has authored 8 rheumatology textbooks, including The Lupus Book (OUP), and 25 book chapters.

Since 1989, The Sjögren's Book has been the prime resource for those affected by this disease. This Fifth Edition is even more comprehensive in its scope. Not only does this book detail how this systemic disease is diagnosed and managed by health care professionals, but it provides a comprehensive guide on how to cope with its myriad manifestations. I recommend this wonderful resource to all my patients.

• CONTENTSContributors Introduction: Why Write a Book on Sjögren's? by Daniel J. Wallace PART ONE What is Sjögren's and Who is the Sjögren's Patient?1. The Sjögren's Foundation: The Patients' and Professionals' Key Resource and AdvocateJANET E. CHURCH AND STEVEN TAYLOR 2. What is Sjögren's?FREDERICK B. VIVINO 3. Who Develops Sjögren's?CHRISTINE H. LEE AND DANIEL J. WALLACE 4. The Impact of Living with Sjögren'sMATTHEW MAKARA 5. The Cost of Living with Sjögren'sSIMON J. BOWMAN AND BENJAMIN FISHER PART TWO The Science of Sjögren's6. Sjögren's and the Immune SystemROBERT I. FOX AND STEVEN E. CARSONS 7. Environmental EffectsJEFFREY W. WILSON, PETER OLSSON AND THOMAS MANDL 8. Genetics and Sjögren'sKATHY L. SIVILS 9. The Gut Microbiome and Sjögren'sANAT GALOR, KARA M CAVUOTO AND SANTANU BANERJEE 10. Causes of Exocrine Gland Dysfunction in Sjögren'sEFSTATHIA K. KAPSOGEORGOU, MICHAEL VOULGARELIS AND ATHANASIOS G. TZIOUFAS PART THREE How is the Body Affected?11. Diagnosis of FatigueDANIEL J. WALLACE, RICHA MISHRA AND FREDERICK B. VIVINO 12. Musculoskeletal Manifestations of Sjögren'sDONALD E. THOMAS JR 13. Sjögren's and Central Nervous System DisordersARUN VARADHACHARY 14. The Internal Organs in Sjögren'sR. HAL SCOFIELD, FOTINI C. SOLIOTIS, STUART S. KASSAN AND HARALAMPOS M. MOUTSOPOULOS 15. The Dry MouthAVA J. WU AND TROY E. DANIELS 16. The Dry EyeCINTIA S. DE PAIVA, ABHA GULATI, REZA DANA AND GARY N. FOULKS PART FOUR Diagnosis17. Diagnostic and Classification Criteria for Sjögren'sMATTHEW MAKARA 18. Laboratory TestsALAN N. BAER 19. Assessing the Salivary Gland Component in Sjögren's: Biopsy & ImagingMALIN V. JONSSON, KATHRINE SKARSTEIN AND CHIARA BALDINI 20. The Difficult-to-Diagnose Sjögren's PatientASTRID RASMUSSEN 21. Diseases Associated with Sjögren'sJANET LEWIS AND FREDERICK B. VIVINO 22. Childhood Sjögren'sSCOTT M. LIEBERMAN, SARA STERN AND JAY MEHTA PART FIVE Managing Sjögren's23. Management of Dry EyePETER DONSHIK 24. Management of Dry MouthVIDYA SANKAR 25. Management of Other Sicca Symptoms: Dry Ears, Nose & SinusesSOO KIM ABBOUD AND LEILA M. HADDAD 26. Vaginal Dryness in Sjögren'sJOLIEN F. VAN NIMWEGAN AND RITA MELKONIAN 27. Management of Chronic Musculoskeletal PainLAN CHEN 28. Management of Pulmonary Complications in Sjögren'sAUGUSTINE LEE 29. Management of Peripheral Nervous System Complications in Sjögren'sSHALINI MAHAJAN AND DANIEL J. WALLACE 30. Central Nervous System Complications in Sjögren'sPANTELIS P. PAVLAKIS, THERESA LAWRENCE FORD, JANET LEWIS, SHALINI MAHAJAN, STEVEN MANDEL AND DANIEL J. WALLACE 31. Cognitive Dysfunction and Central Nervous System Involvement in Sjögren's EDWARD MAITZ AND STEPHEN MAITZ 32. Managing FatigueNANCY CARTERON 33. Depression and Anxiety in Sjögren'sVALERIE G. LOEHR AND E. SHERWOOD BROWN 34. Gastrointestinal Manifestations in Sjögren'sKATERINA SHETLER 35. Gynecological and Urological Aspects of Sjögren'sRITA MELKONIAN 36. Vasculitis in Sjögren'sGHAITH NOAISEH 37. Lymphoma and Other Cancer in Sjögren'sKIERON DUNLEAVY & KATHERINE M. HAMMITT 38. Hepatic and Pancreatic Involvement in Sjögren'sCHADWICK R. JOHR 39. Kidney-Associated Involvement in Sjögren'sDANIEL J. WALLACE 40. Complementary, Alternative & Integrative Approaches to HealthMATTHEW MAKARA 41. Vitamin D and Sjögren'sJEFFREY W. WILSON PART SIX Taking Charge of Your Sjögren's42. Sjögren's: The Self and OthersTERI P. RUMPF AND LYNN C. EPSTEIN 43. Enhancing Resilience Through Mind-Body InteractionsMARGARET BAIM 44. Sleep DisordersH. KENNETH FISHER AND DANIEL J. WALLACE 45. Sex and Sjögren'sANNE E. BURKE 46. Vaccinations in Sjögren'sRICHARD BRASINGTON 47. DisabilityTHOMAS D. SUTTON AND KATHERINE M. HAMMITT PART SEVEN The Future48. Recent and Promising Scientific DevelopmentsSTEVEN E. CARSONS, MABI SINGH, NANCY MCNAMARA AND KATHERINE M. HAMMITT 49. The Sjögren's Foundation Clinical Trials ConsortiumTHERESA LAWRENCE FORD 50. Clinical Trials: What they are, how to get Involved and the Current State in Sjögren'sMATTHEW MAKRA AND DANIEL J. WALLACE 51. International Collaboration and the Information Technology that Fuels it: Keys to a Brighter Future KATHERINE M. HAMMITT

Daniel J. Wallace MD, FACP, MACR is a Professor of Medicine at Cedars-Sinai Medical Center and the David Geffen School of Medicine and co-directs the rheumatology fellowship program at Cedars-Sinai. Dr. Wallace has authored or co-authored nearly 450 peer-reviewed publications, and he has had 10 articles in the New England Journal of Medicine, JAMA, the Lancet and Journal of Clinical Investigation. He has authored 8 rheumatology textbooks, including The Lupus Book (OUP), and 25 book chapters.

Since 1989, The Sjögren's Book has been the prime resource for those affected by this disease. This Fifth Edition is even more comprehensive in its scope. Not only does this book detail how this systemic disease is diagnosed and managed by health care professionals, but it provides a comprehensive guide on how to cope with its myriad manifestations. I recommend this wonderful resource to all my patients.

• CONTENTSContributors Introduction: Why Write a Book on Sjögren's? by Daniel J. Wallace PART ONE What is Sjögren's and Who is the Sjögren's Patient?1. The Sjögren's Foundation: The Patients' and Professionals' Key Resource and AdvocateJANET E. CHURCH AND STEVEN TAYLOR 2. What is Sjögren's?FREDERICK B. VIVINO 3. Who Develops Sjögren's?CHRISTINE H. LEE AND DANIEL J. WALLACE 4. The Impact of Living with Sjögren'sMATTHEW MAKARA 5. The Cost of Living with Sjögren'sSIMON J. BOWMAN AND BENJAMIN FISHER PART TWO The Science of Sjögren's6. Sjögren's and the Immune SystemROBERT I. FOX AND STEVEN E. CARSONS 7. Environmental EffectsJEFFREY W. WILSON, PETER OLSSON AND THOMAS MANDL 8. Genetics and Sjögren'sKATHY L. SIVILS 9. The Gut Microbiome and Sjögren'sANAT GALOR, KARA M CAVUOTO AND SANTANU BANERJEE 10. Causes of Exocrine Gland Dysfunction in Sjögren'sEFSTATHIA K. KAPSOGEORGOU, MICHAEL VOULGARELIS AND ATHANASIOS G. TZIOUFAS PART THREE How is the Body Affected?11. Diagnosis of FatigueDANIEL J. WALLACE, RICHA MISHRA AND FREDERICK B. VIVINO 12. Musculoskeletal Manifestations of Sjögren'sDONALD E. THOMAS JR 13. Sjögren's and Central Nervous System DisordersARUN VARADHACHARY 14. The Internal Organs in Sjögren'sR. HAL SCOFIELD, FOTINI C. SOLIOTIS, STUART S. KASSAN AND HARALAMPOS M. MOUTSOPOULOS 15. The Dry MouthAVA J. WU AND TROY E. DANIELS 16. The Dry EyeCINTIA S. DE PAIVA, ABHA GULATI, REZA DANA AND GARY N. FOULKS PART FOUR Diagnosis17. Diagnostic and Classification Criteria for Sjögren'sMATTHEW MAKARA 18. Laboratory TestsALAN N. BAER 19. Assessing the Salivary Gland Component in Sjögren's: Biopsy & ImagingMALIN V. JONSSON, KATHRINE SKARSTEIN AND CHIARA BALDINI 20. The Difficult-to-Diagnose Sjögren's PatientASTRID RASMUSSEN 21. Diseases Associated with Sjögren'sJANET LEWIS AND FREDERICK B. VIVINO 22. Childhood Sjögren'sSCOTT M. LIEBERMAN, SARA STERN AND JAY MEHTA PART FIVE Managing Sjögren's23. Management of Dry EyePETER DONSHIK 24. Management of Dry MouthVIDYA SANKAR 25. Management of Other Sicca Symptoms: Dry Ears, Nose & SinusesSOO KIM ABBOUD AND LEILA M. HADDAD 26. Vaginal Dryness in Sjögren'sJOLIEN F. VAN NIMWEGAN AND RITA MELKONIAN 27. Management of Chronic Musculoskeletal PainLAN CHEN 28. Management of Pulmonary Complications in Sjögren'sAUGUSTINE LEE 29. Management of Peripheral Nervous System Complications in Sjögren'sSHALINI MAHAJAN AND DANIEL J. WALLACE 30. Central Nervous System Complications in Sjögren'sPANTELIS P. PAVLAKIS, THERESA LAWRENCE FORD, JANET LEWIS, SHALINI MAHAJAN, STEVEN MANDEL AND DANIEL J. WALLACE 31. Cognitive Dysfunction and Central Nervous System Involvement in Sjögren's EDWARD MAITZ AND STEPHEN MAITZ 32. Managing FatigueNANCY CARTERON 33. Depression and Anxiety in Sjögren'sVALERIE G. LOEHR AND E. SHERWOOD BROWN 34. Gastrointestinal Manifestations in Sjögren'sKATERINA SHETLER 35. Gynecological and Urological Aspects of Sjögren'sRITA MELKONIAN 36. Vasculitis in Sjögren'sGHAITH NOAISEH 37. Lymphoma and Other Cancer in Sjögren'sKIERON DUNLEAVY & KATHERINE M. HAMMITT 38. Hepatic and Pancreatic Involvement in Sjögren'sCHADWICK R. JOHR 39. Kidney-Associated Involvement in Sjögren'sDANIEL J. WALLACE 40. Complementary, Alternative & Integrative Approaches to HealthMATTHEW MAKARA 41. Vitamin D and Sjögren'sJEFFREY W. WILSON PART SIX Taking Charge of Your Sjögren's42. Sjögren's: The Self and OthersTERI P. RUMPF AND LYNN C. EPSTEIN 43. Enhancing Resilience Through Mind-Body InteractionsMARGARET BAIM 44. Sleep DisordersH. KENNETH FISHER AND DANIEL J. WALLACE 45. Sex and Sjögren'sANNE E. BURKE 46. Vaccinations in Sjögren'sRICHARD BRASINGTON 47. DisabilityTHOMAS D. SUTTON AND KATHERINE M. HAMMITT PART SEVEN The Future48. Recent and Promising Scientific DevelopmentsSTEVEN E. CARSONS, MABI SINGH, NANCY MCNAMARA AND KATHERINE M. HAMMITT 49. The Sjögren's Foundation Clinical Trials ConsortiumTHERESA LAWRENCE FORD 50. Clinical Trials: What they are, how to get Involved and the Current State in Sjögren'sMATTHEW MAKRA AND DANIEL J. WALLACE 51. International Collaboration and the Information Technology that Fuels it: Keys to a Brighter Future KATHERINE M. HAMMITT

Daniel J. Wallace MD, FACP, MACR is a Professor of Medicine at Cedars-Sinai Medical Center and the David Geffen School of Medicine and co-directs the rheumatology fellowship program at Cedars-Sinai. Dr. Wallace has authored or co-authored nearly 450 peer-reviewed publications, and he has had 10 articles in the New England Journal of Medicine, JAMA, the Lancet and Journal of Clinical Investigation. He has authored 8 rheumatology textbooks, including The Lupus Book (OUP), and 25 book chapters.

Since 1989, The Sjögren's Book has been the prime resource for those affected by this disease. This Fifth Edition is even more comprehensive in its scope. Not only does this book detail how this systemic disease is diagnosed and managed by health care professionals, but it provides a comprehensive guide on how to cope with its myriad manifestations. I recommend this wonderful resource to all my patients.

• CONTENTSContributors Introduction: Why Write a Book on Sjögren's? by Daniel J. Wallace PART ONE What is Sjögren's and Who is the Sjögren's Patient?1. The Sjögren's Foundation: The Patients' and Professionals' Key Resource and AdvocateJANET E. CHURCH AND STEVEN TAYLOR 2. What is Sjögren's?FREDERICK B. VIVINO 3. Who Develops Sjögren's?CHRISTINE H. LEE AND DANIEL J. WALLACE 4. The Impact of Living with Sjögren'sMATTHEW MAKARA 5. The Cost of Living with Sjögren'sSIMON J. BOWMAN AND BENJAMIN FISHER PART TWO The Science of Sjögren's6. Sjögren's and the Immune SystemROBERT I. FOX AND STEVEN E. CARSONS 7. Environmental EffectsJEFFREY W. WILSON, PETER OLSSON AND THOMAS MANDL 8. Genetics and Sjögren'sKATHY L. SIVILS 9. The Gut Microbiome and Sjögren'sANAT GALOR, KARA M CAVUOTO AND SANTANU BANERJEE 10. Causes of Exocrine Gland Dysfunction in Sjögren'sEFSTATHIA K. KAPSOGEORGOU, MICHAEL VOULGARELIS AND ATHANASIOS G. TZIOUFAS PART THREE How is the Body Affected?11. Diagnosis of FatigueDANIEL J. WALLACE, RICHA MISHRA AND FREDERICK B. VIVINO 12. Musculoskeletal Manifestations of Sjögren'sDONALD E. THOMAS JR 13. Sjögren's and Central Nervous System DisordersARUN VARADHACHARY 14. The Internal Organs in Sjögren'sR. HAL SCOFIELD, FOTINI C. SOLIOTIS, STUART S. KASSAN AND HARALAMPOS M. MOUTSOPOULOS 15. The Dry MouthAVA J. WU AND TROY E. DANIELS 16. The Dry EyeCINTIA S. DE PAIVA, ABHA GULATI, REZA DANA AND GARY N. FOULKS PART FOUR Diagnosis17. Diagnostic and Classification Criteria for Sjögren'sMATTHEW MAKARA 18. Laboratory TestsALAN N. BAER 19. Assessing the Salivary Gland Component in Sjögren's: Biopsy & ImagingMALIN V. JONSSON, KATHRINE SKARSTEIN AND CHIARA BALDINI 20. The Difficult-to-Diagnose Sjögren's PatientASTRID RASMUSSEN 21. Diseases Associated with Sjögren'sJANET LEWIS AND FREDERICK B. VIVINO 22. Childhood Sjögren'sSCOTT M. LIEBERMAN, SARA STERN AND JAY MEHTA PART FIVE Managing Sjögren's23. Management of Dry EyePETER DONSHIK 24. Management of Dry MouthVIDYA SANKAR 25. Management of Other Sicca Symptoms: Dry Ears, Nose & SinusesSOO KIM ABBOUD AND LEILA M. HADDAD 26. Vaginal Dryness in Sjögren'sJOLIEN F. VAN NIMWEGAN AND RITA MELKONIAN 27. Management of Chronic Musculoskeletal PainLAN CHEN 28. Management of Pulmonary Complications in Sjögren'sAUGUSTINE LEE 29. Management of Peripheral Nervous System Complications in Sjögren'sSHALINI MAHAJAN AND DANIEL J. WALLACE 30. Central Nervous System Complications in Sjögren'sPANTELIS P. PAVLAKIS, THERESA LAWRENCE FORD, JANET LEWIS, SHALINI MAHAJAN, STEVEN MANDEL AND DANIEL J. WALLACE 31. Cognitive Dysfunction and Central Nervous System Involvement in Sjögren's EDWARD MAITZ AND STEPHEN MAITZ 32. Managing FatigueNANCY CARTERON 33. Depression and Anxiety in Sjögren'sVALERIE G. LOEHR AND E. SHERWOOD BROWN 34. Gastrointestinal Manifestations in Sjögren'sKATERINA SHETLER 35. Gynecological and Urological Aspects of Sjögren'sRITA MELKONIAN 36. Vasculitis in Sjögren'sGHAITH NOAISEH 37. Lymphoma and Other Cancer in Sjögren'sKIERON DUNLEAVY & KATHERINE M. HAMMITT 38. Hepatic and Pancreatic Involvement in Sjögren'sCHADWICK R. JOHR 39. Kidney-Associated Involvement in Sjögren'sDANIEL J. WALLACE 40. Complementary, Alternative & Integrative Approaches to HealthMATTHEW MAKARA 41. Vitamin D and Sjögren'sJEFFREY W. WILSON PART SIX Taking Charge of Your Sjögren's42. Sjögren's: The Self and OthersTERI P. RUMPF AND LYNN C. EPSTEIN 43. Enhancing Resilience Through Mind-Body InteractionsMARGARET BAIM 44. Sleep DisordersH. KENNETH FISHER AND DANIEL J. WALLACE 45. Sex and Sjögren'sANNE E. BURKE 46. Vaccinations in Sjögren'sRICHARD BRASINGTON 47. DisabilityTHOMAS D. SUTTON AND KATHERINE M. HAMMITT PART SEVEN The Future48. Recent and Promising Scientific DevelopmentsSTEVEN E. CARSONS, MABI SINGH, NANCY MCNAMARA AND KATHERINE M. HAMMITT 49. The Sjögren's Foundation Clinical Trials ConsortiumTHERESA LAWRENCE FORD 50. Clinical Trials: What they are, how to get Involved and the Current State in Sjögren'sMATTHEW MAKRA AND DANIEL J. WALLACE 51. International Collaboration and the Information Technology that Fuels it: Keys to a Brighter Future KATHERINE M. HAMMITT