We appreciate the rewarding comments to our article from Hawley and Hendricks. Their suggestion that azathioprine be combined with oral steroids for the treatment of Sjögren syndrome myelopathy when cyclophosphamide cannot be tolerated is most appropriate. Our review of 17 previously reported cases of Sjögren syndrome myelopathy and their treatments, plus our single case experience, clearly indicates that pulsed intravenous steroids followed by oral steroids is an insufficient treatment; combination with another immunosuppressant agent appears to be necessary. Wright et al,1 from the Mayo Clinic in Rochester, Minn, have reported similar success treating myelopathy in Sjögren syndrome using a combination of chlorambucil and prednisone.
Williams CS, Román GC, Butler E. In reply. Arch Neurol. 2002;59(5):875-876. doi: