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Miyamoto ST, Serrano ÉV, Gianórdoli APE, Altoé LB, Noronha BD, Dos Santos PHA, Pedrini APT, da Silva NRS, Favarato LF, Alochio LV, Tomé WA, Lackner A, Valim V. Brazilian version of the "Primary Sjögren's Syndrome - Quality of Life questionnaire (PSS-QoL)": translation, cross-cultural adaptation and validation. Adv Rheumatol 2024; 64:60. [PMID: 39160602 DOI: 10.1186/s42358-024-00395-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/22/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND The Primary Sjögren's Syndrome Quality of Life questionnaire (PSS-QoL) is the first specific instrument to assess health-related quality of life (HRQoL) in Sjögren's disease (SjD). The aim is to translate and cross-culturally adapt the PSS-QoL into Brazilian Portuguese and to evaluate its psychometric properties. METHODS The original English version was translated into Brazilian Portuguese by two native Brazilians who were proficient in the English language. The retranslation was conducted by two native Americans proficient in Brazilian Portuguese. A committee undertook an analysis of the translated and retranslated versions, resulting in the generation of the first Brazilian version, which was submitted to the cross-cultural adaptation phase. In this phase, 50 participants with SjD responded to the instrument in Stages I and II, resulting in the generation of the second and final Brazilian version. To assess the psychometric properties, demographic and clinical data were collected from 75 patients. The HRQoL questionnaires (final Brazilian version of the PSS-QoL, Short Form-36 Health Survey (SF-36) and EuroQoL-5 dimension (EQ-5D)) were completed. Construct validity was analyzed using the Pearson or Spearman correlation coefficient. Reliability was analyzed using Cronbach's alpha and the intraclass correlation coefficient (ICC). RESULTS Eight questions and one response item were revised due to an incomprehension rate of greater than 15% among the participants in the cross-cultural adaptation phase. The final Brazilian version of the PSS-QoL was validated, revealing a high correlation between the total score and functional capacity (r= -0.713, p < 0.001), and vitality (r= -0.770, p < 0. 001) and mental health (r= -0.742, p < 0.001) domains of the SF-36 and a moderate correlation with the other domains of the SF-36 and a moderate correlation with the EQ-5D-tto (r= -0.573, p < 0.001), and EQ-5D-VAS (r= -0.559, p < 0.001). The intraobserver (ICC = 0.939; Cronbach's alpha = 0.964) and interobserver (ICC = 0.965; Cronbach's alpha = 0.964) reliability of the total score showed very high consistency. CONCLUSION The Brazilian version of the PSS-QoL has been demonstrated to be a valid and reproducible instrument for the assessment of HRQoL in patients with SjD.
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Affiliation(s)
- Samira Tatiyama Miyamoto
- Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo (UFES), Av. Marechal Campos, 1468, Maruípe, Vitória, ES, CEP: 29040-090, Brazil.
| | - Érica Vieira Serrano
- Hospital Universitário Cassiano Antônio Moraes (Hucam), Universidade Federal do Espírito Santo (Ufes), Vitória, ES, Brazil
| | - Ana Paula Espíndula Gianórdoli
- Hospital Universitário Cassiano Antônio Moraes (Hucam), Universidade Federal do Espírito Santo (Ufes), Vitória, ES, Brazil
| | - Lara Betini Altoé
- Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo (UFES), Av. Marechal Campos, 1468, Maruípe, Vitória, ES, CEP: 29040-090, Brazil
| | - Bianca Domingos Noronha
- Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo (UFES), Av. Marechal Campos, 1468, Maruípe, Vitória, ES, CEP: 29040-090, Brazil
| | - Pedro Henrique Alves Dos Santos
- Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo (UFES), Av. Marechal Campos, 1468, Maruípe, Vitória, ES, CEP: 29040-090, Brazil
| | - Ana Paula Truhlar Pedrini
- Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo (UFES), Av. Marechal Campos, 1468, Maruípe, Vitória, ES, CEP: 29040-090, Brazil
| | - Nicole Reis Souza da Silva
- Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo (UFES), Av. Marechal Campos, 1468, Maruípe, Vitória, ES, CEP: 29040-090, Brazil
| | - Letícia Fonseca Favarato
- Hospital Universitário Cassiano Antônio Moraes (Hucam), Universidade Federal do Espírito Santo (Ufes), Vitória, ES, Brazil
| | - Luíza Vallory Alochio
- Hospital Universitário Cassiano Antônio Moraes (Hucam), Universidade Federal do Espírito Santo (Ufes), Vitória, ES, Brazil
| | - Weider Andrade Tomé
- Hospital Universitário Cassiano Antônio Moraes (Hucam), Universidade Federal do Espírito Santo (Ufes), Vitória, ES, Brazil
| | - Angelika Lackner
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Valéria Valim
- Hospital Universitário Cassiano Antônio Moraes (Hucam), Programa de Pós-graduação em Saúde Coletiva (PPGSC), Universidade Federal do Espírito Santo (Ufes), Vitória, ES, Brazil
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Beydon M, McCoy S, Nguyen Y, Sumida T, Mariette X, Seror R. Epidemiology of Sjögren syndrome. Nat Rev Rheumatol 2024; 20:158-169. [PMID: 38110617 DOI: 10.1038/s41584-023-01057-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/20/2023]
Abstract
Sjögren syndrome is a phenotypically varied autoimmune disorder that can occur alone in primary Sjögren syndrome or in association with other connective tissue diseases (CTDs), including rheumatoid arthritis, systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). The estimation of the prevalence and incidence of Sjögren syndrome varies depending on diagnostic criteria and study design, making it difficult to estimate geographical and temporal trends. Nonetheless, disease phenotype is influenced by geographical origin, which is a risk factor for systemic activity. Whether mortality in primary Sjögren syndrome is increased compared with that of the general population is not yet known, but extra-glandular manifestations, in particular lymphomas, are clear risk factors for mortality. In CTDs associated with Sjögren syndrome, lymphoma risk seems higher than that of patients with CTD alone, and there is potentially lower disease activity in SLE with Sjögren syndrome and in SSc with Sjögren syndrome than in SLE or SSc alone.
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Affiliation(s)
- Maxime Beydon
- Department of Rheumatology, Bicêtre AP-HP Hôpital, Université Paris-Saclay, Paris, France
| | - Sara McCoy
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yann Nguyen
- Department of Rheumatology, Bicêtre AP-HP Hôpital, Université Paris-Saclay, Paris, France
- Center for Immunology of Viral Infections and Auto-Immune Diseases, INSERM U1184, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Takayuki Sumida
- Department of Internal Medicine, University of Tsukuba, Tsukuba, Japan
| | - Xavier Mariette
- Department of Rheumatology, Bicêtre AP-HP Hôpital, Université Paris-Saclay, Paris, France
- Center for Immunology of Viral Infections and Auto-Immune Diseases, INSERM U1184, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Raphaèle Seror
- Department of Rheumatology, Bicêtre AP-HP Hôpital, Université Paris-Saclay, Paris, France.
- Center for Immunology of Viral Infections and Auto-Immune Diseases, INSERM U1184, Université Paris Saclay, Le Kremlin-Bicêtre, France.
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Mardale DA, Opriș-Belinski D, Bojincă V, Bojincă M, Păsăran E, Săulescu I, Berghea F, Bălănescu A. The Translation, Validation and Cultural Adaptation of Questionnaires Assessing the Quality of Life and Fatigue among Patients with Sjogren's Syndrome for the Romanian Context. Clin Pract 2023; 13:1561-1576. [PMID: 38131686 PMCID: PMC10742904 DOI: 10.3390/clinpract13060137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/06/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
About 70% of patients with Sjogren's syndrome suffer from fatigue, and for a large proportion of patients, it is one of the most noticeable manifestations leading to disability. To date, no study has been conducted in Romania to determine the quality of life of patients and the impact of fatigue in patients with Sjogren's syndrome. The present work proposes the translation, cultural adaptation, and validation of two questionnaires for the Romanian context, namely the 'Profile of Fatigue and Discomfort-Sicca Symptoms Inventory' (PROFAD-SSI-SF) and 'Primary Sjogren's Syndrome-Quality of Life' (PSS-QoL), whose purpose is to assess quality of life and fatigue in patients with Sjogren's syndrome. These two questionnaires were administered to 52 patients with Sjogren's syndrome diagnosed according to the 2016 ACR-EULAR criteria. Subsequently, the conceptual, semantic, and operational analyses of the data were performed with the aim of cultural adaptation. The data obtained were statistically analyzed using indices of measurement accuracy such as internal consistency. Based on statistical analyses, this pilot study shows that the Romanian versions of the PROFAD-SSI and PSS-QoL questionnaires are as reliable as their English counterparts.
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Affiliation(s)
- Denise-Ani Mardale
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.O.-B.); (V.B.); (M.B.); (E.P.); (I.S.); (F.B.); (A.B.)
- Department of Internal Medicine and Rheumatology, ‘Sf. Maria’ Clinical Hospital, 011192 Bucharest, Romania
| | - Daniela Opriș-Belinski
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.O.-B.); (V.B.); (M.B.); (E.P.); (I.S.); (F.B.); (A.B.)
- Department of Internal Medicine and Rheumatology, ‘Sf. Maria’ Clinical Hospital, 011192 Bucharest, Romania
| | - Violeta Bojincă
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.O.-B.); (V.B.); (M.B.); (E.P.); (I.S.); (F.B.); (A.B.)
- Department of Internal Medicine and Rheumatology, ‘Sf. Maria’ Clinical Hospital, 011192 Bucharest, Romania
| | - Mihai Bojincă
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.O.-B.); (V.B.); (M.B.); (E.P.); (I.S.); (F.B.); (A.B.)
- Department of Internal Medicine and Rheumatology, ‘Dr. Ion Cantacuzino’ Hospital, 020475 Bucharest, Romania
| | - Emilia Păsăran
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.O.-B.); (V.B.); (M.B.); (E.P.); (I.S.); (F.B.); (A.B.)
| | - Ioana Săulescu
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.O.-B.); (V.B.); (M.B.); (E.P.); (I.S.); (F.B.); (A.B.)
- Department of Internal Medicine and Rheumatology, ‘Sf. Maria’ Clinical Hospital, 011192 Bucharest, Romania
| | - Florian Berghea
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.O.-B.); (V.B.); (M.B.); (E.P.); (I.S.); (F.B.); (A.B.)
- Department of Internal Medicine and Rheumatology, ‘Sf. Maria’ Clinical Hospital, 011192 Bucharest, Romania
| | - Andra Bălănescu
- Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania; (D.O.-B.); (V.B.); (M.B.); (E.P.); (I.S.); (F.B.); (A.B.)
- Department of Internal Medicine and Rheumatology, ‘Sf. Maria’ Clinical Hospital, 011192 Bucharest, Romania
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Sloesen B, Young A, Forde K, Hodson N, Bentley S, Walsh O, Naujoks C, O'Brien P, Sharma G. Development and content validity assessment of the Dry Eye Disease Questionnaire in patients with dry eye disease, meibomian gland dysfunction, and Sjögren's syndrome dry eye disease. J Patient Rep Outcomes 2023; 7:64. [PMID: 37405617 DOI: 10.1186/s41687-023-00608-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Dry eye disease (DED), Meibomian gland dysfunction (MGD), and Sjögren's syndrome dry eye disease (SS-DED) are eye dryness conditions that show significant overlap in various symptoms of ocular discomfort. The aim of this study was to qualitatively explore the patient experience and evaluate content validity of the newly developed Dry Eye Disease Questionnaire (DED-Q). METHODS Semi-structured interviews were conducted with 61 US adults who reported experiencing ocular symptoms due to their physician-confirmed primary diagnosis of DED (n = 21), MGD (n = 20), or SS-DED (n = 20). The open-ended concept-elicitation phase was followed by cognitive debriefing (CD) of the DED-Q to evaluate participants' understanding and relevance of the instructions, items, response options, and recall periods. Interviews were also conducted with eight specialist healthcare professionals to assess clinical relevance of the concepts included. Verbatim interview transcripts were analyzed using thematic analysis in ATLAS.ti v8 software. RESULTS A total of 29 symptoms and 14 impacts on quality of life were reported across participant interviews. Primary ocular symptoms reported included eye dryness (n = 61/61; 100%), eye irritation (n = 55/61; 90%), eye itch (n = 54/61; 89%), burning sensation (n = 52/61; 85%), and foreign body sensation (n = 51/61; 84%). The most impacted aspects of daily life were using digital screens (n = 46/61; 75%), driving (n = 45/61; 74%), working (n = 39/61; 64%), and reading (n = 37/61; 61%). CD findings showed most participants had good understanding of DED-Q items and confirmed most concepts were relevant to the lived experience of their condition. Aside from few minor changes to the items and examples to facilitate more accurate interpretation, the proposed instruction wording was modified for various symptom and impact modules to encourage participants to focus only on dry eye vision problems. CONCLUSIONS This research identified multiple prevalent symptoms and impacts of DED, MGD, and SS-DED, most of which were similar across the conditions. The DED-Q was confirmed to be a content-valid PRO measure suitable for use in clinical studies to assess the patient experience of DED, MGD, and SS-DED. Future work will focus on evaluating the psychometric properties of the DED-Q for use as an efficacy endpoint in clinical trials.
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Affiliation(s)
| | - Alyson Young
- Adelphi Values, Patient-Centered Outcomes, Cheshire, UK
| | - Katie Forde
- Adelphi Values, Patient-Centered Outcomes, Cheshire, UK
| | - Nicola Hodson
- Adelphi Values, Patient-Centered Outcomes, Cheshire, UK
| | - Sarah Bentley
- Adelphi Values, Patient-Centered Outcomes, Cheshire, UK
| | | | | | | | - Garima Sharma
- Novartis Healthcare Private Limited, Hyderabad, India
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Wiriyakijja P, Niklander S, Santos-Silva AR, Shorrer MK, Simms ML, Villa A, Sankar V, Kerr AR, Riordain RN, Jensen SB, Delli K. World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol 2023:S2212-4403(23)00068-8. [PMID: 37198047 DOI: 10.1016/j.oooo.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project "World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research" to develop a core outcome set for dry mouth. STUDY DESIGN A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized. RESULTS From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains. CONCLUSION There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.
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Orliaguet M, Fong SB, Le Pottier L, Meuric V, Boisramé S, Bonnaure-Mallet M, Pers JO. Tolerance to intraoral biofilms and their effectiveness in improving mouth dryness and modifying oral microbiota in patients with primary Sjögren's syndrome: "Predelfi study". Front Microbiol 2023; 14:1071683. [PMID: 37293235 PMCID: PMC10245914 DOI: 10.3389/fmicb.2023.1071683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/10/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease characterized by exocrine gland dysfunction. No therapeutic strategy is sufficient on its own for the management of dry mouth and therapeutic innovations are required. METHODS This Predelfi study was a single-center, prospective, comparative, randomized, double-blind, cross-over controlled study with the primary objective of assessing the tolerance to and effectiveness of two adhesive biofilms (containing prebiotics and, sodium alginate, respectively) in patients with pSS and hyposialia (#NCT04206826 in ClinicalTrials.gov). Secondary objectives were to obtain initial data regarding the clinical effectiveness of such biofilms in the improvement of signs and symptoms related to dry mouth and potential changes in the oral microbiota. Ten pSS patients with pSS were included (9 females and 1 male) with a mean age of 58.1 ± 14.0 years. RESULTS AND DISCUSSION Tolerance to the prebiotic and sodium alginate biofilms was assessed by the patients (visual analog scale [VAS] score 66.7 and 87.6, respectively) and the practitioner (90 and 100, respectively). The absolute changes in the VAS scores at the start and end of each treatment period highlighted an improvement in mouth dryness for the sodium alginate versus the prebiotic biofilm. The VAS scores for other parameters (mouth burning sensation; taste alteration; chewing; swallowing and speech difficulties) remained globally comparable between the two groups. Unstimulated salivary flow showed no changes regardless of the biofilm used. Regarding the oral microbiota, the sodium alginate biofilm increased the abundance of the Treponema genus, whereas the use of the prebiotic biofilm as the first treatment increased the abundance of the genera Veillonella and Prevotella. Nevertheless, the prebiotic biofilm appeared to stimulate "milder" genera with regard to periodontal infections. Furthermore, pre-treatment with the prebiotic biofilm prevented the emergence of the Treponema genus induced by subsequent treatment with the sodium alginate biofilm, suggesting a potential protective effect.
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Affiliation(s)
| | | | | | | | | | | | - Jacques-Olivier Pers
- Univ Brest, CHU de Brest, Brest, France
- LBAI, U1227, Univ Brest, Inserm, Brest, France
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Dyball S, Reynolds JA, Herrick AL, Haque S, Chinoy H, Bruce E, Naz S, Parker B, Bruce IN. Determinants of health-related quality of life across the spectrum of connective tissue diseases using latent profile analysis: Results from the LEAP cohort. Rheumatology (Oxford) 2022:6935805. [PMID: 36534822 PMCID: PMC10393437 DOI: 10.1093/rheumatology/keac680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Poor health-related quality of life (HR-QoL) is well recognised in patients with connective tissue diseases (CTD). We hypothesised that subgroups of patients across the spectrum of CTD experience different HR-QoL patterns, and aimed to determine patient-level characteristics associated with these different subgroups. METHODS Using the eight continuous domains of the Medical Outcomes Study Short-Form 36 (SF-36) questionnaire we performed data-driven clustering to derive latent profiles (LP) of patients with distinct HR-QoL patterns. Multivariable ordinal logistic regression was used to determine patient-level characteristics associated with each HR-QoL subgroup identified. RESULTS 309 CTD patients completed the SF-36 questionnaire. The most impaired SF-36 domains in each disease group were vitality, general health and bodily pain. The physical component of the SF-36 was consistently more impaired compared with the mental component, with similar scores across disease groups.Three latent profiles were identified with poor (n = 89; 29%), average (n = 190; 61.4%) and excellent (n = 30; 9.7%) HR-QoL. LP were not associated with diagnostic grouping or autoantibody profiles. Black background (OR 0.22 [95% CI 0.08-0.63]), Indo-Asian background (0.39 [0.19-0.78]), concomitant fibromyalgia (0.40 [0.20-0.78]), sicca symptoms (0.56 [0.32-0.98]) and multi-morbidity (Charlson Comorbidity Index, 0.81 [0.67-0.97]) were associated with the 'poor' HR-QoL LP. CONCLUSION Distinct HR-QoL subgroups exist that are not primarily driven by the specific diagnosis or autoantibody profiles. We identified a number of key demographic and clinical factors associated with poor HR-QoL. These factors need to be addressed across the whole CTD spectrum as part of a holistic management approach aimed at improving overall patient outcomes.
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Affiliation(s)
- Sarah Dyball
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, UK.,The Kellgren Centre for Rheumatology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - John A Reynolds
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Rheumatology Department, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Ariane L Herrick
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK.,Department of Rheumatology, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - Sahena Haque
- Department of Rheumatology, Manchester University Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Hector Chinoy
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, UK.,National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK.,Department of Rheumatology, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - Ellen Bruce
- The Kellgren Centre for Rheumatology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Sophia Naz
- Department of Rheumatology, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Ben Parker
- The Kellgren Centre for Rheumatology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, UK.,The Kellgren Centre for Rheumatology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK
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Wang ZHIZ, Zheng QS, Liu HX, Li LJ. Development and Application of the Placebo Response Model in Clinical Trials for Primary Sjögren's Syndrome. Front Immunol 2021; 12:783246. [PMID: 34868062 PMCID: PMC8635096 DOI: 10.3389/fimmu.2021.783246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/28/2021] [Indexed: 01/18/2023] Open
Abstract
This study aimed to develop a placebo response model for pharmaceutical clinical trials of primary Sjogren's syndrome,and to quantitatively analyze the distribution and related factors influencing the placebo response to further optimize the design of clinical trials and evaluate the results of single-arm clinical trials. Public databases, including PubMed, Embase, and Cochrane Library were searched for reports on randomized placebo-controlled trials for Sjögren's syndrome which used the change from baseline in ESSDAI score as the primary outcome. The model-based meta-analysis method was used to evaluate the time course and the related influencing factors of the placebo response for ESSDAI in such clinical trials. A virtual placebo control group was constructed based on the final placebo response model to determine the treatment efficacy of belimumab and cyclosporine A for primary Sjögren's syndrome in a single-arm study. A total of 12 studies involving 450 subjects were included in the analysis. The established model described the time-course characteristics of the changes in ESSDAI score from the baseline in the 48 weeks placebo group. We found that the onset time of placebo response was approximately 12 weeks, and its efficacy plateaued at 48 weeks. The baseline ESSDAI score had a significant effect on the maximum value of the placebo response; the maximum value of the placebo response decreased by 0.552 for every 1 score rise in the baseline ESSDAI score. The efficacy of belimumab and cyclosporine A in the single-arm trial was comparable to that of the placebo response at the same baseline; no significant therapeutic advantage was observed. The placebo response model established in this study could provide a basis for designing clinical trials for primary Sjogren's syndrome in the future. It may also provide a reliable external efficacy control standard for single-arm clinical trials.
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Affiliation(s)
| | - Qing-Shan Zheng
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | | | - Lu-Jin Li
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Parisis D, Chivasso C, Perret J, Soyfoo MS, Delporte C. Current State of Knowledge on Primary Sjögren's Syndrome, an Autoimmune Exocrinopathy. J Clin Med 2020; 9:E2299. [PMID: 32698400 PMCID: PMC7408693 DOI: 10.3390/jcm9072299] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 12/13/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is a chronic systemic autoimmune rheumatic disease characterized by lymphoplasmacytic infiltration of the salivary and lacrimal glands, whereby sicca syndrome and/or systemic manifestations are the clinical hallmarks, associated with a particular autoantibody profile. pSS is the most frequent connective tissue disease after rheumatoid arthritis, affecting 0.3-3% of the population. Women are more prone to develop pSS than men, with a sex ratio of 9:1. Considered in the past as innocent collateral passive victims of autoimmunity, the epithelial cells of the salivary glands are now known to play an active role in the pathogenesis of the disease. The aetiology of the "autoimmune epithelitis" still remains unknown, but certainly involves genetic, environmental and hormonal factors. Later during the disease evolution, the subsequent chronic activation of B cells can lead to the development of systemic manifestations or non-Hodgkin's lymphoma. The aim of the present comprehensive review is to provide the current state of knowledge on pSS. The review addresses the clinical manifestations and complications of the disease, the diagnostic workup, the pathogenic mechanisms and the therapeutic approaches.
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Affiliation(s)
- Dorian Parisis
- Laboratory of Pathophysiological and Nutritional Biochemistry, Université Libre de Bruxelles, 1070 Brussels, Belgium; (D.P.); (C.C.); (J.P.)
- Department of Rheumatology, Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium;
| | - Clara Chivasso
- Laboratory of Pathophysiological and Nutritional Biochemistry, Université Libre de Bruxelles, 1070 Brussels, Belgium; (D.P.); (C.C.); (J.P.)
| | - Jason Perret
- Laboratory of Pathophysiological and Nutritional Biochemistry, Université Libre de Bruxelles, 1070 Brussels, Belgium; (D.P.); (C.C.); (J.P.)
| | | | - Christine Delporte
- Laboratory of Pathophysiological and Nutritional Biochemistry, Université Libre de Bruxelles, 1070 Brussels, Belgium; (D.P.); (C.C.); (J.P.)
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10
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Patients with non-Sjögren's sicca report poorer general and oral health-related quality of life than patients with Sjögren's syndrome: a cross-sectional study. Sci Rep 2020; 10:2063. [PMID: 32034249 PMCID: PMC7005680 DOI: 10.1038/s41598-020-59078-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/23/2020] [Indexed: 12/17/2022] Open
Abstract
Understanding the impact of the disease on quality of life is crucial in patient management. In this cross-sectional study, general and oral health-related quality of life questionnaires, and thorough examinations of oral and ocular dryness were performed in age- and sex-matched patients with primary Sjögren’s syndrome (pSS group), non-Sjögren’s syndrome sicca (non-SS group) and healthy controls. General and oral health-related quality of life were investigated with the 36-Item Short Form Health Survey and the 14-Item Oral Health Impact Profile questionnaires, respectively. Subjective symptoms of xerostomia and ocular dryness were recorded using the Summated Xerostomia Inventory and Ocular Surface Disease Index, respectively. Clinical examinations included evaluation of clinical oral dryness scores, candida counts, unstimulated and stimulated saliva secretory rates, tear osmolarity, tear film break-up time, Schirmer I test and ocular surface staining. Both patient groups had pronounced signs and symptoms of xerostomia and ocular dryness. Even though the non-SS patients had less severe clinical signs than the pSS patients, they demonstrated much poorer general and oral health-related quality of life. In conclusion, non-SS patients require more attention in order to improve their quality of life.
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11
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Psychological distress and quality of life are improved in autoimmune patients through Tandem-Psychotherapy, combining individual hypnosis and eye movement desensitization and reprocessing (EMDR) treatment for trauma, followed by supportive-expressive group therapy. Clin Rheumatol 2019; 39:1331-1339. [PMID: 31858339 DOI: 10.1007/s10067-019-04862-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/09/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Autoimmune diseases are associated with psychological distress, resulting in greatly impaired quality of life. Tandem-Psychotherapy comprises trauma-focused psychotherapy with hypnosis and eye movement desensitization and reprocessing (EMDR), followed by supportive-expressive group therapy. The objective was to evaluate whether Tandem-Psychotherapy could reduce psychological distress and improve quality of life. METHODS In a case-control study, 45 patients were divided into two groups: 24 patients in the therapy group (TG) and 21 in the control group (CG). The autoimmune diagnoses were undifferentiated connective tissue disease (9 patients in TG and 12 in CG), Behçet's syndrome (4/TG, 5/CG), mixed connective tissue disease (3/TG, 1/CG), and other diagnoses (8/TG and 3/CG). At start of treatment point, the patients were evaluated with SCL-90-R for distress and psychological symptoms, Life Stressor Checklist-Revised for relevant trauma, and SF-36 for quality of life. SF36 and SCL-90 were repeated at the end of treatment and at 6-month follow-up. RESULTS Relevant trauma was found in 24/24 TG patients and in 17/21 CG. Eighteen out of twenty-four TG patients exhibited psychiatric comorbidity with 18/21 in the CG. At start of treatment, all patients exhibited high level of distress (GSI > 0.5) and high Depression and Anxiety scores in SCL-90-R. At end of therapy, the TG exhibited greatly improved GSI (p < 0.001), Depression (p < 0.001), and Anxiety (p < 0.001) compared with the GC; SF-36 scores were also much better in the TG, with significant differences ranging from p = 0.002 to p = 0.0004 at end of therapy. These results persisted at the 6-month follow-up. CONCLUSIONS Tandem-Psychotherapy is effective for improving psychological symptoms and quality of life in autoimmune patients with high levels of distress and relevant psychiatric comorbidity.Key Points• Psychological distress is very high in autoimmune patients, often for previous traumatic experiences.• Psychological support must be both trauma-focused and aimed to improve social functioning.• Quality of life is very much improved by reducing psychological distress.• Tandem-Psychotherapy is feasible because it is contained within a relatively limited time, also for patients with history of trauma.
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12
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Zinkevičienė A, Dumalakienė I, Mieliauskaitė D, Vilienė R, Narkevičiūtė I, Girkontaitė I. sICAM-1 as potential additional parameter in the discrimination of the Sjögren syndrome and non-autoimmune sicca syndrome: a pilot study. Clin Rheumatol 2019; 38:2803-2809. [PMID: 31152257 DOI: 10.1007/s10067-019-04621-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Both Sjögren's syndrome (SS) and non-autoimmune sicca syndrome (nSS) can show symptoms of dry eyes and a dry mouth, and objective reductions in tear and saliva production. Dry eyes and dry mouth are frequent but they are distinct pathological entities that require diagnostic discrimination. METHODS The aim of present study was to compare the serum levels of sICAM-1, TFF3, RANTES, adiponectin, and FGF in primary (pSS), secondary due to rheumatoid arthritis (sSS), non-autoimmune sicca syndrome (nSS), and healthy groups. The serum levels of selected molecules were determined by enzyme-linked immunosorbent assay (ELISA) in 29 patients with pSS, 30 with sSS, 17 with nSS, and 15 healthy subjects. RESULTS sICAM-1 was significantly elevated in pSS and sSS patients compared with nSS group. Levels of FGF, TFF3, and RANTES were significantly increased in pSS, sSS, and nSS patients compared with healthy controls. No significant correlations were found between the levels of measured molecules and the clinical parameters. CONCLUSIONS Our study showed that sICAM-1 might be useful as an additional parameter for differential diagnosis of SS and nSS, and TFF could be additional diagnostic marker for SS diagnosis. KEY POINTS • sICAM-1 was significantly elevated in Sjögren syndrome patients compared with non-autoimmune sicca syndrome group. • TFF was significantly elevated in Sjögren syndrome patients compared with healthy controls. • They might be useful as additional parameters for differential diagnosis.
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Affiliation(s)
- Auksė Zinkevičienė
- Department of Immunology, State Research Institute Centre for Innovative Medicine, Santariškių g. 5, LT-08406, Vilnius, Lithuania. .,Department of Experimental, Preventive and Clinical Medicine, State Research Institute Centre for Innovative Medicine, Santariškių g. 5, LT-08406, Vilnius, Lithuania.
| | - Irena Dumalakienė
- Department of Immunology, State Research Institute Centre for Innovative Medicine, Santariškių g. 5, LT-08406, Vilnius, Lithuania
| | - Diana Mieliauskaitė
- Department of Experimental, Preventive and Clinical Medicine, State Research Institute Centre for Innovative Medicine, Santariškių g. 5, LT-08406, Vilnius, Lithuania
| | - Rita Vilienė
- Department of Immunology, State Research Institute Centre for Innovative Medicine, Santariškių g. 5, LT-08406, Vilnius, Lithuania
| | - Ieva Narkevičiūtė
- Department of Immunology, State Research Institute Centre for Innovative Medicine, Santariškių g. 5, LT-08406, Vilnius, Lithuania
| | - Irutė Girkontaitė
- Department of Immunology, State Research Institute Centre for Innovative Medicine, Santariškių g. 5, LT-08406, Vilnius, Lithuania
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13
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Miyamoto ST, Lendrem DW, Ng WF, Hackett KL, Valim V. Managing fatigue in patients with primary Sjögren's syndrome: challenges and solutions. Open Access Rheumatol 2019; 11:77-88. [PMID: 31118841 PMCID: PMC6503647 DOI: 10.2147/oarrr.s167990] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/15/2019] [Indexed: 12/17/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) patients identify fatigue as their most important symptom and the one most difficult to cope with, but there are still many challenges and few solutions to manage this debilitating symptom. Promising pharmacological treatments, such as rituximab, have failed in more stringent tests including randomized controlled trials (RCTs) and meta-analysis. While non-pharmacological interventions may be safer, less costly, and address other common comorbidities, to date only aerobic exercise seems to be effective at reducing fatigue in pSS. All interventions, pharmacological or not, need to be tested in high-quality RCTs. The aim of this review is to provide an overview of fatigue management in pSS and discuss potential opportunities for future research.
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Affiliation(s)
- Samira Tatiyama Miyamoto
- Department of Integrated Education in Health, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Dennis William Lendrem
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Trust, , Newcastle upon Tyne, UK
| | - Wan-Fai Ng
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Trust, , Newcastle upon Tyne, UK
| | - Katie Louise Hackett
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Trust, , Newcastle upon Tyne, UK.,Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Valéria Valim
- Department of Medical Clinic, Universidade Federal do Espírito Santo, Vitória, Brazil.,Rheumatology Outpatient Clinic, Hospital Universitário Cassiano Antônio de Moraes (HUCAM), Vitória, Brazil
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14
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Bodewes ILA, van der Spek PJ, Leon LG, Wijkhuijs AJM, van Helden-Meeuwsen CG, Tas L, Schreurs MWJ, van Daele PLA, Katsikis PD, Versnel MA. Fatigue in Sjögren's Syndrome: A Search for Biomarkers and Treatment Targets. Front Immunol 2019; 10:312. [PMID: 30863411 PMCID: PMC6399420 DOI: 10.3389/fimmu.2019.00312] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 02/06/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease, where patients often suffer from fatigue. Biological pathways underlying fatigue are unknown. In this study aptamer-based SOMAscan technology is used to identify potential biomarkers and treatment targets for fatigue in pSS. Methods: SOMAscan® Assay 1.3k was performed on serum samples of healthy controls (HCs) and pSS patients characterized for interferon upregulation and fatigue. Differentially expressed proteins (DEPs) between pSS patients and HC or fatigued and non-fatigued pSS patients were validated and discriminatory capacity of markers was tested using independent technology. Results: Serum concentrations of over 1,300 proteins were compared between 63 pSS patients and 20 HCs resulting in 58 upregulated and 46 downregulated proteins. Additionally, serum concentrations of 30 interferon positive (IFNpos) and 30 interferon negative (IFNneg) pSS patients were compared resulting in 25 upregulated and 13 downregulated proteins. ELISAs were performed for several DEPs between pSS patients and HCs or IFNpos and IFNneg all showing a good correlation between protein levels measured by ELISA and relative fluorescence units (RFU) measured by the SOMAscan. Comparing 22 fatigued and 23 non-fatigued pSS patients, 16 serum proteins were differentially expressed, of which 14 were upregulated and 2 were downregulated. Top upregulated DEPs included neuroactive synaptosomal-associated protein 25 (SNAP-25), alpha-enolase (ENO1) and ubiquitin carboxyl-terminal hydrolase isozyme L1 (UCHL1). Furthermore, the proinflammatory mediator IL36a and several complement factors were upregulated in fatigued compared to non-fatigued pSS patients. ROC analysis indicated that DEPs showed good capacity to discriminate fatigued and non-fatigued pSS patients. Conclusion: In this study we validated the use of aptamer-based proteomics and identified a novel set of proteins which were able to distinguish fatigued from non-fatigued pSS patients and identified a so-called “fatigue signature.”
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Affiliation(s)
- Iris L A Bodewes
- Department of Immunology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Peter J van der Spek
- Department of Bioinformatics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands.,Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Leticia G Leon
- Department of Immunology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Annemarie J M Wijkhuijs
- Department of Immunology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | | | - Liselotte Tas
- Department of Immunology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Marco W J Schreurs
- Department of Immunology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Paul L A van Daele
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Peter D Katsikis
- Department of Immunology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Marjan A Versnel
- Department of Immunology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
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15
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Miyamoto ST, Valim V, Fisher BA. Health-related quality of life and costs in Sjögren's syndrome. Rheumatology (Oxford) 2019; 60:2588-2601. [PMID: 30770918 DOI: 10.1093/rheumatology/key370] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/13/2018] [Indexed: 02/06/2023] Open
Abstract
Health-related quality of life (HRQoL) has an increasing role in medical decision-making. This review of the literature aims to provide an overview on HRQoL, costs, and work disability in SS, a disease characterized by focal lymphocytic infiltration of exocrine glands with no therapeutics of proven immunomodulatory potential. HRQoL is markedly reduced in SS in multiple studies across many countries when compared with HRQoL in healthy controls. The reduction in HRQoL is similar to that observed in other chronic diseases such as RA, SLE, FM and, interestingly, non-SS sicca syndrome. Impaired HRQoL in SS has been found to be associated with fatigue, pain/articular involvement, ocular and oral involvement, pruritus, sexual dysfunction, impaired sleep, pulmonary manifestations, psychological dysfunction and impaired physical function. Until now, no therapeutic has been shown to improve HRQoL in an adequately powered double-blind, placebo-controlled randomized controlled trial. Although primary SS does not, in general, impair life expectancy and is often inappropriately considered a benign 'nuisanvce' disease for those patients without systemic manifestations, the associated costs and work disability are striking. This, together with the significant reduction in HRQoL, strongly argues for the development of new therapeutic approaches to manage this neglected disease.
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Affiliation(s)
- Samira T Miyamoto
- Department of Integrated Education in Health, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Valéria Valim
- Department of Medical Clinic, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Benjamin A Fisher
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.,Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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16
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Milic V, Grujic M, Barisic J, Marinkovic-Eric J, Duisin D, Cirkovic A, Damjanov N. Personality, depression and anxiety in primary Sjogren's syndrome - Association with sociodemographic factors and comorbidity. PLoS One 2019; 14:e0210466. [PMID: 30653543 PMCID: PMC6336324 DOI: 10.1371/journal.pone.0210466] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/25/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Patients with primary Sjögren’s Syndrome (pSS) have diminished health quality and fatigue, arthralgia along with dryness of the mouth and eyes have major impact on their psychological and social aspects of life. The purpose of this study was to determine psychological features of patients with pSS. We analyzed personality, depression and anxiety of patients with primary Sjögren’s Syndrome (pSS) in comparison with patients with rheumatoid arthritis (RA) and healthy controls (HC) and assessed their association with sociodemographic factors and comorbidity. Methods In 105 pSS patients (mean age 51.34 years, mean disease duration 5.98 years), 52 RA patients (mean age 51.37 years, mean disease duration 8.10 years) and 54 HC (mean age 51.35 years) clinical and sociodemographic characteristics were determined and results analyzed. At enrollment patients and controls completed the Revisited NEO Personality Inventory Five-Factor model (NEO-PI-R), the Zung Self-Rating Depression Scale and the Zung Self-Rating Anxiety Scale. Statistical analyses were performed using SPSS [Version 16.0]. The relative size of the effect was assessed based on standardized estimates of effect size (d). Results Patients with pSS, similarly to RA patients had higher scores of Neuroticism (d = 0.46, p = 0.007) and lower scores of Extraversion (d = 0.51, p = 0.001) and Openness for experience (d = 0.65, p = 0.013) compared to HC. There was no significant differences between pSS group and HC in the depression (d = 0.171, p>0.05). However, patients with pSS had higher anxiety in comparison to HC (p<0.0001). In multivariate models, education and satisfaction with family relationships were significant predictors for psychological characteristics of patients, independently of clinical diagnosis. Conclusions Our study is the first to show that patients with pSS scored high on neuroticism and anxiety and low on sociability. Education and satisfaction with family relationships predisposed to their psychological profile. Psychological assessment of patients with pSS may improve understanding and treatment of this clinical condition.
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Affiliation(s)
- Vera Milic
- Department of Rheumatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- * E-mail:
| | - Milica Grujic
- Department of Rheumatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jasmina Barisic
- Department of Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Jelena Marinkovic-Eric
- Department of Medical Statistics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragana Duisin
- Department of Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Andja Cirkovic
- Department of Medical Statistics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nemanja Damjanov
- Department of Rheumatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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17
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Bodewes ILA, Al-Ali S, van Helden-Meeuwsen CG, Maria NI, Tarn J, Lendrem DW, Schreurs MWJ, Steenwijk EC, van Daele PLA, Both T, Bowman SJ, Griffiths B, Ng WF, Versnel MA. Systemic interferon type I and type II signatures in primary Sjögren's syndrome reveal differences in biological disease activity. Rheumatology (Oxford) 2018; 57:921-930. [PMID: 29474655 DOI: 10.1093/rheumatology/kex490] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Indexed: 12/14/2022] Open
Abstract
Objective To assess the relationships between systemic IFN type I (IFN-I) and II (IFN-II) activity and disease manifestations in primary SS (pSS). Methods RT-PCR of multiple IFN-induced genes followed by principal component analysis of whole blood RNA of 50 pSS patients was used to identify indicator genes of systemic IFN-I and IFN-II activities. Systemic IFN activation levels were analysed in two independent European cohorts (n = 86 and 55, respectively) and their relationships with clinical features were analysed. Results Three groups could be stratified according to systemic IFN activity: IFN inactive (19-47%), IFN-I (53-81%) and IFN-I + II (35-55%). No patient had isolated IFN-II activation. IgG levels were highest in patients with IFN-I + II, followed by IFN-I and IFN inactive patients. The prevalence of anti-SSA and anti-SSB was higher among those with IFN activation. There was no difference in total-EULAR SS Disease Activity Index (ESSDAI) or ClinESSDAI between the three subject groups. For individual ESSDAI domains, only the biological domain scores differed between the three groups (higher among the IFN active groups). For patient reported outcomes, there were no differences in EULAR Sjögren's syndrome patient reported index (ESSPRI), fatigue or dryness between groups, but pain scores were lower in the IFN active groups. Systemic IFN-I but not IFN-I + II activity appeared to be relatively stable over time. Conclusions Systemic IFN activation is associated with higher activity only in the ESSDAI biological domain but not in other domains or the total score. Our data raise the possibility that the ESSDAI biological domain score may be a more sensitive endpoint for trials targeting either IFN pathway.
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Affiliation(s)
- Iris L A Bodewes
- Department of Immunology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Shereen Al-Ali
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Department of Biology, College of Science, University of Basrah, Basrah, Iraq
| | | | - Naomi I Maria
- Department of Immunology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jessica Tarn
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Dennis W Lendrem
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Marco W J Schreurs
- Department of Immunology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Eline C Steenwijk
- Department of Immunology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Paul L A van Daele
- Department of Immunology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Tim Both
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Simon J Bowman
- Rheumatology Department, University Hospital Birmingham, Birmingham, UK
| | - Bridget Griffiths
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Wan-Fai Ng
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,National Institute for Health Research, Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | | | - Marjan A Versnel
- Department of Immunology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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18
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Omma A, Tecer D, Kucuksahin O, Sandikci SC, Yildiz F, Erten S. Do the European League Against Rheumatism (EULAR) Sjögren's syndrome outcome measures correlate with impaired quality of life, fatigue, anxiety and depression in primary Sjögren's syndrome? Arch Med Sci 2018; 14:830-837. [PMID: 30002701 PMCID: PMC6040141 DOI: 10.5114/aoms.2017.70300] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 08/31/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The aim of the study was to investigate whether there is a relationship between the European League Against Rheumatism (EULAR) outcome measures and quality of life (QoL), fatigue, anxiety and depression in patients with pSS and to define determinants which could affect quality of life. MATERIAL AND METHODS The study included 105 pSS patients and 72 age/sex-matched healthy controls (HCs). Cross-sectional clinical data were collected, including the Hospital Anxiety and Depression Scale (HADS), the Multidimensional Assessment of Fatigue (MAF) scale, the Short Form (SF-36), EULAR Sjögren's syndrome disease activity index (ESSDAI) and EULAR Sjögren's syndrome patient reported index (ESSPRI). RESULTS The SF-36 scores were significantly lower and anxiety, depression and fatigue scores were significantly higher in the pSS group than in the control group (all p-value < 0.05). ESSDAI was negatively correlated with SF-36 scores and positively with MAF. ESSPRI was negatively correlated with SF-36 scores except for the mental health subdimension, and a positive correlation was determined with MAF, HADS-A and HADS-D. Multiple linear regression analysis revealed that HADS-A, HADS-D, MAF, ESSPRI and ESSDAI were associated with most SF-36 subscales. CONCLUSIONS The results of this study provide further evidence supporting the use of ESSDAI and ESSPRI in daily practice. Quality of life was diminished in patients with pSS and was associated with different symptoms. This should be taken into account when managing patients with pSS.
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Affiliation(s)
- Ahmet Omma
- Department of Rheumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Duygu Tecer
- Department of Rheumatology, Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
| | - Orhan Kucuksahin
- Division of Rheumatology, Internal Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Sevinc Can Sandikci
- Department of Rheumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Fatih Yildiz
- Department of Rheumatology, Van Training and Research Hospital, Van, Turkey
| | - Sukran Erten
- Division of Rheumatology, Internal Medicine, Yildirim Beyazit University, Ankara, Turkey
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19
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Fernández-Martínez G, Zamora-Legoff V, Hernández Molina G. Oral health-related quality of life in primary Sjögren's syndrome. ACTA ACUST UNITED AC 2018; 16:92-96. [PMID: 29754950 DOI: 10.1016/j.reuma.2018.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess health-related quality of life (HRQoL) and oral health-related quality of life, and correlate them with unstimulated whole salivary flow (UWSF) and oral sicca symptoms in patients with primary Sjögren's syndrome (PSS). METHODS We included 60 patients with PSS and 60 healthy controls matched according to gender and age (±3 years). We measured the UWSF and scored the European League Against Rheumatism (EULAR) Sjögren's Syndrome Patient Reported Index (ESSPRI). We assessed the short version of the SF-36 as a generic measurement of HRQoL and the Xerostomia Quality of Life Scale (XeQoLS) questionnaire to evaluate oral quality of life. We evaluated oral symptoms using an 8-item Visual Analogue Scale (VAS) questionnaire. RESULTS We observed a poorer HRQoL (lower scores in SF-36) and oral quality of life (higher scores in XeQoLS), as well as a greater severity of symptoms in the VAS questionnaire upon comparing patients vs. controls. The XeQoL correlated with the UWSF (τ = -0.24, P = .008), the ESSPRI (τ =0.45, P = .0001), VAS 1-2 and VAS 5-8 and the SF-36 score (τ = -0.28, P = .002). CONCLUSIONS Patients with PSS had a poorer HRQoL and oral quality of life than controls. UWSF contributes to the oral quality of life which, in turn, has an impact on HRQoL. Symptomatic treatment of xerostomia as well as the prevention of infections, decay and tooth loss would help to improve the oral quality of life in these patients.
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Affiliation(s)
| | - Víctor Zamora-Legoff
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Gabriela Hernández Molina
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
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Liu Z, Dong Z, Liang X, Liu J, Xuan L, Wang J, Zhang G, Hao W. Health-related quality of life and psychological status of women with primary Sjögren's syndrome: A cross-sectional study of 304 Chinese patients. Medicine (Baltimore) 2017; 96:e9208. [PMID: 29390343 PMCID: PMC5815755 DOI: 10.1097/md.0000000000009208] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 11/25/2022] Open
Abstract
Patients with primary Sjögren syndrome (pSS) always suffer from dryness, pain, and fatigue caused by the involvement of multiple different systems or organs. The uncomfortable disease symptoms, the consequent disability, and the side effects of therapeutic drugs decrease the quality of life and lead to emotional problems. We investigated the health-related quality of life and psychological status of a large cohort of women patients with pSS and associated factors.A total of 304 women with pSS referred to Peking Union Medical College Hospital during 2011 and 2014 were included. The internationally recognized Short Form (36) Health Survey (SF-36) was used to assess patients' quality of life; a higher score indicated a better quality of life. Patients' psychological status was assessed by the Hospital Anxiety and Depression Scale (HADS), and higher scores predicted more anxiety or depression.Patients with pSS had remarkably lower SF-36 scores. The Hospital Anxiety Scale (HAS) and Hospital Depression Scale (HDS) scores of the pSS patients (7 [4,10] and 6 [3,10], respectively) were significantly higher than that of patients with other internal diseases (3.37 ± 2.81 and 3.83 ± 3.14; both P < .001). Negative predictors of quality of life were: pain (physical condition, β = -0.225; P < .001); fatigue (physical condition, β = -0.298; P < .001; and mental condition, β = -0.319; P < .001). Risk factors for anxiety were: young age (β = -0.059; P = .035); pain (β = 0.025; P = .028); or fatigue (β = 0.029; P = .004). Risk factors for depression were: xeroderma (β = 0.030; P = .003); pain (β = 0.022; P = .047); or fatigue (β = 0.033; P = .001).Patients with pSS have a low quality of life with anxiety and depression. Pain and fatigue are primary factors for lower quality of life, which cause more anxiety and depression.
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Affiliation(s)
- Zhaoxiang Liu
- Department of Traditional Chinese Medicine, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhenhua Dong
- Department of Traditional Chinese Medicine, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science
| | - Xiaochun Liang
- Department of Traditional Chinese Medicine, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science
| | - Jinhe Liu
- Department of Traditional Chinese Medicine, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science
| | - Lei Xuan
- Department of Traditional Chinese Medicine, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science
| | - Jing Wang
- Department of Traditional Chinese Medicine, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science
| | - Gaili Zhang
- Department of Traditional Chinese Medicine, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science
| | - Weixin Hao
- Department of Traditional Chinese Medicine, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science
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Hammitt KM, Naegeli AN, van den Broek RWM, Birt JA. Patient burden of Sjögren's: a comprehensive literature review revealing the range and heterogeneity of measures used in assessments of severity. RMD Open 2017; 3:e000443. [PMID: 28955493 PMCID: PMC5604724 DOI: 10.1136/rmdopen-2017-000443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/20/2017] [Accepted: 08/11/2017] [Indexed: 12/11/2022] Open
Abstract
CONTEXT The severity of Sjögren's syndrome has been evaluated using a wide variety of clinical measures and patient-reported outcomes (PROs). This may contribute to the lack of clarity concerning the burden of Sjögren's from the patient perspective. OBJECTIVE To perform a comprehensive peer-reviewed literature analysis of the patient aspects of Sjögren's, focusing on PROs, to investigate the complexity underlying the evaluation of the syndrome and to elucidate the discordance between the different measures. METHODS We searched Embase for articles published between January 2005 and September 2015. Research articles, clinical and diagnostic reviews, and validation studies with a focus on patient aspects of Sjögren's were selected as the primary information source. RESULTS 157 articles met the eligibility criteria. A wide variety of assessment measures used to evaluate glandular, extraglandular and functional domains were observed. Many different, non-validated Visual Analogue Scales, with a wide range of anchor words, were used in the quantification of Sjögren's disease burden, impeding comparisons between studies. Relatively few clinical trials of drug therapies used validated scales: European League Against Rheumatism Sjögren's Syndrome Patient Reported Index was used most often for symptom assessment and 36 Item Short Form Survey for quality of life (QoL). CONCLUSION A wide range and diversity of measures are used to evaluate the patient burden of Sjögren's; most are not validated for use in this disease. PRO endpoints, validated specifically in Sjögren's, that demonstrate improvement are needed. These measures should focus on QoL aspects important to patients and will most likely involve gauging change in function rather than patient-reported symptoms.
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Affiliation(s)
| | - April N Naegeli
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | | | - Julie A Birt
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
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Abstract
The subcommittee reviewed the prevalence, incidence, risk factors, natural history, morbidity and questionnaires reported in epidemiological studies of dry eye disease (DED). A meta-analysis of published prevalence data estimated the impact of age and sex. Global mapping of prevalence was undertaken. The prevalence of DED ranged from 5 to 50%. The prevalence of signs was higher and more variable than symptoms. There were limited prevalence studies in youth and in populations south of the equator. The meta-analysis confirmed that prevalence increases with age, however signs showed a greater increase per decade than symptoms. Women have a higher prevalence of DED than men, although differences become significant only with age. Risk factors were categorized as modifiable/non-modifiable, and as consistent, probable or inconclusive. Asian ethnicity was a mostly consistent risk factor. The economic burden and impact of DED on vision, quality of life, work productivity, psychological and physical impact of pain, are considerable, particularly costs due to reduced work productivity. Questionnaires used to evaluate DED vary in their utility. Future research should establish the prevalence of disease of varying severity, the incidence in different populations and potential risk factors such as youth and digital device usage. Geospatial mapping might elucidate the impact of climate, environment and socioeconomic factors. Given the limited study of the natural history of treated and untreated DED, this remains an important area for future research.
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Cornec D, Devauchelle‐Pensec V, Mariette X, Jousse‐Joulin S, Berthelot J, Perdriger A, Puéchal X, Le Guern V, Sibilia J, Gottenberg J, Chiche L, Hachulla E, Yves Hatron P, Goeb V, Hayem G, Morel J, Zarnitsky C, Dubost JJ, Saliou P, Pers JO, Seror R, Saraux A. Severe Health‐Related Quality of Life Impairment in Active Primary Sjögren's Syndrome and Patient‐Reported Outcomes: Data From a Large Therapeutic Trial. Arthritis Care Res (Hoboken) 2017; 69:528-535. [DOI: 10.1002/acr.22974] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/14/2016] [Accepted: 06/21/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Divi Cornec
- Centre Hospitalier Universitaire de la Cavale Blanche, and EA 2216, INSERM ESPRI, ERI29, Université de Brest, LabEx IGOBrest France
| | - Valérie Devauchelle‐Pensec
- Centre Hospitalier Universitaire de la Cavale Blanche, and EA 2216, INSERM ESPRI, ERI29, Université de Brest, LabEx IGOBrest France
| | - Xavier Mariette
- Assistance Publique‐Hôpitaux de Paris, Hôpitaux Universitaires Paris‐Sud, INSERM U1184, Université Paris‐SudLe Kremlin Bicêtre France
| | - Sandrine Jousse‐Joulin
- Centre Hospitalier Universitaire de la Cavale Blanche, and EA 2216, INSERM ESPRI, ERI29, Université de Brest, LabEx IGOBrest France
| | | | | | | | | | - Jean Sibilia
- Hôpitaux Universitaires de Strasbourg and Université de StrasbourgStrasbourg France
| | | | | | - Eric Hachulla
- Hôpital Claude Huriez and Université Lille Nord‐de‐FranceLille France
| | | | - Vincent Goeb
- Centres Hospitaliers Régionaux Universitaires de AmiensAmiens France
| | - Gilles Hayem
- Centre Hospitalier Universitaire Ambroise ParéBoulogne France
| | - Jacques Morel
- Centre Hospitalier Universitaire LapeyronieMontpellier France
| | | | | | - Philippe Saliou
- Centres Hospitaliers Régionaux Universitaires MorvanBrest France
| | - Jacques Olivier Pers
- EA 2216, INSERM ESPRI, ERI29, Université de Brest, LabEx IGO, and Centre Hospitalier Universitaire Morvan, and EA 2216, Université Bretagne OccidentaleBrest France
| | - Raphaèle Seror
- Assistance Publique‐Hôpitaux de Paris, Hôpitaux Universitaires Paris‐Sud, INSERM U1184, Université Paris‐SudLe Kremlin Bicêtre France
| | - Alain Saraux
- Centre Hospitalier Universitaire de la Cavale Blanche, and EA 2216, INSERM ESPRI, ERI29, Université de Brest, LabEx IGOBrest France
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Shim EJ, Hahm BJ, Go DJ, Lee KM, Noh HL, Park SH, Song YW. Modeling quality of life in patients with rheumatic diseases: the role of pain catastrophizing, fear-avoidance beliefs, physical disability, and depression. Disabil Rehabil 2017; 40:1509-1516. [PMID: 28291952 DOI: 10.1080/09638288.2017.1300691] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To examine factors in the fear-avoidance model, such as pain, pain catastrophizing, fear-avoidance beliefs, physical disability, and depression and their relationships with physical and psychological quality of life in patients with rheumatic diseases. MATERIALS AND METHODS The data were obtained from 360 patients with rheumatic diseases who completed self-report measures assessing study variables. Structural equation modeling was used to examine the hypothesized relationships among factors specified in the fear-avoidance model predicting physical and psychological quality of life. RESULTS Final models fit the data well, explaining 96% and 82% of the variance in physical and psychological quality of life, respectively. Higher pain catastrophizing was related to stronger fear-avoidance beliefs that had a direct negative association with physical disability and depression, which, in turn, negatively affected physical quality of life. Pain severity was also directly related to physical disability. Physical disability also affected physical quality of life indirectly through depression. The hypothesized relationships specified in the model were also confirmed for psychological quality of life. However, physical disability had an indirect association with psychological quality of life via depression. CONCLUSION The current results underscore the significant role of cognitive, affective, and behavioral factors in perceived physical disability and their mediated detrimental effect on physical and psychological quality of life in patients with rheumatic diseases. Implications for rehabilitation The fear-avoidance model is applicable to the prediction of quality of life in patients with rheumatic diseases. As pain-catastrophizing and fear-avoidance beliefs are important factors linked to physical disability and depression, intervening these cognitive factors is necessary to improve physical function and depression in patients with rheumatic diseases. Considering the strong association between depression and physical and psychological quality of life, the assessment and treatment of the former should be included in the rehabilitation of patients with rheumatic diseases. Interventions targeting physical function and depression are likely to be effective in terms of improving physical and psychological quality of life in patients with rheumatic diseases.
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Affiliation(s)
- Eun-Jung Shim
- a Department of Psychology , Pusan National University , Busan , Republic of Korea
| | - Bong-Jin Hahm
- b Department of Neuropsychiatry , Seoul National University Hospital , Seoul , Republic of Korea.,c Department of Psychiatry and Behavioral Science , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Dong Jin Go
- d Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine , Medical Research Center, Seoul National University , Seoul , Republic of Korea.,e Department of Internal Medicine, Division of Rheumatology , Seoul National University College of Medicine , Seoul , Republic of Korea
| | - Kwang-Min Lee
- c Department of Psychiatry and Behavioral Science , Seoul National University College of Medicine , Seoul , Republic of Korea.,f Department of Psychiatry , Gyeonggi provincial Medical Center Uijeongbu Hospital , Uijeongbusi , Republic of Korea
| | - Hae Lim Noh
- a Department of Psychology , Pusan National University , Busan , Republic of Korea
| | - Seung-Hee Park
- a Department of Psychology , Pusan National University , Busan , Republic of Korea
| | - Yeong Wook Song
- d Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine , Medical Research Center, Seoul National University , Seoul , Republic of Korea.,e Department of Internal Medicine, Division of Rheumatology , Seoul National University College of Medicine , Seoul , Republic of Korea
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25
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Abstract
BACKGROUND Patients with dry eye syndrome are known to suffer from anxiety and depression. OBJECTIVES Analysis of psychological disorders in therapy-resistant dry eye syndrome. MATERIAL AND METHODS A retrospective analysis of the training for interactive psychiatric screening (TRIPS) questionnaire from 110 patients with therapy-resistant dry eye syndrome was carried out. The results of the questionnaire allow the diagnosis of psychological disorders and vegetative disorders. Patients were divided into groups with anxiety, depression, mixed diagnoses, vegetative disorders and no diagnosis. A sicca score was used for assessment of dryness comprising the Schirmer test, measurement of tear meniscus, break up time, lipid layer thickness, the use of fluorescein and rose bengal staining tests and the subjective visual analogue scale. The diagnosis of dry eye syndrome was compared with the psychological disorders of anxiety and depression. RESULTS Of the patients 52.7 % had psychological disorders with anxiety in 21.8 %, depression in 15.3 %, mixed diagnoses in 14.5 %, dystonia in 25.4 % and in 22.7 % no psychological disorders were diagnosed. General anxiety was frequent and panic disorders were often associated with other kinds of anxiety. Severe depression, such as bipolar disorder was rare. Dry eye scores were highest in the mixed group (0.59), and lowest in the group with mild anxiety (0.38). No single sicca phase disorder could be correlated with any of the psychological diagnoses. CONCLUSION Patients with therapy-resistant dry eye syndrome often suffer from anxiety and depression. The psychological stress acts on the nervous system to suppress lacrimal gland function. Further investigation of the correlation between the lacrimal tear film phase and psychological disorders is recommended. Knowledge of personality disorders may allow psychological support that would improve the treatment options for dry eye syndrome.
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Affiliation(s)
- J Nepp
- Universitäts-Augenklinik Wien, MUW, Waehringer Guertel 18-20, 1090, Wien, Österreich.
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26
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Zhang Q, Wang X, Chen H, Shen B. Sjögren's syndrome is associated with negatively variable impacts on domains of health-related quality of life: evidence from Short Form 36 questionnaire and a meta-analysis. Patient Prefer Adherence 2017; 11:905-911. [PMID: 28546741 PMCID: PMC5436777 DOI: 10.2147/ppa.s132751] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this article was to systematically review the literature to identify the impact of primary Sjögren's syndrome (pSS) on specific health-related quality of life (HRQoL) domains. METHODS A meta-analysis was performed, and the related articles were searched in Medline, Embase, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine, and Web of Science databases and in reference lists of articles and systematic reviews. Score of the Short Form 36 (SF-36) questionnaire was used as the outcome measurement, and mean differences (MD) with 95% confidence intervals (CIs) were calculated. RESULTS Seven studies were included, comprising 521 patients with pSS and 9,916 healthy controls. The SF-36 questionnaire score of each domain (physical function, role physical [RP] function, emotional role function, vitality, mental health, social function, body pain, general health, physical component scale, mental component scale) was lower in patients with pSS than in healthy controls, especially the score in the dimension of RP function. CONCLUSION This meta-analysis showed that patients had lower pSS score in each dimension of the SF-36, mostly in the RP function. This demonstrated that targeted interventions should be carried out to improve the HRQoL of pSS patients.
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Affiliation(s)
- Qiuxiang Zhang
- Department of Nursing, The Second Affiliated Hospital of Nantong University
- School of Nursing, Nantong University
| | - Xulin Wang
- Department of Epidemiology and Medical Statistics, Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Haoyang Chen
- Department of Nursing, The Second Affiliated Hospital of Nantong University
- School of Nursing, Nantong University
| | - Biyu Shen
- Department of Nursing, The Second Affiliated Hospital of Nantong University
- Correspondence: Biyu Shen, Department of Nursing, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, People’s Republic of China, Tel/fax +86 513 8506 1318, Email
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Both T, Dalm VASH, van Hagen PM, van Daele PLA. Reviewing primary Sjögren's syndrome: beyond the dryness - From pathophysiology to diagnosis and treatment. Int J Med Sci 2017; 14:191-200. [PMID: 28367079 PMCID: PMC5370281 DOI: 10.7150/ijms.17718] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/21/2016] [Indexed: 12/17/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease, characterized by lymphocytic infiltration of the secretory glands. This process leads to sicca syndrome, which is the combination of dryness of the eyes, oral cavity, pharynx, larynx and/or vagina. Extraglandular manifestations may also be prevalent in patients with pSS, including cutaneous, musculoskeletal, pulmonary, renal, hematological and neurological involvement. The pathogenesis of pSS is currently not well understood, but increased activation of B cells followed by immune complex formation and autoantibody production are thought to play important roles. pSS is diagnosed using the American-European consensus group (AECG) classification criteria which include subjective symptoms and objective tests such as histopathology and serology. The treatment of pSS warrants an organ based approach, for which local treatment (teardrops, moistures) and systemic therapy (including non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, disease-modifying antirheumatic drugs (DMARDS) and biologicals) can be considered. Biologicals used in the treatment of pSS mainly affect the total numbers of B cells (B cell depletion (Rituximab)) or target proteins required for B cell proliferation and/or activation (e.g. B cell activating factor (BAFF)) resulting in decreased B cell activity. The aim of this review is to provide physicians a general overview concerning the pathogenesis, diagnosis and management of pSS patients.
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Affiliation(s)
- Tim Both
- Department of Internal Medicine, Division of Clinical Immunology
| | - Virgil A S H Dalm
- Department of Internal Medicine, Division of Clinical Immunology;; Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - P Martin van Hagen
- Department of Internal Medicine, Division of Clinical Immunology;; Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - Paul L A van Daele
- Department of Internal Medicine, Division of Clinical Immunology;; Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
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28
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Koçer B, Tezcan ME, Batur HZ, Haznedaroğlu Ş, Göker B, İrkeç C, Çetinkaya R. Cognition, depression, fatigue, and quality of life in primary Sjögren's syndrome: correlations. Brain Behav 2016; 6:e00586. [PMID: 28032007 PMCID: PMC5167008 DOI: 10.1002/brb3.586] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/12/2016] [Accepted: 08/23/2016] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the prevalence and pattern of cognitive dysfunction observed in primary Sjögren's syndrome (PSS) and to examine the relationships between cognitive abilities, depression, fatigue, and quality of life. MATERIALS AND METHODS Thirty-two subjects with PSS were compared with 19 healthy controls on comprehensive neuropsychological, depression, fatigue, health state, and daily-life activities tests. RESULTS There was low performance in Clock Drawing, COWAT, Paced Auditory Serial Addition Test (PASAT), Colorless Word Reading (Stroop1) and Recognizing Colors (Stroop2) Patterns of STROOP test, SDLT, Auditory-Verbal Learning Test (AVLT), immediate and long-term verbal memory, Benton Judgment of Line Orientation Test (BJLOT), and in all the patterns of RCFT in PSS patients compared to the healthy control group (p < .05). It was observed an increased depression frequency and fatigue severity, impairment in health condition, and a decreased quality of life in PSS cases compared to the healthy controls (p < .05). All the depression, fatigue severity, and quality of life tests showed a significant positive correlation with each other (p < .05). A significant negative correlation between Clock Drawing and SF-36-BP (p = .031, r = -.382) and SF-36-GH (p = .027, r = -.392) was observed. CONCLUSIONS Clock Drawing, PASAT, and AVLT are very useful tests to determine the subclinical and clinical cognitive dysfunction to evaluate attention, information processing speed, executive functions, and short-term and long-term verbal memory in PSS patients. Depression and fatigue may not affect the neuropsychological tests performance.
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Affiliation(s)
- Belgin Koçer
- Department of Neurology Gazi University School of Medicine Ankara Turkey
| | | | - Hale Zeynep Batur
- Department of Neurology Gazi University School of Medicine Ankara Turkey
| | | | - Berna Göker
- Department of Rheumatology Gazi University School of Medicine Ankara Turkey
| | - Ceyla İrkeç
- Department of Neurology Gazi University School of Medicine Ankara Turkey
| | - Rümeysa Çetinkaya
- Department of Neurology Gazi University School of Medicine Ankara Turkey
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Mandl T, Jørgensen TS, Skougaard M, Olsson P, Kristensen LE. Work Disability in Newly Diagnosed Patients with Primary Sjögren Syndrome. J Rheumatol 2016; 44:209-215. [DOI: 10.3899/jrheum.160932] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 12/16/2022]
Abstract
Objective.To study longterm work disability and possible predictors in newly diagnosed patients with primary Sjögren syndrome (pSS).Methods.Because we wanted to include only patients with full work availability potential, eligible patients were aged 18–62 years. Fifty-one patients (mean age 46 yrs, range 18–61 yrs, 50 women) diagnosed with pSS between January 2001 and December 2012 were included in the study. For each patient we randomly selected 4 reference subjects from the general population and matched for age, sex, and area of residence. We linked data to the Swedish Social Insurance Agency and calculated the proportion as well as net days of work disability in 30-day intervals from 12 months before pSS diagnosis until 24 months after .Results.Work disability was increased in patients with pSS in comparison to general population comparators. At diagnosis, 26% of patients were work-disabled, while 37% and 41% were disabled at 12 and 24 months after diagnosis, respectively (p < 0.05 and p < 0.05 vs baseline). Prior work disability status at diagnosis (OR 15.4, 95% CI 2.9–81.9; p = 0.001), concomitant fibromyalgia (OR 10.5, 95% CI 2.0–56.0; p = 0.006), and each additional year of age (OR 1.1, 95% CI 1.0–1.2; p = 0.009) were found to be associated with work disability 24 months after diagnosis.Conclusion.Patients with pSS showed an increased work disability, in comparison with the general population, which increased significantly during the first 2 years after diagnosis. Work disability at diagnosis, concomitant fibromyalgia, and increasing age, but not anti-SSA/anti-SSB antibodies or disease activity, were associated with longterm work disability.
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30
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Depression and anxiety in dry eye disease: a systematic review and meta-analysis. Eye (Lond) 2016; 30:1558-1567. [PMID: 27518547 DOI: 10.1038/eye.2016.186] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/16/2016] [Indexed: 12/19/2022] Open
Abstract
AimTo evaluate the association of dry eye disease (DED) with depression and anxiety.Patients and methodsWe conducted a systematic review and meta-analysis of studies that reported the prevalence, incidence and/or severity grading of depression and/or anxiety in DED patients and healthy controls. We searched MEDLINE, EMBASE, PsycINFO, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform for relevant studies.ResultsTwenty-two eligible studies consisted of 2 980 026 patients were analyzed. DED was associated with an increased prevalence of depression (summary odds ratio (OR)=2.92, 95% CI: 2.13-4.01, P<0.00001) and anxiety (OR=2.80, 95% CI: 2.61-3.02, P<0.00001). The depression score (standardized mean difference (SMD)=0.81, 95% CI: 0.48-1.15, P<0.00001) and anxiety score (SMD=0.37, 95% CI: 0.10-0.64, P=0.007) were higher in DED patients than in controls. Subgroup analyses revealed that the prevalence and severity of depression are greatest in primary Sjogren's syndrome patients. No study reported the incidence.ConclusionDepression and anxiety are more prevalent in DED patients than in controls. Among patients with DED, those suffering from primary Sjogren's syndrome have higher prevalence and severity of depression.
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31
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Brito-Zerón P, Baldini C, Bootsma H, Bowman SJ, Jonsson R, Mariette X, Sivils K, Theander E, Tzioufas A, Ramos-Casals M. Sjögren syndrome. Nat Rev Dis Primers 2016; 2:16047. [PMID: 27383445 DOI: 10.1038/nrdp.2016.47] [Citation(s) in RCA: 447] [Impact Index Per Article: 55.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sjögren syndrome (SjS) is a systemic autoimmune disease that primarily affects the exocrine glands (mainly the salivary and lacrimal glands) and results in the severe dryness of mucosal surfaces, principally in the mouth and eyes. This disease predominantly affects middle-aged women, but can also be observed in children, men and the elderly. The clinical presentation of SjS is heterogeneous and can vary from sicca symptoms to systemic disease (characterized by peri-epithelial lymphocytic infiltration of the affected tissue or the deposition of the immune complex) and lymphoma. The mechanism underlying the development of SjS is the destruction of the epithelium of the exocrine glands, as a consequence of abnormal B cell and T cell responses to the autoantigens Ro/SSA and La/SSB, among others. Diagnostic criteria for SjS include the detection of autoantibodies in patient serum and histological analysis of biopsied salivary gland tissue. Therapeutic approaches for SjS include both topical and systemic treatments to manage the sicca and systemic symptoms of disease. SjS is a serious disease with excess mortality, mainly related to the systemic involvement of disease and the development of lymphomas in some patients. Knowledge of SjS has progressed substantially, but this disease is still characterized by sicca symptoms, the systemic involvement of disease, lymphocytic infiltration to exocrine glands, the presence of anti-Ro/SSA and anti-La/SSB autoantibodies and the increased risk of lymphoma in patients with SjS.
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Affiliation(s)
- Pilar Brito-Zerón
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA-Sanitas, Barcelona, Spain.,Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.,Department of Autoimmune Diseases, ICMiD, Hospital Clínic, C/Villarroel, 170, 08036 Barcelona, Spain
| | | | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Simon J Bowman
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Roland Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Xavier Mariette
- Université Paris Sud, INSERM, Paris, France.,Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Paris, France
| | - Kathy Sivils
- Oklahoma Sjögren's syndrome Center of Research Translation, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Elke Theander
- Department of Rheumatology, Malmö University Hospital, Lund University, Lund, Sweden
| | - Athanasios Tzioufas
- Department of Pathophysiology, School of Medicine, National University of Athens, Athens, Greece
| | - Manuel Ramos-Casals
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.,Department of Autoimmune Diseases, ICMiD, Hospital Clínic, C/Villarroel, 170, 08036 Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
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Karageorgas T, Fragioudaki S, Nezos A, Karaiskos D, Moutsopoulos HM, Mavragani CP. Fatigue in Primary Sjögren's Syndrome: Clinical, Laboratory, Psychometric, and Biologic Associations. Arthritis Care Res (Hoboken) 2016; 68:123-31. [PMID: 26315379 DOI: 10.1002/acr.22720] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/20/2015] [Accepted: 08/18/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To identify independent contributors of fatigue in primary Sjögren's syndrome (SS) patients, taking into account clinical, laboratory, and psychological features, and to explore the potential role of interferon (IFN)-induced gene indoleamine 2,3-dioxygenase (IDO-1), anti-21-hydroxylase (anti-21[OH]) antibodies, and soluble BAFF. METHODS Detailed clinical and laboratory characteristics were recorded for 106 primary SS patients. The Functional Assessment of Chronic Illness Therapy-Fatigue, Zung Depression Scale, State-Trait Anxiety Inventory, Eysenck Personality Questionnaire Scale, and Athens Insomnia Scale were adopted to assess fatigue, depression, anxiety, and sleep disturbances, respectively. Peripheral whole blood expression levels of IDO-1, as well as type I and II IFN-induced genes were calculated using quantitative reverse transcriptase-polymerase chain reaction. Serum anti-21(OH) antibodies and soluble BAFF levels were determined by a radioimmunoassay and an enzyme-linked immunosorbent assay, respectively. Univariate and multivariate models were performed to identify determinants of fatigue. RESULTS Fatigue was detected in 32 of 106 (30.2%) primary SS patients. In univariate analysis, fatigue was associated with arthralgias/myalgias, fibromyalgia hydroxychloroquine therapy, both state and trait anxiety scores, depression, and neuroticism, as well as impaired sleep patterns. Multivariate analysis revealed neuroticism (odds ratio [OR] 6.9, [95% confidence interval (95% CI) 1.7-28.0]), depression (OR 3.0 [95% CI 0.8-11.0]), and fibromyalgia (OR 5.5 [95% CI 1.1-27.7]) as independent fatigue contributors. Soluble BAFF levels, anti-21(OH) autoantibodies, and IDO-1 messenger RNA expression did not significantly differ between fatigued and nonfatigued primary SS patients. CONCLUSION Depression, neuroticism, and fibromyalgia play a major role in primary SS-associated fatigue and should be addressed in clinical practice, with active collaboration between rheumatologists and mental health professionals. Further studies are warranted in order to explore underlying pathophysiologic pathways that might explain fatigue in the setting of primary SS.
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Affiliation(s)
| | | | - Adrianos Nezos
- National and Kapodistrian University of Athens, Athens, Greece
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Rojas-Alcayaga G, Herrera Ronda A, Espinoza Santander I, Bustos Reydet C, Ríos Erazo M, Wurmann P, Sabugo F, Geenen R. Illness Experiences in Women with Oral Dryness as a Result of Sjögren's Syndrome: The Patient Point of View. Musculoskeletal Care 2016; 14:233-242. [PMID: 27061842 DOI: 10.1002/msc.1134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sjögren's syndrome and the associated dryness can have multiple consequences. The aim of the present qualitative study was to give an in-depth account of the life experiences of women with primary Sjögren's syndrome (pSS) and health-related behaviours, and to summarize these experiences in an integrated model. METHODS Twelve women diagnosed with pSS who regularly attended the Hospital of the University of Chile participated in detailed interviews. The data were analysed using qualitative methods based on the principles of grounded theory. RESULTS Selective coding identified three categories: illness experience, social interaction and psychological response. An integrated model was developed connecting these dynamic aspects and suggesting how they could lead to a life cycle crisis in cases of maladjustment. We found that problem-solving strategies, reconstruction of identity, acceptance and a social support may prevent this life cycle crisis. DISCUSSION Xerostomia and other consequences of pSS can have a profound influence on daily life. However, the severity of the consequences depends on individual experiences with the illness, social influences and the psychological responses of the patient. Physicians, dentists and other healthcare professionals can help the patient by listening to their problems and exploring solutions based on a psychological approach.
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Affiliation(s)
- Gonzalo Rojas-Alcayaga
- Department of Oral Pathology, Faculty of Dentistry, Universidad de Chile, Santiago, Chile.,Behavioral Science Area, Institute for Research in Dental Science, Universidad de Chile, Santiago, Chile
| | - Andrea Herrera Ronda
- Behavioral Science Area, Institute for Research in Dental Science, Universidad de Chile, Santiago, Chile
| | | | - Claudia Bustos Reydet
- Behavioral Science Area, Institute for Research in Dental Science, Universidad de Chile, Santiago, Chile
| | - Matías Ríos Erazo
- Behavioral Science Area, Institute for Research in Dental Science, Universidad de Chile, Santiago, Chile
| | - Pamela Wurmann
- Rheumatology Section, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Francisca Sabugo
- Rheumatology Section, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, the Netherlands
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Nocturne G, Seror R, Fogel O, Belkhir R, Boudaoud S, Saraux A, Larroche C, Le Guern V, Gottenberg JE, Mariette X. CXCL13 and CCL11 Serum Levels and Lymphoma and Disease Activity in Primary Sjögren's Syndrome. Arthritis Rheumatol 2016; 67:3226-33. [PMID: 26359802 DOI: 10.1002/art.39315] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 07/30/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Non-Hodgkin's lymphoma (NHL) is a severe complication of primary Sjögren's syndrome (SS). Ectopic germinal centers (GCs) in the salivary glands are predictors of the occurrence of NHL. Given the association between CCL11 and CXCL13 and ectopic GCs, we assessed the link between these chemokines and NHL, as well as the association between these chemokines and disease activity, in patients with primary SS. METHODS Serum levels of CCL11 and CXCL13 were evaluated by multiplex assay in 385 patients included in the Assessment of Systemic Signs and Evolution of Sjögren's Syndrome (ASSESS) cohort. The association between chemokine levels, B cell biomarkers, and patient subsets was assessed using Spearman's test for continuous data and the nonparametric Mann-Whitney U test for categorical data. Multivariate analyses were performed to identify parameters associated with lymphoma and disease activity. RESULTS Seventeen patients had a history of lymphoma, and 5 of them had developed NHL during followup. The median serum levels of CCL11 and CXCL13 in the total cohort were 106.48 pg/ml (interquartile range 69.33-149.85) and 108.31 pg/ml (interquartile range 58.88-200.13), respectively. Patients with lymphoma had higher levels of CXCL13 than did patients without lymphoma (P = 0.006) and a trend toward a higher level of CCL11 (P = 0.056). Low C4 and high BAFF levels were associated with NHL on multivariate analysis (P = 0.01 and P = 0.0002, respectively). CCL11 and CXCL13 levels correlated positively with the rheumatoid factor titer, the κ-to-λ free light chain ratio, and the β2 -microglubulin level. CXCL13 was the only parameter associated with disease activity on multivariate analysis. CONCLUSION These findings demonstrate a link between CXCL13 and CCL11 and disease activity and lymphoma. This highlights the continuum between chronic B cell activation, disease activity, and lymphomagenesis in patients with primary SS.
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Affiliation(s)
- G Nocturne
- Université Paris-Sud, INSERM UMR1184, Le Kremlin-Bicêtre, France
| | - R Seror
- Université Paris-Sud, INSERM UMR1184, and Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France
| | - O Fogel
- Université Paris-Sud, INSERM UMR1184, Le Kremlin-Bicêtre, France
| | - R Belkhir
- Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - S Boudaoud
- Université Paris-Sud, INSERM UMR1184, Le Kremlin-Bicêtre, France
| | - A Saraux
- Centre Hospitalier Universitaire (CHU) de Brest, Brest, France
| | | | | | - J E Gottenberg
- Hôpital de Hautepierre, CHU de Strasbourg, Strasbourg, France
| | - X Mariette
- Université Paris-Sud, INSERM UMR1184, and Hôpital Bicêtre, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France
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Milin M, Cornec D, Chastaing M, Griner V, Berrouiguet S, Nowak E, Marhadour T, Saraux A, Devauchelle-Pensec V. Sicca symptoms are associated with similar fatigue, anxiety, depression, and quality-of-life impairments in patients with and without primary Sjögren's syndrome. Joint Bone Spine 2016; 83:681-685. [PMID: 26774177 DOI: 10.1016/j.jbspin.2015.10.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/28/2015] [Indexed: 09/30/2022]
Abstract
OBJECTIVE To compare quality of life (QoL), depression, anxiety, and fatigue in prospectively included patients with primary Sjögren's syndrome (pSS) or with sicca but no diagnosis of Sjögren's syndrome. METHODS Patients undergoing a multidisciplinary evaluation at a single university center in Brest, France, for suspected pSS and having sicca symptoms were included prospectively between November 2006 and December 2013. The same standardized investigations were performed in all patients. pSS and sicca not due to pSS diagnoses were based on evaluating physician opinion. Each patient completed three validated questionnaires on QoL (SF-36), fatigue (MFI), depression and anxiety (HADS). RESULTS Of the 95 included patients, 55 (57.9%) had pSS and 40 (42.1%) had sicca without pSS. Gender distribution, age, disease duration, and sicca symptoms were similar in the two groups. The pSS group had a significantly higher proportion of patients with abnormal objective tests for dryness (Schirmer's test and salivary flow rate). The SF-36, HADS, and MFI scores were similarly altered in the two groups. Anxiety was more common than depression in both groups. The most affected domains were vitality in the SF-36 and general/physical fatigue in the MFI. Extraglandular systemic involvement was not a major determinant of QoL alteration in patients with pSS. CONCLUSIONS Sicca symptoms are associated with severe alterations in SF-36, HADS, and MFI scores regardless of objective test abnormalities and pSS diagnosis. Anxiety is more common than depression and should be taken into account when managing all patients with sicca symptoms.
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Affiliation(s)
- Morgane Milin
- Rheumatology Unit and Immunology Department (EA 2216), hôpital de la Cavale-Blanche, université Bretagne-Occidentale, CHU de Brest, BP 814, 29609 Brest cedex, France.
| | - Divi Cornec
- Rheumatology Unit and Immunology Department (EA 2216), hôpital de la Cavale-Blanche, université Bretagne-Occidentale, CHU de Brest, BP 814, 29609 Brest cedex, France
| | - Myriam Chastaing
- Psychiatric Unit, université Bretagne-Occidentale, CHU de Brest, BP 814, 29609 Brest cedex, France
| | - Veronique Griner
- Psychiatric Unit, université Bretagne-Occidentale, CHU de Brest, BP 814, 29609 Brest cedex, France
| | - Sofian Berrouiguet
- Psychiatric Unit, université Bretagne-Occidentale, CHU de Brest, BP 814, 29609 Brest cedex, France
| | - Emmanuel Nowak
- Inserm CIC 0502, CHU de Brest, 29609 Brest cedex, France
| | - Thierry Marhadour
- Rheumatology Unit and Immunology Department (EA 2216), hôpital de la Cavale-Blanche, université Bretagne-Occidentale, CHU de Brest, BP 814, 29609 Brest cedex, France
| | - Alain Saraux
- Rheumatology Unit and Immunology Department (EA 2216), hôpital de la Cavale-Blanche, université Bretagne-Occidentale, CHU de Brest, BP 814, 29609 Brest cedex, France
| | - Valérie Devauchelle-Pensec
- Rheumatology Unit and Immunology Department (EA 2216), hôpital de la Cavale-Blanche, université Bretagne-Occidentale, CHU de Brest, BP 814, 29609 Brest cedex, France
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Brito-Zerón P, Theander E, Baldini C, Seror R, Retamozo S, Quartuccio L, Bootsma H, Bowman SJ, Dörner T, Gottenberg JE, Mariette X, Bombardieri S, de Vita S, Mandl T, Ng WF, Kruize AA, Tzioufas A, Vitali C, Buyon J, Izmirly P, Fox R, Ramos-Casals M, on behalf of the EULAR Sjögren Synd. Early diagnosis of primary Sjögren’s syndrome: EULAR-SS task force clinical recommendations. Expert Rev Clin Immunol 2015; 12:137-56. [DOI: 10.1586/1744666x.2016.1109449] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Devauchelle-Pensec V, Gottenberg JE, Jousse-Joulin S, Berthelot JM, Perdriger A, Hachulla E, Hatron PY, Puechal X, Le Guern V, Sibilia J, Chiche L, Goeb V, Vittecoq O, Larroche C, Fauchais AL, Hayem G, Morel J, Zarnitsky C, Dubost JJ, Dieudé P, Pers JO, Cornec D, Seror R, Mariette X, Nowak E, Saraux A. Which and How Many Patients Should Be Included in Randomised Controlled Trials to Demonstrate the Efficacy of Biologics in Primary Sjögren's Syndrome? PLoS One 2015; 10:e0133907. [PMID: 26368934 PMCID: PMC4569343 DOI: 10.1371/journal.pone.0133907] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 07/03/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The goal of this study was to determine how the choice of the primary endpoint influenced sample size estimates in randomised controlled trials (RCTs) of treatments for primary Sjögren's syndrome (pSS). METHODS We reviewed all studies evaluating biotechnological therapies in pSS to identify their inclusion criteria and primary endpoints. Then, in a large cohort (ASSESS), we determined the proportion of patients who would be included in RCTs using various inclusion criteria sets. Finally, we used the population of a large randomised therapeutic trial in pSS (TEARS) to assess the impact of various primary objectives and endpoints on estimated sample sizes. These analyses were performed only for the endpoints indicating greater efficacy of rituximab compared to the placebo. RESULTS We identified 18 studies. The most common inclusion criteria were short disease duration; systemic involvement; high mean visual analogue scale (VAS) scores for dryness, pain, and fatigue; and biological evidence of activity. In the ASSESS cohort, 35 percent of patients had recent-onset disease (lower than 4 years), 68 percent systemic manifestations, 68 percent high scores on two of three VASs, and 52 percent biological evidence of activity. The primary endpoints associated with the smallest sample sizes (nlower than 200) were a VAS dryness score improvement higher to 20 mm by week 24 or variable improvements (10, 20, or 30 mm) in fatigue VAS by week 6 or 16. For patients with systemic manifestations, the ESSDAI change may be the most logical endpoint, as it reflects all domains of disease activity. However, the ESSDAI did not improve significantly with rituximab therapy in the TEARS study. Ultrasound score improvement produced the smallest sample size estimate in the TEARS study. CONCLUSION This study provides valuable information for designing future RCTs on the basis of previously published studies. Previous RCTs used inclusion criteria that selected a small part of the entire pSS population. The endpoint was usually based on VASs assessing patient complaints. In contrast to VAS dryness cut-offs, VAS fatigue cut-offs did not affect estimated sample sizes. SGUS improvement produced the smallest estimated sample size. Further studies are required to validate standardised SGUS modalities and assessment criteria. Thus, researchers should strive to develop a composite primary endpoint and to determine its best cut-off and assessment time point.
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Affiliation(s)
- Valérie Devauchelle-Pensec
- Rheumatology Department, CHU de la Cavale Blanche, Boulevard Tanguy Prigent, 29609, Brest, France
- EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, 29200, Brest, France
| | | | - Sandrine Jousse-Joulin
- Rheumatology Department, CHU de la Cavale Blanche, Boulevard Tanguy Prigent, 29609, Brest, France
- EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, 29200, Brest, France
| | | | - Aleth Perdriger
- Rheumatology Department, C.H.U. Hôpital Sud, 35000, Rennes, France
| | - Eric Hachulla
- Internal Medicine Department, Claude Huriez Hospital, Lille2 University, 59037, Lille Cedex, France
| | - Pierre Yves Hatron
- Internal Medicine Department, Claude Huriez Hospital, Lille2 University, 59037, Lille Cedex, France
| | - Xavier Puechal
- Internal Medicine Department, Hôpital Cochin, Paris, France
| | | | - Jean Sibilia
- Rheumatology Department, Strasbourg University Hospital, Strasbourg, France
| | - Laurent Chiche
- Internal Medicine Department, Hôpital de la Conception, 147 Bd Baille, 13005, Marseille, France
| | - Vincent Goeb
- Rheumatology Department, C.H.R.U. d’Amiens, 76 230 Bois-Guillaume, France
| | - Olivier Vittecoq
- Rheumatology Department, C.H.R.U. de Rouen, 76 230 Bois-Guillaume, France
| | - Claire Larroche
- Internal Medicine Department, Bobigny University Hospital, Paris, France
| | | | - Gilles Hayem
- Rheumatology Department, Ambroise Paré University Hospital, Paris, France
| | - Jacques Morel
- Immuno-Rhumatology Department, C.H.U. Lapeyronie, 34295 Montpellier, France
| | | | - Jean Jacques Dubost
- Rheumatology Department, Gabriel Montpied Teaching Hospital, Place H. Dunant, Clermont-Ferrand, 63000, France
| | - Philippe Dieudé
- Rheumatology Department, Bichat Claude-Bernard Hospital, Paris, France
| | - Jacques Olivier Pers
- EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, 29200, Brest, France
| | - Divi Cornec
- Rheumatology Department, CHU de la Cavale Blanche, Boulevard Tanguy Prigent, 29609, Brest, France
- EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, 29200, Brest, France
| | - Raphaele Seror
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), INSERM U1012, Université Paris-Sud, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Xavier Mariette
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), INSERM U1012, Université Paris-Sud, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | | | - Alain Saraux
- Rheumatology Department, CHU de la Cavale Blanche, Boulevard Tanguy Prigent, 29609, Brest, France
- EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, 29200, Brest, France
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Paganotti MA, Valim V, Serrano ÉV, Miyamoto ST, Giovelli RA, Santos MCLFS. Validação e propriedades psicométricas do Eular Sjögren's Syndrome Patient Reported Index (ESSPRI) para a língua portuguesa. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 55:439-45. [DOI: 10.1016/j.rbr.2015.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 10/31/2014] [Accepted: 06/28/2015] [Indexed: 02/07/2023] Open
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Dudek JE, Białaszek W, Ostaszewski P. Quality of life in women with lipoedema: a contextual behavioral approach. Qual Life Res 2015. [DOI: 10.1007/s11136-015-1080-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Joint and muscle pain are commonly observed in patients with primary Sjögren's syndrome (pSS). Different types of pain can be distinguished, that is, articular pain, neuropathic pain and widespread pain. Articular pain is due to more or less evident synovitis, usually involving peripheral joints such as hand joints, wrists, knees and ankles. Drugs used to treat rheumatoid arthritis, or lupus synovitis, are also employed for articular involvement in pSS. Pure sensory neuropathies and, more often, small fibre neuropathies are responsible for neuropathic pain in pSS. This is usually localised in the legs and arms with a characteristic glove or sock distribution. Widespread pain, often assuming the features of fibromyalgia, has also been reported in patients with pSS. The pathological mechanisms underlying both neuropathic pain and widespread (fibromyalgia) pain in pSS have not been so far completely clarified.
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Affiliation(s)
- Claudio Vitali
- Outpatient Clinics of Rheumatology, Casa di Cura di Lecco, Lecco, Italy; Istituto S. Stefano, Como, Italy.
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Inal V, Kitapcioglu G, Karabulut G, Keser G, Kabasakal Y. Evaluation of quality of life in relation to anxiety and depression in primary Sjögren’s syndrome. Mod Rheumatol 2014. [DOI: 10.3109/s10165-010-0329-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cho HJ, Yoo JJ, Yun CY, Kang EH, Lee HJ, Hyon JY, Song YW, Lee YJ. The EULAR Sjogren's syndrome patient reported index as an independent determinant of health-related quality of life in primary Sjogren's syndrome patients: in comparison with non-Sjogren's sicca patients. Rheumatology (Oxford) 2013; 52:2208-17. [DOI: 10.1093/rheumatology/ket270] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Sicca symptoms and their impact on quality of life among very long-term survivors after hematopoietic SCT. Bone Marrow Transplant 2013; 48:988-93. [PMID: 23292241 DOI: 10.1038/bmt.2012.260] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 11/06/2012] [Accepted: 11/13/2012] [Indexed: 01/01/2023]
Abstract
The objective of this prospective cross-sectional case-control study was to examine the prevalence of dryness symptoms and its impact on quality of life (QoL) among very long-term survivors after hematopoietic SCT (HSCT) in comparison with their respective sibling donors. Forty-four allogeneic HSCT recipients with a long-term survival (median: 17.5; range: 11-26 years) were included. Their respective, HLA-identical sibling donors served as controls. Clinical examinations included saliva flow rates (SFR) and the Schirmer's test. The presence of sicca symptoms of mouth, eyes and skin were inquired. The social functioning (SF)-36 questionnaire was applied. Recipients had lower (P<0.01) unstimulated and stimulated mean SFR than donors. Schirmer's test results <5 mm was found in 45% of the recipients in comparison with 27% of the donors (P = 0.07). Xerostomia (34 vs 4 subjects), xerophtalmia (23 vs 3) and dry skin (32 vs 12) were reported more often by the recipients than donors (P<0.001). Sicca symptoms and their objective findings correlated with QoL. The mean SF-36 scores of the donors were significantly higher than those of the recipients for physical component summary. In conclusion, sicca symptoms are common amongst long-term survivors of HSCT and affect remarkably the QoL.
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Deák M, Szvetnik A, Balog A, Sohár N, Varga R, Pokorny G, Tóth G, Kiss M, Kovács L. Neuroimmune interactions in Sjögren's syndrome: relationship of exocrine gland dysfunction with autoantibodies to muscarinic acetylcholine receptor-3 and mental health status parameters. Neuroimmunomodulation 2013; 20:79-86. [PMID: 23235351 DOI: 10.1159/000345177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/12/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Antimuscarinic acetylcholine receptor-3 (m3AChR) autoantibodies have been described in primary Sjögren's syndrome (pSS). The aim of this study was to compare various methods for their detection and to assess the contributions of anti-m3AChR and other immunological and psychosocial factors to the pathomechanism of secondary SS (sSS). METHODS Sixty-five rheumatoid arthritis (RA) patients, 103 systemic lupus erythematosus (SLE) patients, 76 pSS patients and 50 controls were compared. Three immunodominant epitopes of m3AChR were synthesized and used in ELISA. Two extracellular epitopes were also prepared in fusion with glutathione-S-transferase and one in conjugation with bovine serum albumin. Mental health status was assessed with the 36-item Short-Form Health Survey and Functional Assessment of Chronic Illness Therapy fatigue scale. Correlations were evaluated between glandular function and anti-m3AChR positivities and specificities, features of SLE and RA, and mental health parameters. RESULTS Fourteen RA and 27 SLE patients had sSS. The autoantibody levels to all epitopes of m3AChR were significantly higher in pSS and SLE patients than in the controls. The fusion protein forms discriminated RA from pSS and SLE; furthermore, the YNIP fusion protein also distinguished pSS from SLE. The prevalence and the mean levels of all autoantibodies did not differ statistically between sicca and non-sicca SLE or RA patients. Glandular dysfunction correlated with higher age in SLE and RA and an impaired health-related quality of life in SLE. CONCLUSIONS The second and third extracellular loops of m3AChR are antigenic in pSS. Immunoassays with antigens as fusion peptides demonstrate the best performance. Sicca SLE patients have worse mental health status. Anti-m3AChR antibodies represent a peculiar example of neuroimmune interactions.
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Affiliation(s)
- Magdolna Deák
- Department of Rheumatology, Faculty of Medicine, Albert Szent-Györgyi Health Centre, University of Szeged, Szeged, Hungary.
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Outcome measures for primary Sjögren’s syndrome. J Autoimmun 2012; 39:97-102. [DOI: 10.1016/j.jaut.2012.01.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 01/22/2012] [Indexed: 02/02/2023]
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Haldorsen K, Bjelland I, Bolstad AI, Jonsson R, Brun JG. A five-year prospective study of fatigue in primary Sjögren's syndrome. Arthritis Res Ther 2011; 13:R167. [PMID: 21996338 PMCID: PMC3308101 DOI: 10.1186/ar3487] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 10/11/2011] [Indexed: 12/01/2022] Open
Abstract
Introduction Fatigue is prevalent in primary Sjögren's syndrome (pSS), and contributes to the considerably reduced health related quality of life in this disease. The symptom is included in proposed disease activity and outcome measures for pSS. Several studies indicate that there is an inflammatory component of fatigue in pSS and other chronic inflammatory rheumatic diseases. The purpose of this study was to investigate fatigue change in pSS in a longitudinal study, and explore whether any clinical or laboratory variables at baseline, including serum cytokines, were associated with a change in fatigue scores over time. Methods A clinical and laboratory investigation of 141 patients fulfilling the American-European consensus criteria of pSS was undertaken in the period May 2004 to April 2005. Median time since diagnosis was 5.5 years. Examinations included the fatigue questionnaires: fatigue severity scale (FSS), fatigue visual analogue scale (VAS), functional assessment of chronic illness therapy - fatigue (FACIT-F) and medical outcome study short form-36 (SF-36) vitality, which were repeated in a follow-up investigation in January and February 2010. Results A total of 122 patients (87%) responded at both time-points. Thirty-five percent of patients experienced a clinically significant FSS increase. On the group level, fatigue measures did not change except that there was a slight deterioration in SF-36 vitality score. High serum anti-Sjögren's syndrome A antigen (anti-SSA) showed weak associations with high baseline fatigue, and patients with increasing fatigue had lower baseline unstimulated whole salivary volume. Weak associations between increasing fatigue and serum immunoglobulin G (IgG), and the pro-inflammatory cytokine interleukin-17 (IL-17), were observed. Baseline sicca symptoms correlated with higher fatigue both at baseline and with increasing fatigue over time. Linear regression analysis did not identify any predictive ability of clinical or laboratory measures on fatigue change over time. Conclusions Fatigue remained mainly unchanged over time. Using multivariate models did not reveal any clinical or laboratory predictors of fatigue change over time.
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Affiliation(s)
- Karstein Haldorsen
- Broegelmann Research Laboratory, The Gade Institute, Laboratory Bldg,, Haukeland University Hospital, N-5021 Bergen, Norway.
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47
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Primary Sjögren’s syndrome in Moroccan patients: characteristics, fatigue and quality of life. Rheumatol Int 2011; 32:2637-43. [DOI: 10.1007/s00296-011-2009-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 07/10/2011] [Indexed: 10/18/2022]
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Hyphantis T, Palieraki K, Voulgari PV, Tsifetaki N, Drosos AA. Coping with health-stressors and defence styles associated with health-related quality of life in patients with systemic lupus erythematosus. Lupus 2011; 20:893-903. [PMID: 21562019 DOI: 10.1177/0961203311398264] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study aimed to assess the association of coping with health-stressors and defence styles with health-related quality of life (HRQOL) in systemic lupus erythematosus (SLE). In 56 SLE patients we assessed disease activity (SLEDAI), functional limitations (HAQ), psychological distress (SCL-90-R), defence styles (Defence Style Questionnaire), hostility (HDHQ), coping with health-stressors (Sense of Coherence scale) and HRQOL (WHOQOL-BREF). Two hundred and eight rheumatologic patients (168 with rheumatoid arthritis [RA] and 40 with primary Sjögren's syndrome [SS]) served as disease controls. SLE patients' HRQOL was similar to that of patients with RA and primary SS after adjusting for demographic and disease variables. Psychological distress was significantly associated with most aspects of HRQOL, but sense of coherence mediated the relationship of psychological distress with Physical HRQOL; this mediation effect was unique to SLE, as mediation analyses showed. Maladaptive action defence style was also significantly associated with Environment HRQOL independently of psychological distress (p < 0.024). These findings indicate that, apart from the early assessment and treatment of psychological distress, clinicians and consultation-liaison psychiatrists should bear in mind the SLE patients' psychological resources and coping capacities to deal with the stress of the disease, since such traits, although usually underestimated, are strongly independently associated with HRQOL.
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Affiliation(s)
- T Hyphantis
- Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece.
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SAITO S, TOGASHI A, KANEKO F, YAMAMOTO T, UCHIDA T, OYAMA N. Primary Sjögren’s syndrome with myalgia mimicking dermatomyositis. J Dermatol 2010; 37:837-9. [DOI: 10.1111/j.1346-8138.2010.00888.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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50
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Ng WF, Bowman SJ, Griffiths B. United Kingdom Primary Sjogren's Syndrome Registry--a united effort to tackle an orphan rheumatic disease. Rheumatology (Oxford) 2010; 50:32-9. [DOI: 10.1093/rheumatology/keq240] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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