Blood T follicular regulatory (TFR) cells and T follicular helper (TFH) cells could serve as biomarkers of ectopic lymphoid activity in primary Sjögren syndrome (pSS). In 16 patients with pSS, activated PD1+ICOS+ TFH cells in blood were associated with disease activity, whereas the ratio of TFR cells to TFH cells was indicative of ectopic lymphoid neogenesis in minor salivary glands. The ratio of TFR cells to TFH cells in blood also discriminated between patients with pSS and healthy donors.