When do you consider immunosuppression in patients with Sjogren's neuropathy?   

Only when disease activity is moderate-severe, impairing QoL, or rapidly progressive, ie mononeuritis multiplex/vasculitis, with significant risk of end-organ/tissue damage. Occasionally, autonomic neuropathy in SjD can be so debilitating to patient, and all other supportive treatments have failed, ...

@Nancy L. Carteron: I totally agree with your answer. I'll add (and I'm sure you'll agree), I find this question one of the most difficult dilemmas in my SLE and Sjogren's patients. Even with moderate to severe neuropathy that is progressing... without a sural nerve biopsy showing active inflammati...

If the neuropathy is vasculitic, in association with cutaneous LCV, with palpable purpura and a foot drop, for example, I would definitely use DMARDS. These vasculitic neuropathies (mononeuritis multiplex) tend to be motor as well as sensory. I would screen for concomitant hep C infection in every s...