Influence of exposure to climate-related hazards in the phenotypic expression of primary Sjögren's syndrome

OBJECTIVES

To analyse how the key components at the time of diagnosis of the Sjögren's phenotype (epidemiological profile, sicca symptoms, and systemic disease) can be influenced by the potential exposure to climate-related natural hazards.

METHODS

For the present study, the following variables were selected for harmonisation and refinement: age, sex, country, fulfilment of 2002/2016 criteria items, dry eyes, dry mouth, and overall ESSDAI score. Climate-related hazards per country were defined according to the OECD and included seven climate-related hazard types: extreme temperature, extreme precipitation, drought, wildfire, wind threats, river flooding, and coastal flooding. Climatic variables were defined as dichotomous variables according to whether each country is ranked among the ten countries with the most significant exposure.

RESULTS

After applying data-cleaning techniques and excluding people from countries not included in the OECD climate rankings, the database study analysed 16,042 patients from 23 countries. The disease was diagnosed between 1 and 3 years earlier in people living in countries included among the top 10 worst exposed to extreme precipitation, wildfire, wind threats, river flooding, and coastal flooding. A lower frequency of dry eyes was observed in people living in countries exposed to wind threats, river flooding, and coastal flooding, with a level of statistical association being classified as strong (p<0.0001 for the three variables). The frequency of dry mouth was significantly lower in people living in countries exposed to river flooding (p<0.0001) and coastal flooding (p<0.0001). People living in countries included in the worse climate scenarios for extreme temperature (p<0.0001) and river flooding (p<0.0001) showed a higher mean ESSDAI score in comparison with people living in no-risk countries. In contrast, those living in countries exposed to worse climate scenarios for wind threats (p<0.0001) and coastal flooding (p<0.0001) showed a lower mean ESSDAI score in comparison with people living in no-risk countries.

CONCLUSIONS

Local exposure to extreme climate-related hazards plays a role in modulating the presentation of Sjögren across countries concerning the age at which the disease is diagnosed, the frequency of dryness, and the degree of systemic activity.

Exposure to air pollution as an environmental determinant of how Sjögren's disease is expressed at diagnosis

OBJECTIVES

To analyse how the potential exposure to air pollutants can influence the key components at the time of diagnosis of Sjögren's phenotype (epidemiological profile, sicca symptoms, and systemic disease).

METHODS

For the present study, the following variables were selected for harmonization and refinement: age, sex, country, fulfilment of 2002/2016 criteria items, dry eyes, dry mouth, and overall ESSDAI score. Air pollution indexes per country were defined according to the OECD (1990-2021), including emission data of nitrogen and sulphur oxides (NO/SO), particulate matter (PM2.5 and 1.0), carbon monoxide (CO) and volatile organic compounds (VOC) calculated per unit of GDP, Kg per 1000 USD.

RESULTS

The results of the chi-square tests of independence for each air pollutant with the frequency of dry eyes at diagnosis showed that, except for one, all variables exhibited p-values <0.0001. The most pronounced disparities emerged in the dry eye prevalence among individuals inhabiting countries with the highest NO/SO exposure, a surge of 4.61 percentage points compared to other countries, followed by CO (3.59 points), non-methane (3.32 points), PM2.5 (3.30 points), and PM1.0 (1.60 points) exposures. Concerning dry mouth, individuals residing in countries with worse NO/SO exposures exhibited a heightened frequency of dry mouth by 2.05 percentage points (p<0.0001), followed by non-methane exposure (1.21 percentage points increase, p=0.007). Individuals inhabiting countries with the worst NO/SO, CO, and PM2.5 pollution levels had a higher mean global ESSDAI score than those in lower-risk nations (all p-values <0.0001). When systemic disease was stratified according to DAS into low, moderate, and high systemic activity levels, a heightened proportion of individuals manifesting moderate/severe systemic activity was observed in countries with worse exposures to NO/SO, CO, and PM2.5 pollutant levels.

CONCLUSIONS

For the first time, we suggest that pollution levels could influence how SjD appears at diagnosis in a large international cohort of patients. The most notable relationships were found between symptoms (dryness and general body symptoms) and NO/SO, CO, and PM2.5 levels.

AB1529-HPR CROSS-CULTURAL ADAPTATION, RELIABILITY AND CONVERGENT VALIDITY OF THE TURKISH VERSION OF THE PRIMARY SJOGREN’S SYNDROME QUALITY OF LIFE QUESTIONNAIRE

Background

To completely comprehend the burden of an illness and the success of its treatment, it is essential to analyze the patients’ perspective on health-related quality of life. Because of this, the Primary Sjögren’s Syndrome-Quality of Life questionnaire (PSS-QoL) was developed, which evaluates the disease’s physical and psychosocial effects in PSS patients.

Objectives

In the literature, there is no Turkish questionnaire evaluating quality of life in patients with PSS. Therefore, the aim of this study was to translate and evaluate cross-culturally adaptation the PSS-QoL into the Turkish language and investigate its convergent validity and reliability in Turkish-speaking population with PSS.

Methods

Patients completed PSS-QoL questionnaire, the EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI) and Euro-QoL 5D (EQ-5D). To test the convergent validity of PSS-QoL, correlation between PSS-QoL and EQ-5D and ESSPRI were assessed with Pearson correlation test. In order to investigate the internal consistency and test-retest reliability, Cronbach’s alpha and Intraclass Correlation Coefficient (ICC) values interpreted, respectively.

Results

Seventy-nine patients with PSS (53.30 + 11.98 years, 74F/5M) were enrolled in the study. Good and moderate correlations were found between the PSS-QoL and ESSPRI (r: 0.818, p<0.001) and EQ-5D-pain/ discomfort (r:0.589, p<0.001). Correlations of subscales of PSS-QoL with subscales of ESSPRI and EQ-5D ranged from fair to strong (Table 1). Cronbach’s alpha and ICC values of the PSS-QoL total score were found to be as 0.955 and 0.914, respectively, indicating excellent reliability.

Table 1.

Correlations of PSS-QoL and EQ-5D, ESSPRI

PSS-QoLPhysicalDiscomfortDrynessPsychosocialtotal scorePSS-QoLPSS-QoLPSS-QoLPSS-QoLEQ-5D-mobility0.543**0.514**0.678**0.761**0.891**EQ-5D-usual activities0.466**0.342*0.371**0.233*0.460**EQ-5D-pain/discomfort0.589**0.651**0.710**0.442**0.394**EQ-5D-anxiety/depression0.574**0.570**0.557**0.436**0.439**EQ-5D-HS-0.625**-0.540**-0.495**-0.437**-0.547**ESSPRI-dryness0.589**0.706**0.448**0.722**0.348*ESSPRI-pain0.673**0.694**0.824**0.421**0.494**ESSPRI-fatigue0.780**0.668**0.669**0.497**0.690**

EQ-5D, Euro-QoL-5 dimension; ESSPRI, EULAR Sjögren’s Syndrome Patient Reported Index; HS, health state; PSS-QoL, Quality of Life in Primary Sjögren’s Syndrome. *p<0.05, **p<0.001.

Conclusion

This study demonstrated that Turkish version of PSS-QoL is reliable and valid tool to assess quality of life in PSS patients. Therefore, PSS-QoL can be used to assess quality of life in Turkish-speaking PSS patients.

References

[1]Lackner A, Stradner MH, Hermann J et al. Assessing health-related quality of life in primary Sjögren’s syndrome—the PSS-QoL. In Seminars in arthritis and rheumatism 2018; Vol. 48, No. 1,105-110.

[2]Beaton DE, Bombardier C, Guillemin F et al. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 2000; 25(24):3186-3191.

[3]Group, The EuroQol. EuroQol-a new facility for the measurement of health-related quality of life. Health policy 1990; 16.3: 199-208.

[4]Seror R, Ravaud P, Mariette X et al. EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI): development of a consensus patient index for primary Sjögren’s syndrome. Annals of the rheumatic diseases 2011; 70(6), 968-972.

Disclosure of Interests

None declared