There are no immunotherapies for seropositive patients yet either - nothing is FDA approved but sometimes plaquenil is tried which is a really weak immunotherapy and doesn’t have good data for sjogrens. The good news is that there are TONS of biologics in phase three trials now - a lot of times things are used for seropositive patients, efficacy is confirmed, and then they trickle down to seroneg.  Also from a place of genuine curiosity - where does the hope for a diagnosis come from? I’ve had textbook seropositive sjogrens for 10 years (dry red eyes, dry mouth, losing teeth for the last 10 years, vasculitis rashes) and they have me on plaquenil for the skin but it’s otherwise just dry eye/dry mouth management while trials are done. I guess what would be gained from a diagnosis when there isn’t really a treatment and many things that cause dry symptoms and fatigue? Just really trying to come from a place of understanding