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immunosuppressive agents and/or B-cell targeted therapies might enable steroid sparing but their use remains to be established Patients with pSS, cryoglobulinaemia and low serum complement levels have a high risk of developing lymphoma and/or membranoproliferative glomerulonephritis, which responds well to steroid treatment plus rituximab and plasma exchange Renal disease in pSS is often pauci-symptomatic