The interplay between cognition, depression, anxiety, and sleep in primary Sjogren's syndrome patients

Age-associated B cell infiltration in salivary glands represents a hallmark of Sjögren's-like disease in aging mice

Sjögren's disease (SjD), characterized by circulating autoantibodies and exocrine gland inflammation, is typically diagnosed in women over 50 years of age. However, the contribution of age to SjD pathogenesis is unclear. C57BL/6 female mice at different ages were studied to investigate how aging influences the dynamics of salivary gland inflammation. Salivary glands were characterized for immune cell infiltration, inflammatory gene expression, and saliva production. At 8 months, gene expression of several chemokines involved in immune cell trafficking was significantly elevated. At this age, age-associated B cells (ABCs), a unique subset of B cells expressing the myeloid markers CD11b and/or CD11c, were preferentially enriched in the salivary glands compared to other organs like the spleen or liver. The salivary gland ABCs increased with age and positively correlated with increased CD4 T follicular helper cells. By 14 months, lymphocytic foci of well-organized T and B cells spontaneously developed in the salivary glands. In addition, the mice progressively developed high titers of serum autoantibodies. A subset of aged mice developed salivary gland dysfunction mimicking SjD patients. Our data demonstrates that aging is a significant confounding factor for SjD. Thus, aged female C57BL/6 mice are more appropriate and a valuable preclinical model for investigating SjD pathogenesis and novel therapeutic interventions.

Sjögren's syndrome and Parkinson's Disease: A bidirectional two-sample Mendelian randomization study

BACKGROUND

Previous observational studies have reported an association between Sjögren's syndrome (SS) and an increased risk of Parkinson's Disease (PD). However, the causal relationship between these conditions remains unclear. The objective of this study was to investigate the causal impact of SS on the risk of developing PD, utilizing the Mendelian randomization (MR) approach.

METHODS

We conducted a bidirectional MR analysis using publicly available genome-wide association studies (GWAS) data. The primary analysis utilized the inverse-variance weighted (IVW) method. Complementary methods, such as MR-Egger regression, weighted mode, weighted median, and MR-pleiotropy residual sum and outlier (MR-PRESSO), were utilized to identify and correct for the presence of horizontal pleiotropy.

RESULTS

The IVW MR analysis revealed no significant association between SS and PD (IVW: OR = 1.00, 95% CI = 0.94-1.07, P = 0.95). Likewise, the reverse MR analysis did not identify any significant causal relationship between PD and SS (IVW: OR = 0.98, 95% CI = 0.85-1.12, P = 0.73). The results from MR-Egger regression, weighted median, and weighted mode approaches were consistent with the IVW method. Sensitivity analyses suggested that horizontal pleiotropy is unlikely to introduce bias to the causal estimates.

CONCLUSION

This study does not provide evidence to support the assertion that SS has a conclusive impact on the risk of PD, which contradicts numerous existing observational reports. Further investigation is necessary to determine the possible mechanisms behind the associations observed in these observational studies.

Electroencephalogram-detected stress levels in the frontal lobe region of patients with dry eye

PURPOSE

To evaluate stress levels extracted from prefrontal electroencephalogram (EEG) signals and investigate their relationship with dry eye symptoms.

METHODS

This prospective, cross-sectional, comparative study included 25 eyes of 25 patients with aqueous tear-deficient dry eye (low Schirmer group), 25 eyes of 25 patients with short tear breakup time dry eye (short breakup time group), and 24 eyes of 24 individuals without dry eye. An EEG test, the Japanese version of the Ocular Surface Disease Index (OSDI), and a stress questionnaire were administered. EEG-detected stress levels were assessed under three conditions: eyes closed, eyes open, and eyes open under ocular surface anesthesia.

RESULTS

Stress levels were significantly lower when the eyes were closed than when they were open in all groups (all P < 0.05). Stress levels during eyes open under ocular surface anesthesia were significantly lower than those during eyes open without anesthesia only in the low Schirmer group; no differences were found between the short breakup time and control groups. OSDI scores were associated with EEG-detected stress levels (P = 0.06) and vital staining score (P < 0.05) in the low Schirmer group; they were not associated with EEG-detected stress (P > 0.05), but with subjective stress questionnaire scores and breakup time values in the short breakup time group (P < 0.05).

CONCLUSIONS

In the low Schirmer group, peripheral nerve stimulation caused by ocular surface damage induced stress reactions in the frontal lobe, resulting in dry eye symptoms. Conversely, in the short breakup time group, the stress response in the frontal lobe was not related to symptom development.

Causal relationships between Sjögren's syndrome and Parkinson's disease: A Mendelian randomization study

BACKGROUND

Epidemiological and observational studies have indicated an association between Sjögren's syndrome (SS) and Parkinson's disease (PD). However, consistent conclusions have not been reached due to various limitations. In order to determine whether SS and PD are causally related, we conducted a Mendelian randomization study (MR) with two samples.

METHODS

Data for SS derived from the FinnGen consortium's R9 release (2495 cases and 365 533 controls). Moreover, data for PD were acquired from the publicly available GWAS of European ancestry, which involved 33 674 cases and 449 056 controls. The inverse variance weighted, along with four other effective methodologies, were employed to comprehensively infer the causal relationships between SS and PD. To assess the estimation's robustness, a number of sensitivity studies were performed. To determine the probability of reverse causality, we performed a reverse MR analysis.

RESULTS

There was no evidence of a significant causal effect of SS on PD risks based on the MR [odds ratio (OR) = 1.03; 95% confidence interval (CI) = 0.95-1.11; p = .45]. Similarly, no evidence supported the causal effects of PD on SS (OR = 0.92; 95% CI = 0.81-1.04; p = .20). These findings held up under rigorous sensitivity analysis.

CONCLUSIONS

MR bidirectional analysis did not reveal any cause-and-effect relationship between SS and PD, or vice versa. Further study of the mechanisms that may underlie the probable causal association between SS and PD is needed.

Age-associated B cell infiltration in salivary glands represents a hallmark of Sjögren's-like disease in aging mice

Sjögren's disease (SjD), characterized by circulating autoantibodies and exocrine gland inflammation, is typically diagnosed in women over 50 years of age. However, the contribution of age to SjD pathogenesis is unclear. C57BL/6 female mice at different ages were studied to investigate how aging influences the dynamics of salivary gland inflammation. Salivary glands were characterized for immune cell infiltration, inflammatory gene expression, oxidative stress, and saliva production. At 8 months, gene expression of several chemokines involved in immune cell trafficking was significantly elevated. At this age, Age-associated B cells (ABCs), a unique subset of B cells expressing the myeloid markers CD11b and/or CD11c, were preferentially enriched in the salivary glands compared to other organs like the spleen or liver. The salivary gland ABCs increased with age and positively correlated with increased CD4 T follicular helper cells. By 14 months, lymphocytic foci of well-organized T and B cells spontaneously developed in the salivary glands. In addition, the mice progressively developed high titers of serum autoantibodies. A subset of aged mice developed salivary gland dysfunction mimicking SjD patients. Our data demonstrates that aging is a significant confounding factor for SjD. Thus, aged female C57BL/6 mice are more appropriate and a valuable preclinical model for investigating SjD pathogenesis and novel therapeutic interventions.

Development and validation of a nomogram for predicting fatigue in patients with primary Sjögren's syndrome

OBJECTIVE

To develop and validate a nomogram to predict fatigue in patients with primary Sjögren's syndrome (pSS).

METHODS

In this cross-sectional study, 251 patients with SS from the Affiliated Hospital of Nantong University were recruited. The patients were randomly divided into two groups: training group (n = 167) and validation group (n = 84). In the training group, univariate analysis and multivariate Cox regression analysis were performed on sociodemographic factors, disease activity, anxiety/depression, clinical indicators, and so on. According to the risk factors of fatigue in SS patients, a nomograph was established. In the training group and validation group, the performance of the nomogram was verified by three forms: receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA).

RESULT

The incidence of fatigue was 40.6%. EULAR Sjögren's Syndrome Disease Activity Index, EULAR SS patient reported index, and depression were independent risk factors of fatigue in SS patients. The C-index of nomogram was 0.8532 in training set and 0.7381 in verification set, respectively. As to the Hosmer-Lemeshow test, the P value of modeling patients is 0.996 in verification (P > 0.05). DCA further validated the clinical utility of this nomogram.

CONCLUSION

The nomogram constructed in this study can effectively predict the occurrence of fatigue in SS patients, which is helpful for clinical decision-making and subsequent intervention implementation. Key Points • Fatigue was widespread in patients with primary Sjögren's syndrome, and the incidence of fatigue was 40.6%. • Disease activity and depression were independent risk factors of fatigue in patients with Sjögren's syndrome. • This was the first comprehensive nomogram to predict fatigue for Sjögren's syndrome patients.

Fatigue and sleep quality in Chinese adults with connective tissue disease: A cross-sectional study

OBJECTIVES

This study aims to evaluate fatigue and sleep quality among adults with connective tissue disease (CTD), and the interrelationship.

METHODS

From April 2020 to February 2021, adult CTD patients hospitalized were invited to complete sociodemographic and disease-related data, Fatigue Severity Scale (FSS), and Pittsburgh Sleep Quality Index (PSQI), as well as laboratory detection through computer query. Statistical analysis was performed using SPSS 22.0.

RESULTS

A total of 363 patients with CTD were included in the study. Of which, 313 patients were accompanied by single CTD (systemic lupus erythematosus (SLE) = 109, Sjogren's syndrome (SS) = 51, rheumatoid arthritis (RA) = 44, idiopathic inflammatory myopathies (IIM) = 36, Vasculitis = 17, systemic sclerosis (SSc) = 14, other = 42, respectively), and 50 patients had CTD ≥ 2. Compared with CTD = 1, patients with CTD ≥ 2 had longer disease duration, higher erythrocyte sedimentation rate, and higher IgG level (all P < 0.05). The prevalence of poor sleep quality in 363 CTD patients was 61.2%, among which, 59.1% for CTD = 1 and 74.0% for CTD ≥ 2, with significant difference (P = 0.045). Additionally, 75.5% experienced fatigue, and 75.4% for CTD = 1, 76.0% for CTD ≥ 2 (P = 0.927). Fatigue and sleep quality interacted in CTD patients (r = 0.236, P < 0.01; χ2 = 11.302, P = 0.001). Interestingly, no significant differences were found in the prevalence of fatigue and poor sleep quality among CTD subgroups, as well as the FSS score, the seven components of sleep quality and total PSQI score (P > 0.05).

CONCLUSIONS

More than 3/5 CTD patients experience fatigue and poor sleep quality, and not different among CTD subgroups. Targeted interventions are needed to reduce fatigue, improve sleep quality, and ultimately improve the prognosis of patients with CTD.

Sleep Time and Depression Symptoms as Predictors of Cognitive Development Among Adolescents: A Cross-Lagged Study From China

Sleep time and depression symptoms are important factors affecting cognitive development in adolescents. Based on the China Education Panel Survey (CEPS) database, this study used a two-wave cross-lagged model to examine the bidirectional relationship between sleep time, depression symptoms, and cognitive development. Descriptive statistics showed that Chinese adolescents' cognitive development increased significantly from 7th to 8th grade in junior high school, but unfortunately, their depression level and average sleep time per night demonstrated a slightly deteriorating trend. Correlation analysis showed that there was a relatively stable negative correlation between cognitive development, sleep time, and depression symptoms. Moreover, the cross-lagged model revealed that there was a bidirectional relationship between cognitive development and sleep time, a bidirectional relationship between depression symptoms and sleep time, and a unidirectional relationship between depression symptoms and cognitive development. Male adolescents in the subgroup were consistent with the total sample. Among female adolescents, only cognitive development and sleep time have a bidirectional relationship, while depression symptoms and cognitive development, and depression symptoms and sleep time have a unidirectional relationship. Therefore, it is of significance to take targeted action to promote cognitive development and healthy growth in adolescents worldwide.

Time Use and Cognitive Achievement among Adolescents in China: Depression Symptoms as Mediators

Everyone's time is limited, and there is competition between different aspects of time use; this requires comprehensive consideration of the effects of different aspects of time use on cognitive achievement in adolescents. This study uses a dataset of 11,717 students from a nationally representative large-scale survey project conducted in 2013 to 2014 to clarify the relationship between time use (including working on homework, playing sports, surfing the Internet, watching TV, and sleeping) and cognitive achievement among Chinese adolescents, and explores the mediating role of depression symptoms in the relationship between time use and cognitive achievement. The results of the correlation analysis show that the average daily time spent on homework, playing sports, and sleeping is significantly positively correlated with cognitive achievement (p < 0.01), while time spent surfing the Internet and watching TV are significantly negatively correlated with cognitive achievement (p < 0.01). The results of the mediating effect model show that depression symptoms play a mediating role in the relationship between time use and cognitive achievement among Chinese adolescents. Specifically, time spent playing sports (indirect effect = 0.008, p < 0.001) and sleeping (indirect effect = 0.015, p < 0.001) have a positive effect on cognitive achievement when using depression symptoms as mediators; time spent on homework (indirect effect = -0.004, p < 0.001), surfing the Internet (indirect effect = -0.002, p = 0.046), and watching TV (indirect effect = -0.005, p < 0.001) have a negative effect on cognitive achievement when using depression symptoms as mediators. This study contributes to the understanding of the relationship between time use and cognitive achievement among Chinese adolescents.

Central Nervous System Involvement in Primary Sjögren's Syndrome: Narrative Review of MRI Findings

Central nervous system (CNS) involvement is one of the numerous extraglandular manifestations of primary Sjögren's syndrome (pSS). Moreover, neurological complaints precede the sicca symptoms in 25-60% of the cases. We review the magnetic resonance imaging (MRI) lesions typical for pSS, involving the conventional examination, volumetric and morphometric studies, diffusion tensor imaging (DTI) and resting-state fMRI. The most common radiological lesions in pSS are white matter hyperintensities (WMH), scattered alterations hyperlucent on T2 and FLAIR sequences, typically located periventricularly and subcortically. Cortical atrophy and ventricular dilatation can also occur in pSS. Whilst these conditions are thought to be more common in pSS than healthy controls, DTI and resting-state fMRI alterations demonstrate evident microstructural changes in pSS. As pSS is often accompanied by cognitive symptoms, these MRI alterations are expectedly related to them. This relationship is not clearly delineated in conventional MRI studies, but DTI and resting-state fMRI examinations show more convincing correlations. In conclusion, the CNS manifestations of pSS do not follow a certain pattern. As the link between the MRI lesions and clinical manifestations is not well established, more studies involving larger populations should be performed to elucidate the correlations.

The Relationship Between Sjogren's Syndrome and Sleep Disturbance: A Case Report

Sjogren's syndrome is an autoimmune disorder characterized by the infiltration and disruption of exocrine glands by the host's immune cells. It is the third most common autoimmune syndrome after systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). This syndrome most commonly affects females. This disorder most typically presents as sicca symptoms, though plenty of other symptoms can exist. One of these other symptoms is the disturbance of sleep. The insomnia component of Sjogren's syndrome is the focus of this case report.