Clinical assessment in the rituximab and disease-modifying anti-rheumatic drug treatment groups. Clinical evaluation was performed as follows: (A) global disease activity visual analogic scale (VAS), (B) pain VAS, (C) fatigue VAS, (D) dryness VAS, (E) physician global assessment (GA) VAS, (F) unstimulated salivary flow, and (G) Schirmer I test. Bars in the line charts indicate mean ± standard error of the mean. **P <0.01 and *P <0.05, comparison between the two treatment arms at the corresponding time point. DMARD, disease-modifying anti-rheumatic drug; RTX, rituximab.