Objectives <p>To explore the risk of relapse after glucocorticoids (GCs) withdrawal in patients with stable Sjögren’s disease-associated interstitial lung disease (SjD-ILD).</p> Methods <p>This was a single-center, retrospective cohort study conducted at Peking Union Medical College Hospital between February 2016 and January 2024. The study compared two treatment strategies for patients with stable SjD-ILD: GC withdrawal versus GC maintenance. The primary endpoint was to compare the relapse rates between the two groups over a 3-year follow-up period. The secondary endpoints included changes in pulmonary function, serological markers, and adverse events.</p> Results <p>A total of 134 patients were included in this study, with 61 in the GC withdrawal group and 73 in the GC maintenance group. Over the 3-year follow-up, 16 patients (27.93%) in the withdrawal group and 19 patients (28.77%) in the maintenance group experienced a relapse. No significant difference was found in relapse rates between the two groups (HR = 1.011, 95% CI 0.517–1.977, <i>p</i> = 0.974). Changes in pulmonary function, ESR, hs-CRP, C3, and C4 levels showed no significant differences, while IgG changes differed at the 2- and 3-year follow-up (<i>p</i> &lt; 0.05). Adverse event rates were similar between groups.</p> Conclusions <p>GCs’ withdrawal in patients with stable SjD-ILD did not increase the relapse risk compared to continuing low-dose GCs’ therapy. These findings suggest that cautious GCs’ withdrawal might be a viable option for patients with stable, clinically inactive SjD-ILD.</p> <p><Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec align="left" colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> <p><b>Key Points</b></p> </entry> </row> <row> <entry align="left" colname="c1"> <p>• <i>Glucocorticoid withdrawal in stable pSS-ILD did not increase relapse risk compared to continuing low-dose GC therapy</i>.</p> </entry> </row> </tbody> </tgroup> </Table></p>