Infections in Sjögren's disease: a clinical concern or not?

Patients with autoimmune diseases are particularly prone to infections due to both the underlying immune dysfunction and the use of immunosuppressive therapies. Sjögren's disease (SjD) serves as a valuable model for studying the complex interplay between autoimmunity and infections. This review focuses on the infection risks associated with SjD, emphasising key areas such as oral, respiratory, and urogenital infections, along with complications arising from systemic infections. The role of infections in SjD-associated lymphoma treatment complications is also addressed. Additionally, the recent COVID-19 pandemic has highlighted the vulnerability of autoimmune patients to severe viral infections, complicating disease management. While biologic therapies, including predominantly rituximab and belimumab have become increasingly utilised, they carry inherent risks of infections due to their immunosuppressive effects. Emerging therapies, such as ianalumab, iscalimab, dazodalibep, and remibrutinib, show efficacy in reducing disease activity but also present infection risks, with reports of upper respiratory infections and serious cases, including pneumonia and COVID-19. By exploring these infection-related challenges, this review underscores the importance of understanding the infection-autoimmunity relationship to improve outcomes for patients with SjD and similar autoimmune conditions.