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Price EJ, Benjamin S, Bombardieri M, Bowman S, Carty S, Ciurtin C, Crampton B, Dawson A, Fisher BA, Giles I, Glennon P, Gupta M, Hackett KL, Larkin G, Ng WF, Ramanan AV, Rassam S, Rauz S, Smith G, Sutcliffe N, Tappuni A, Walsh SB. British Society for Rheumatology guideline on management of adult and juvenile onset Sjögren disease. Rheumatology (Oxford) 2024:keae152. [PMID: 38621708 DOI: 10.1093/rheumatology/keae152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/02/2024] [Indexed: 04/17/2024] Open
Abstract
Sjögren disease (SD) is a chronic, autoimmune disease of unknown aetiology with significant impact on quality of life. Although dryness (sicca) of the eyes and mouth are the classically described features, dryness of other mucosal surfaces and systemic manifestations are common. The key management aim should be to empower the individual to manage their condition-conserving, replacing and stimulating secretions; and preventing damage and suppressing systemic disease activity. This guideline builds on and widens the recommendations developed for the first guideline published in 2017. We have included advice on the management of children and adolescents where appropriate to provide a comprehensive guideline for UK-based rheumatology teams.
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Affiliation(s)
- Elizabeth J Price
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Stuart Benjamin
- The Academy Library and Information Service, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Michele Bombardieri
- Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Barts Health NHS Trust, London, UK
- Centre for Experimental Medicine and Rheumatology, The William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Simon Bowman
- Department of Rheumatology, Milton Keynes University Hospital, Milton Keynes, UK
- Department of Rheumatology, University Hospitals Birmingham NHSFT, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Sara Carty
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Coziana Ciurtin
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Bridget Crampton
- Patient Representative, Sjogren's UK Helpline Lead, Sjogren's UK (British Sjögren's Syndrome Association), Birmingham, UK
| | - Annabel Dawson
- Patient Representative, Sjogren's UK (British Sjögren's Syndrome Association), Birmingham, UK
| | - Benjamin A Fisher
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre and Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Giles
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Peter Glennon
- General Practice, NHS Staffordshire & Stoke on Trent ICB, Stafford, UK
| | - Monica Gupta
- Department of Rheumatology, Gartnavel General Hospital, Glasgow, UK
| | - Katie L Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | | | - Wan-Fai Ng
- Translational and Clinical Research Institute & Newcastle NIHR Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Department of Rheumatology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Saad Rassam
- Haematology and Haemato-Oncology, KIMS Hospital, Maidstone, Kent, UK
| | - Saaeha Rauz
- Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Guy Smith
- Department of Ophthalmology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | | | - Anwar Tappuni
- Institute of Dentistry, Queen Mary University of London, London, UK
| | - Stephen B Walsh
- London Tubular Centre, University College London, London, UK
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Hasan H, Lotery A, Price EJ, Smith GT. An objective method of diagnosing hydroxychloroquine maculopathy. Eye (Lond) 2021; 35:1922-1929. [PMID: 32929180 PMCID: PMC8225631 DOI: 10.1038/s41433-020-01174-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/22/2020] [Accepted: 08/26/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hydroxychloroquine (HCQ) maculopathy is irreversible; primary prevention is done by regular monitoring. Guidelines of the Royal College of Ophthalmologists identify definite toxicity as having abnormal results of two screening tests, we present a quantitative method for interpreting these guidelines. METHODS We obtained ocular coherence tomography (OCT) scans of 100 patients who have been on HCQ for 5 years or more (patients) and 70 age-matched controls. Both groups had 10'2 visual field (VF) test. We used linear regression to determine the cut-off points for each of the eight Early Treatment of Diabetic Retinopathy Study (ETDRS) macular sectors for the VF and OCT. We calculated the probability of developing maculopathy using logistic regression. RESULTS Mean patient age: 59.9 years, 85% females, no statistically significant age difference between the patients and the control groups. DIAGNOSIS 64% rheumatoid arthritis, 14% Sjogren's syndrome, 16% systemic lupus and 6% various other rheumatology conditions. Mean duration of use was 6.3 years. Logistic regression results show strong negative correlation between the outer nuclear layer (ONL) volume and probability of toxicity. Goodness of fit was tested using Hosmer and Lemeshow test that indicates a high significance with a high P-value of 1. CONCLUSIONS Combining the ONL volume reduction and VF retinal sensitivity reduction per each of the eight ETDRS macular sectors provides an accurate and objective way of diagnosing HCQ maculopathy, this helps busy eye units establishing an optometrist-led or virtual service because it is independent of the assessor's level of experience.
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Affiliation(s)
- Hani Hasan
- Ophthalmology Department, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon, SN3 6BB, UK.
| | - Andrew Lotery
- Ophthalmology Department, University of Southampton, Southampton General Hospital LD 70 MP 806, Tremona Road, Southampton, SO16 6YD, UK
| | - Elizabeth J Price
- Rheumatology Department, Consultant Rheumatologist, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon, SN3 6BB, UK
| | - Guy T Smith
- Ophthalmology Department, Consultant Ophthalmologist, Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon, SN3 6BB, UK
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Ciurtin C, Cho Y, Al-Obaidi M, Jury EC, Price EJ. Barriers to translational research in Sjögren's syndrome with childhood onset: challenges of recognising and diagnosing an orphan rheumatic disease. Lancet Rheumatol 2021; 3:e138-e148. [PMID: 38279369 DOI: 10.1016/s2665-9913(20)30393-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 01/28/2024]
Abstract
Sjögren's syndrome was considered for many years a disease of adulthood, characterised by immune infiltration of exocrine glands, leading to dryness (eg, dry mouth and eyes), which is a cardinal symptom. As of the last 20 years, it became apparent that although the disease is very rare in children, its clinical presentation differs from that of adults, posing substantial challenges to the recognition, diagnosis, and classification of patients with childhood-onset Sjögren's syndrome. This Viewpoint explores comparative classification criteria for children (not validated) and adults with Sjögren's syndrome, as well as differences in the clinical presentation of childhood-onset versus adult-onset Sjögren's syndrome, offering ideas about how we can improve the diagnosis of Sjögren's syndrome in children. A review of the role of medical history and clinical assessment, serology, glandular function assessment, and imaging, as well as salivary and lachrymal gland biopsy in the diagnosis of children with Sjögren's syndrome is included. Additionally, we provide suggestions about further research and registry data collection that is required to address the unmet needs of these patients.
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Affiliation(s)
- Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, Department of Medicine, University College London, London, UK; Department of Rheumatology, University College London Hospital NHS Trust, London, UK.
| | - Youna Cho
- University College London Medical School, University College London, London, UK
| | - Muthana Al-Obaidi
- Department of Paediatric Rheumatology, Great Ormond Hospital for Children NHS Trust, London, UK
| | - Elizabeth C Jury
- Centre for Rheumatology, Department of Medicine, University College London, London, UK
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Hackett KL, Davies K, Tarn J, Bragg R, Hargreaves B, Miyamoto S, McMeekin P, Mitchell S, Bowman S, Price EJ, Pease C, Emery P, Andrews J, Lanyon P, Hunter J, Gupta M, Bombardieri M, Sutcliffe N, Pitzalis C, McLaren J, Cooper A, Regan M, Giles I, Isenberg D, Vadivelu S, Coady D, Dasgupta B, McHugh N, Young-Min S, Moots R, Gendi N, Akil M, Griffiths B, Lendrem DW, Ng WF. Pain and depression are associated with both physical and mental fatigue independently of comorbidities and medications in primary Sjögren's syndrome. RMD Open 2019; 5:e000885. [PMID: 31168409 PMCID: PMC6525628 DOI: 10.1136/rmdopen-2018-000885] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/20/2019] [Accepted: 03/27/2019] [Indexed: 01/01/2023] Open
Abstract
Objectives To report on fatigue in patients from the United Kingdom primary Sjögren's syndrome (pSS) registry identifying factors associated with fatigue and robust to assignable causes such as comorbidities and medications associated with drowsiness. Methods From our cohort (n = 608), we identified those with comorbidities associated with fatigue, and those taking medications associated with drowsiness. We constructed dummy variables, permitting the contribution of these potentially assignable causes of fatigue to be assessed. Using multiple regression analysis, we modelled the relationship between Profile of Fatigue and Discomfort physical and mental fatigue scores and potentially related variables. Results Pain, depression and daytime sleepiness scores were closely associated with both physical and mental fatigue (all p ≤ 0.0001). In addition, dryness was strongly associated with physical fatigue (p ≤ 0.0001). These effects were observed even after adjustment for comorbidities associated with fatigue or medications associated with drowsiness. Conclusions These findings support further research and clinical interventions targeting pain, dryness, depression and sleep to improve fatigue in patients with pSS.This finding is robust to both the effect of other comorbidities associated with fatigue and medications associated with drowsiness.
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Affiliation(s)
- Kate L Hackett
- Department of Life & Health Sciences, Northumbria University Department of Public Health and Wellbeing, Newcastle upon Tyne, UK
| | - Kristen Davies
- Musculoskeletal Research Group, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Jessica Tarn
- Musculoskeletal Research Group, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Rebecca Bragg
- Musculoskeletal Research Group, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Ben Hargreaves
- Musculoskeletal Research Group, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Samira Miyamoto
- Musculoskeletal Research Group, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Departamento de Educação Integrada em Saúde, Universidade Federal do Espirito Santo, Vitoria, Brazil
| | - Peter McMeekin
- Department of Life & Health Sciences, Northumbria University Department of Public Health and Wellbeing, Newcastle upon Tyne, UK
| | - Sheryl Mitchell
- Musculoskeletal Services, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Simon Bowman
- Rheumatology Research Group, University of Birmingham, Birmingham, UK
| | - Elizabeth J Price
- Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Colin Pease
- Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Emery
- Rheumatology, University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
- Musculoskeletal, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Jacqueline Andrews
- Musculoskeletal, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Peter Lanyon
- Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Michele Bombardieri
- Experimental Medicine and Rheumatology, Queen Mary University of London, London, UK
| | - Nurhan Sutcliffe
- Barts Health NHS Trust, London, UK
- Rheumatology, Barts and The London School of Medicine and Dentistry, London, UK
| | - Costantino Pitzalis
- Experimental Medicine and Rheumatology, William Harvey Research Institute Experimental Medicine and Musculoskeletal Sciences, London, UK
| | | | | | | | - Ian Giles
- Centre for Rheumatology, University College London, London, UK
| | - David Isenberg
- Centre for Rheumatology, University College London, London, UK
| | | | - David Coady
- City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| | - Bhaskar Dasgupta
- Department of Rheumatology, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
| | - Neil McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | | | - Robert Moots
- Rheumatology, Aintree University Hospitals, Liverpool, UK
| | - Nagui Gendi
- Department of Rheumatology, Basildon Hospital, Basildon, UK
| | - Mohammed Akil
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Bridget Griffiths
- Musculoskeletal Services, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Dennis W Lendrem
- Musculoskeletal Research Group, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
- Musculoskeletal Ageing, NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | - Wan-Fai Ng
- Musculoskeletal Ageing, NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
- Musculoskeletal Research Group, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
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Abstract
SS is a chronic, autoimmune disease of unknown aetiology for which there is no known curative treatment. Although dryness of the eyes and mouth are the classically described features, patients often experience drying of other mucosal surfaces and systemic manifestations, including fatigue and arthralgia. There is an association with other autoimmune diseases, especially thyroid disease, coeliac disease and primary biliary cholangitis. Systemic features may affect up to 70% and include inflammatory arthritis, skin involvement, haematological abnormalities, neuropathies, interstitial lung disease and a 5-10% lifetime risk of B cell lymphoma. Treatment should aim to empower patients to manage their condition; conserve, replace and stimulate secretions; prevent damage; and suppress underlying systemic disease activity.
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Affiliation(s)
- Elizabeth J Price
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Alan N Baer
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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6
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Fisher BA, Everett CC, Rout J, O'Dwyer JL, Emery P, Pitzalis C, Ng WF, Carr A, Pease CT, Price EJ, Sutcliffe N, Makdissi J, Tappuni AR, Gendi NST, Hall FC, Ruddock SP, Fernandez C, Hulme CT, Davies KA, Edwards CJ, Lanyon PC, Moots RJ, Roussou E, Richards A, Sharples LD, Bombardieri M, Bowman SJ. Effect of rituximab on a salivary gland ultrasound score in primary Sjögren's syndrome: results of the TRACTISS randomised double-blind multicentre substudy. Ann Rheum Dis 2017; 77:412-416. [PMID: 29275334 PMCID: PMC5867400 DOI: 10.1136/annrheumdis-2017-212268] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To compare the effects of rituximab versus placebo on salivary gland ultrasound (SGUS) in primary Sjögren's syndrome (PSS) in a multicentre, multiobserver phase III trial substudy. METHODS Subjects consenting to SGUS were randomised to rituximab or placebo given at weeks 0, 2, 24 and 26, and scanned at baseline and weeks 16 and 48. Sonographers completed a 0-11 total ultrasound score (TUS) comprising domains of echogenicity, homogeneity, glandular definition, glands involved and hypoechoic foci size. Baseline-adjusted TUS values were analysed over time, modelling change from baseline at each time point. For each TUS domain, we fitted a repeated-measures logistic regression model to model the odds of a response in the rituximab arm (≥1-point improvement) as a function of the baseline score, age category, disease duration and time point. RESULTS 52 patients (n=26 rituximab and n=26 placebo) from nine centres completed baseline and one or more follow-up visits. Estimated between-group differences (rituximab-placebo) in baseline-adjusted TUS were -1.2 (95% CI -2.1 to -0.3; P=0.0099) and -1.2 (95% CI -2.0 to -0.5; P=0.0023) at weeks 16 and 48. Glandular definition improved in the rituximab arm with an OR of 6.8 (95% CI 1.1 to 43.0; P=0.043) at week 16 and 10.3 (95% CI 1.0 to 105.9; P=0.050) at week 48. CONCLUSIONS We demonstrated statistically significant improvement in TUS after rituximab compared with placebo. This encourages further research into both B cell depletion therapies in PSS and SGUS as an imaging biomarker. TRIAL REGISTRATION NUMBER 65360827, 2010-021430-64; Results.
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Affiliation(s)
- Benjamin A Fisher
- National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, 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
| | - Colin C Everett
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - John Rout
- Birmingham Dental Hospital, Birmingham, UK
| | - John L O'Dwyer
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Paul Emery
- Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Costantino Pitzalis
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Wan-Fai Ng
- Institute of Cellular Medicine, University of Newcastle, Newcastle-upon-Tyne, UK
| | - Andrew Carr
- Newcastle Dental Hospital, Newcastle-upon-Tyne, UK
| | - Colin T Pease
- Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | | | | | - Jimmy Makdissi
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anwar R Tappuni
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Frances C Hall
- Department of Clinical Medicine, University of Cambridge, Addenbrookes Hospital, Cambridge, UK
| | - Sharon P Ruddock
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Catherine Fernandez
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Claire T Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kevin A Davies
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Christopher John Edwards
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton, Southampton, UK
| | - Peter C Lanyon
- Nottingham University Hospitals NHS Trust, and Nottingham NHS Treatment Centre, Nottingham, UK
| | - Robert J Moots
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Euthalia Roussou
- Barking Havering and Redbridge University Hospitals NHS trust (BHRUT), King George Hospital, Goodmayes, UK
| | | | - Linda D Sharples
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Michele Bombardieri
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Simon J Bowman
- National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, 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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7
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Bezzina OM, Gallagher P, Mitchell S, Bowman SJ, Griffiths B, Hindmarsh V, Hargreaves B, Price EJ, Pease CT, Emery P, Lanyon P, Bombardieri M, Sutcliffe N, Pitzalis C, Hunter J, Gupta M, McLaren J, Cooper AM, Regan M, Giles IP, Isenberg DA, Saravanan V, Coady D, Dasgupta B, McHugh NJ, Young-Min SA, Moots RJ, Gendi N, Akil M, MacKay K, Ng WF, Robinson LJ. Subjective and Objective Measures of Dryness Symptoms in Primary Sjögren's Syndrome: Capturing the Discrepancy. Arthritis Care Res (Hoboken) 2017; 69:1714-1723. [PMID: 27992710 PMCID: PMC5698764 DOI: 10.1002/acr.23165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/06/2016] [Indexed: 12/26/2022]
Abstract
Objective To develop a novel method for capturing the discrepancy between objective tests and subjective dryness symptoms (a sensitivity scale) and to explore predictors of dryness sensitivity. Methods Archive data from the UK Primary Sjögren's Syndrome Registry (n = 688) were used. Patients were classified on a scale from −5 (stoical) to +5 (sensitive) depending on the degree of discrepancy between their objective and subjective symptoms classes. Sensitivity scores were correlated with demographic variables, disease‐related factors, and symptoms of pain, fatigue, anxiety, and depression. Results Patients were on average relatively stoical for both types of dryness symptoms (mean ± SD ocular dryness −0.42 ± 2.2 and −1.24 ± 1.6 oral dryness). Twenty‐seven percent of patients were classified as sensitive to ocular dryness and 9% to oral dryness. Hierarchical regression analyses identified the strongest predictor of ocular dryness sensitivity to be self‐reported pain and that of oral dryness sensitivity to be self‐reported fatigue. Conclusion Ocular and oral dryness sensitivity can be classified on a continuous scale. The 2 symptom types are predicted by different variables. A large number of factors remain to be explored that may impact symptom sensitivity in primary Sjögrenʼs syndrome, and the proposed method could be used to identify relatively sensitive and stoical patients for future studies.
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Affiliation(s)
- Oriana M Bezzina
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Gallagher
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Sheryl Mitchell
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Simon J Bowman
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Bridget Griffiths
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Victoria Hindmarsh
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ben Hargreaves
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Elizabeth J Price
- Great Western Hospitals NHS Foundation Trust, Swindon, Wiltshire, UK
| | - Colin T Pease
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Peter Lanyon
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Michele Bombardieri
- Barts and the London NHS Trust and Barts and the London School of Medicine and Dentistry, London, UK
| | | | - Costantino Pitzalis
- Barts and the London NHS Trust and Barts and the London School of Medicine and Dentistry, London, UK
| | - John Hunter
- Gartnavel General Hospital, Glasgow, Scotland
| | | | | | - Anne M Cooper
- Royal Hampshire County Hospital, Winchester and Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - Ian P Giles
- University College London Hospitals NHS Foundation Trust, London, UK
| | - David A Isenberg
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Neil J McHugh
- Royal National Hospital for Rheumatic Diseases, Bath, UK
| | | | | | | | | | | | - W Fai Ng
- Musculoskeletal Research Group, Institute of Cellular Medicine & Newcastle NIHR Biomedical Research Centre for Ageing and Chronic Diseases, Newcastle University, and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lucy J Robinson
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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8
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Price EJ, Rauz S, Tappuni AR, Sutcliffe N, Hackett KL, Barone F, Granata G, Ng WF, Fisher BA, Bombardieri M, Astorri E, Empson B, Larkin G, Crampton B, Bowman SJ. The British Society for Rheumatology guideline for the management of adults with primary Sjögren's Syndrome. Rheumatology (Oxford) 2017; 56:1828. [PMID: 28957572 DOI: 10.1093/rheumatology/kex375] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Elizabeth J Price
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon
| | - Saaeha Rauz
- Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham
- Birmingham and Midland Eye Centre, City Hospital NHS Trust, Birmingham
| | | | - Nurhan Sutcliffe
- Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Barts Health NHS Trust, London
| | - Katie L Hackett
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University & Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne
| | - Francesca Barone
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Guido Granata
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham
| | - Wan-Fai Ng
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University & Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne
| | - Benjamin A Fisher
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Michele Bombardieri
- Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Barts Health NHS Trust, London
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London
| | - Elisa Astorri
- Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Barts Health NHS Trust, London
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London
| | - Ben Empson
- Community Rheumatology department, Modality partnership, Birmingham
| | | | | | - Simon J Bowman
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Price EJ, Rauz S, Tappuni AR, Sutcliffe N, Hackett KL, Barone F, Granata G, Ng WF, Fisher BA, Bombardieri M, Astorri E, Empson B, Larkin G, Crampton B, Bowman SJ. The British Society for Rheumatology guideline for the management of adults with primary Sjögren's Syndrome. Rheumatology (Oxford) 2017; 56:1643-1647. [PMID: 28957549 DOI: 10.1093/rheumatology/kex163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Elizabeth J Price
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon
| | - Saaeha Rauz
- Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham
- Birmingham and Midland Eye Centre, City Hospital NHS Trust, Birmingham
| | | | - Nurhan Sutcliffe
- Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Barts Health NHS Trust, London
| | - Katie L Hackett
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University & Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne
| | - Francesca Barone
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Guido Granata
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham
| | - Wan-Fai Ng
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University & Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne
| | - Benjamin A Fisher
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Michele Bombardieri
- Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Barts Health NHS Trust, London
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London
| | - Elisa Astorri
- Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Barts Health NHS Trust, London
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London
| | - Ben Empson
- Community Rheumatology department, Modality partnership, Birmingham
| | | | | | - Simon J Bowman
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Price EJ, Rauz S, Tappuni AR, Sutcliffe N, Hackett KL, Barone F, Granata G, Ng WF, Fisher BA, Bombardieri M, Astorri E, Empson B, Larkin G, Crampton B, Bowman SJ. The British Society for Rheumatology guideline for the management of adults with primary Sjögren's Syndrome. Rheumatology (Oxford) 2017; 56:e24-e48. [PMID: 28957550 DOI: 10.1093/rheumatology/kex166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Indexed: 06/07/2023] Open
Affiliation(s)
- Elizabeth J Price
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon
| | - Saaeha Rauz
- Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham
- Birmingham and Midland Eye Centre, City Hospital NHS Trust, Birmingham
| | | | - Nurhan Sutcliffe
- Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Barts Health NHS Trust, London
| | - Katie L Hackett
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University & Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne
| | - Francesca Barone
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Guido Granata
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham
| | - Wan-Fai Ng
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University & Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne
- Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne
| | - Benjamin A Fisher
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Michele Bombardieri
- Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Barts Health NHS Trust, London
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London
| | - Elisa Astorri
- Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Barts Health NHS Trust, London
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London
| | - Ben Empson
- Community Rheumatology department, Modality partnership, Birmingham
| | | | | | - Simon J Bowman
- Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Bowman SJ, Everett CC, O'Dwyer JL, Emery P, Pitzalis C, Ng WF, Pease CT, Price EJ, Sutcliffe N, Gendi NST, Hall FC, Ruddock SP, Fernandez C, Reynolds C, Hulme CT, Davies KA, Edwards CJ, Lanyon PC, Moots RJ, Roussou E, Giles IP, Sharples LD, Bombardieri M. Randomized Controlled Trial of Rituximab and Cost-Effectiveness Analysis in Treating Fatigue and Oral Dryness in Primary Sjögren's Syndrome. Arthritis Rheumatol 2017; 69:1440-1450. [PMID: 28296257 DOI: 10.1002/art.40093] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 03/07/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate whether rituximab, an anti-B cell therapy, improves symptoms of fatigue and oral dryness in patients with primary Sjögren's syndrome (SS). METHODS We conducted a multicenter, randomized, double-blind, placebo-controlled, parallel-group trial that included health economic analysis. Anti-Ro-positive patients with primary SS, symptomatic fatigue, and oral dryness were recruited from 25 UK rheumatology clinics from August 2011 to January 2014. Patients were centrally randomized to receive either intravenous (IV) placebo (250 ml saline) or IV rituximab (1,000 mg in 250 ml saline) in 2 courses at weeks 0, 2, 24, and 26, with pre- and postinfusion medication including corticosteroids. The primary end point was the proportion of patients achieving a 30% reduction in either fatigue or oral dryness at 48 weeks, as measured by visual analog scale. Other outcome measures included salivary and lacrimal flow rates, quality of life, scores on the European League Against Rheumatism (EULAR) Sjögren's Syndrome Patient Reported Index and EULAR Sjögren's Syndrome Disease Activity Index, symptoms of ocular and overall dryness, pain, globally assessed disease activity, and cost-effectiveness. RESULTS All 133 patients who were randomized to receive placebo (n = 66) or rituximab (n = 67) were included in the primary analysis. Among patients with complete data, 21 of 56 placebo-treated patients and 24 of 61 rituximab-treated patients achieved the primary end point. After multiple imputation of missing outcomes, response rates in the placebo and rituximab groups were 36.8% and 39.8%, respectively (adjusted odds ratio 1.13 [95% confidence interval 0.50, 2.55]). There were no significant improvements in any outcome measure except for unstimulated salivary flow. The mean ± SD costs per patient for rituximab and placebo were £10,752 ± 264.75 and £2,672 ± 241.71, respectively. There were slightly more adverse events (AEs) reported in total for rituximab, but there was no difference in serious AEs (10 in each group). CONCLUSION The results of this study indicate that rituximab is neither clinically effective nor cost-effective in this patient population.
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Affiliation(s)
- Simon J Bowman
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | | | | | - Wan-Fai Ng
- University of Newcastle, Newcastle-upon-Tyne, UK
| | | | | | | | | | - Frances C Hall
- University of Cambridge, Addenbrookes Hospital, Cambridge, UK
| | | | | | | | | | | | - Christopher J Edwards
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton, Southampton, UK
| | - Peter C Lanyon
- University of Nottingham and Circle Nottingham, Nottingham NHS Treatment Centre, Nottingham, UK
| | | | - Euthalia Roussou
- King George Hospital, Barking Havering and Redbridge University Hospitals NHS Trust, Essex, UK
| | - Ian P Giles
- University College London Hospital, London, UK
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Ng WF, Miller A, Bowman SJ, Price EJ, Kitas GD, Pease C, Emery P, Lanyon P, Hunter J, Gupta M, Giles I, Isenberg D, McLaren J, Regan M, Cooper A, Young-Min SA, McHugh N, Vadivelu S, Moots RJ, Coady D, MacKay K, Dasgupta B, Sutcliffe N, Bombardieri M, Pitzalis C, Griffiths B, Mitchell S, Miyamoto ST, Trenell M. Physical activity but not sedentary activity is reduced in primary Sjögren's syndrome. Rheumatol Int 2017; 37:623-631. [PMID: 28013357 PMCID: PMC5357288 DOI: 10.1007/s00296-016-3637-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 12/19/2016] [Indexed: 12/11/2022]
Abstract
The aim of the study was to evaluate the levels of physical activity in individuals with primary Sjögren's syndrome (PSS) and its relationship to the clinical features of PSS. To this cross-sectional study, self-reported levels of physical activity from 273 PSS patients were measured using the International Physical Activity Questionnaire-short form (IPAQ-SF) and were compared with healthy controls matched for age, sex and body mass index. Fatigue and other clinical aspects of PSS including disease status, dryness, daytime sleepiness, dysautonomia, anxiety and depression were assessed using validated tools. Individuals with PSS had significantly reduced levels of physical activity [median (interquartile range, IQR) 1572 (594-3158) versus 3708 (1732-8255) metabolic equivalent of task (MET) × min/week, p < 0.001], but similar levels of sedentary activity [median (IQR) min 300 (135-375) versus 343 (223-433) (MET) × min/week, p = 0.532] compared to healthy individuals. Differences in physical activity between PSS and controls increased at moderate [median (IQR) 0 (0-480) versus 1560 (570-3900) MET × min/week, p < 0.001] and vigorous intensities [median (IQR) 0 (0-480) versus 480 (0-1920) MET × min/week, p < 0.001]. Correlation analysis revealed a significant association between physical activity and fatigue, orthostatic intolerance, depressive symptoms and quality of life. Sedentary activity did not correlate with fatigue. Stepwise linear regression analysis identified symptoms of depression and daytime sleepiness as independent predictors of levels of physical activity. Physical activity is reduced in people with PSS and is associated with symptoms of depression and daytime sleepiness. Sedentary activity is not increased in PSS. Clinical care teams should explore the clinical utility of targeting low levels of physical activity in PSS.
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Affiliation(s)
- Wan-Fai Ng
- Musculoskeletal Research Group, Institute of Cellular Medicine and NIHR Biomedical Research Centre for Ageing and Chronic Disease, Newcastle University, Newcastle upon Tyne, UK.
| | - Ariana Miller
- MoveLab, Physical Activity and Exercise Research, Institute of Cellular Medicine and NIHR Biomedical Research Centre for Ageing and Chronic Disease, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - George D Kitas
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley, UK
| | - Colin Pease
- Institute of Rheumatic and Musculoskeletal Medicine, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, University of Leeds, Leeds, UK
| | - Paul Emery
- Institute of Rheumatic and Musculoskeletal Medicine, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, University of Leeds, Leeds, UK
| | | | | | | | - Ian Giles
- University College London Hospitals NHS Foundation Trust, London, UK
| | - David Isenberg
- University College London Hospitals NHS Foundation Trust, London, UK
| | - John McLaren
- NHS Fife, Whyteman's Brae Hospital, Kirkcaldy, UK
| | | | - Annie Cooper
- Royal Hampshire County Hospital, Winchester, UK
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - Neil McHugh
- Royal National Hospital for Rheumatic Diseases, Bath, UK
| | | | | | | | | | | | - Nurhan Sutcliffe
- Barts and the London School of Medicine and Dentistry, London, UK
| | | | | | - Bridget Griffiths
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sheryl Mitchell
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Samira Tatiyama Miyamoto
- Universidade Federal do Espirito Santo, Vitoria and Universidade Federal de São Paulo, São Paulo, Brazil
| | - Michael Trenell
- MoveLab, Physical Activity and Exercise Research, Institute of Cellular Medicine and NIHR Biomedical Research Centre for Ageing and Chronic Disease, Newcastle University, Newcastle upon Tyne, UK
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Juarez M, Toms TE, de Pablo P, Mitchell S, Bowman S, Nightingale P, Price EJ, Griffiths B, Hunter J, Gupta M, Bombardieri M, Sutdliffe N, Pitzalis C, Pease C, Andrews J, Emery P, Regan M, Giles I, Isenberg D, Moots R, Collins KS, Ng WF, Kitas GD. Cardiovascular risk factors in women with primary Sjögren's syndrome: United Kingdom primary Sjögren's syndrome registry results. Arthritis Care Res (Hoboken) 2014; 66:757-64. [PMID: 24877201 PMCID: PMC4529667 DOI: 10.1002/acr.22227] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Objective To determine the prevalence of traditional cardiovascular risk factors using established definitions in a large cohort of clinically well-characterized primary Sjögren's syndrome (SS) patients and to compare them to healthy controls. Methods Data on cardiovascular risk factors in primary SS patients and controls were collected prospectively using a standardized pro forma. Cardiovascular risk factors were defined according to established definitions. The prevalence of cardiovascular risk factors in the primary SS group was determined and compared to that in the control group. Results Primary SS patients had a higher prevalence of hypertension (28–50% versus 15.5–25.6%; P < 0.01) and hypertriglyceridemia (21% versus 9.5%; P = 0.002) than age- and sex-matched healthy controls. Furthermore, a significant percentage (56%) of hypertensive patients expected to be on antihypertensive treatment according to best practice was not receiving it. Conclusion Primary SS patients are more than 2 times more likely to experience hypertension and hypertriglyceridemia than age- and sex-matched healthy controls. Additionally, hypertension is underdiagnosed and suboptimally treated in primary SS.
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James K, Lendrem D, Mitchell S, Hindmarsh V, Bowman S, Price EJ, Pease CT, Emery P, Lanyon P, Hunter J, Gupta M, Bombardieri M, Sutcliffe N, Pitzalis C, McLaren J, Cooper A, Regan M, Giles IP, Isenberg DA, Vadivelu S, Coady D, Dasgupta B, McHugh N, Griffiths B, Ng WF. 205. The UK Primary Sjögren’s Syndrome Registry (UKPSSR): A Valuable Resource for Future Sjögren’s Syndrom Research. Rheumatology (Oxford) 2014. [DOI: 10.1093/rheumatology/keu114.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
OBJECTIVE To evaluate the characteristics of patients presenting with symptoms suggestive of Sjögren's syndrome (SS) but failing to satisfy diagnostic criteria. METHODS Clinical, serological and histological data were collected on 34 patients presenting with dry eyes and/or mouth who did not satisfy the Vitali criteria for the diagnosis of SS. They were compared with 136 patients with primary SS, 38 patients with secondary SS, and 13 patients without SS. Questionnaires on symptoms from each group were compared with 43 healthy controls. RESULTS The 34 patients who did not satisfy the diagnostic criteria for SS or any other connective tissue disease were designated dry eyes and mouth syndrome (DEMS). Their demography including age was similar to that of a primary SS group and there was no more atrophy seen on their biopsies compared with SS and non-SS controls. They scored highly on visual analogue scales of symptoms but had few objective signs. All were negative for anti-Ro and anti-La although the prevalence of antinuclear antibodies (19%) was increased compared with a normal population. There was no excess of SS-associated tissue types. CONCLUSION There was no evidence that age, salivary gland atrophy or subclinical SS accounted for the symptoms in DEMS. Most of the patients fitted into a spectrum of disease which tended more towards fibromyalgia and/or chronic fatigue syndrome.
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Affiliation(s)
- E J Price
- Department of Rheumatology, Princess Margaret Hospital, Okus Road, Swindon SN1 4JU, UK
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Price EJ, Hay EM, Isenberg DA. Research and training review of the use of LAS, LAT and flexible training positions. Rheumatology (Oxford) 2001; 40:1413-5. [PMID: 11752514 DOI: 10.1093/rheumatology/40.12.1413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E J Price
- Department of Rheumatology, Princess Margaret Hospital, Swindon, UK
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Price EJ, Rigby SP, Clancy U, Venables PJ. A double blind placebo controlled trial of azathioprine in the treatment of primary Sjögren's syndrome. J Rheumatol 1998; 25:896-9. [PMID: 9598887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To establish whether there is a place for low dose azathioprine (AZA) as a disease modifying agent in patients with uncomplicated primary Sjögren's syndrome (SS). METHODS Twenty-five patients with primary SS were entered into a double blind, placebo controlled trial of AZA (1 mg/kg/day) for a period of 6 months. RESULTS Six patients, all receiving active drug, withdrew because of side effects. There was no significant change in disease activity variables when measured clinically, serologically, or histologically. CONCLUSION This trial suggests that low dose AZA does not have a role as a disease modifying agent in SS.
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Affiliation(s)
- E J Price
- Department of Rheumatology, Charing Cross Hospital and Kennedy Institute of Rheumatology, London, England, UK
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Brookes SM, Cohen SB, Price EJ, Webb LM, Feldmann M, Maini RN, Venables PJ. T cell clones from a Sjögren's syndrome salivary gland biopsy produce high levels of IL-10. Clin Exp Immunol 1996; 103:268-72. [PMID: 8565310 PMCID: PMC2200346 DOI: 10.1046/j.1365-2249.1996.d01-623.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Sjögren's syndrome (SS) is characterized by a focal periductal salivary gland infiltrate consisting mainly of T and B lymphocytes. Most of the T cells bear the memory CD4+ Th1-like phenotype and express high levels of class II, though CD8+ cells are also present. We have studied 17 labial salivary gland and 15 peripheral blood T cell clones from a patient with primary SS. The tissue clones were 71% CD8+ and 29% CD4+, and the peripheral blood-derived clones were 60% CD8+ and 40% CD4+. The CD4+ T cell clones from both the salivary gland and autologous peripheral blood were of the Th1 phenotype, in that they produced interferon-gamma (IFN-gamma) and IL-2 but very little IL-4 after 24 h stimulation with phorbol myristate acetate and anti-CD3 antibody. The salivary gland-derived CD4+ clones produced 15 times more IL-10 (7.92 ng/ml) than peripheral blood-derived CD4+ clones (0.52 ng/ml, P < or = 0.02). The tissue CD8+ clones produced 1.2 times (P < 0.04) more IFN-gamma and CD4+ clones produced 3.5 times less IL-2 (P < 0.02) than the respective PBM-derived clones. The accumulation of Th1-type cells producing high levels of IL-10 in the salivary gland suggests a specific immunoregulatory function at the site of inflammation in SS.
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Affiliation(s)
- S M Brookes
- Kennedy Institute of Rheumatology, London, UK
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Abstract
With increasing awareness and improved diagnostic tests, Sjögren's syndrome (SS) is becoming recognized as a common autoimmune disease, affecting as many as 3% of women over age 55 years. Apart from keratoconjunctivitis sicca, systemic features are common, leading to considerable morbidity and occasionally mortality. Predisposing factors for SS include HLA determinants that have been linked to DR3 and heterozygosity for DQ-1 and DQ-2. There is accumulating evidence that activated epithelial cells and their interaction with T cells play a central role in pathogenesis. Some restriction of T-cell receptor gene usage to V beta 6.7b and V beta 13.2 and a profile of cytokine production consistent with Th-1-type cells has been observed in affected tissues. Antibodies to Ro (SS-A) and La (SS-B) are found in about 50% of patients and are associated with more severe glandular and extraglandular manifestations. There is evidence that the antibodies are pathogenic, not only in patients, but in their infants born with congenital heart block. Studies of herpesviruses have led to conflicting results, and interest has recently focussed on retroviruses, based on the findings of the expression of retroviral elements in salivary glands of SS patients and antiretrovial antibodies in serum. Mice infected with or transgenic for retroviruses develop SS-like pathology and are currently being studied as animal models of the disease. In the last few years, considerable progress has been made in the understanding of the pathogenesis of SS, and the disease has become the prototype for the investigation of a viral etiology for autoimmune rheumatic disease. Study of its etiopathogenesis may be the key to understanding autoimmune disease in general.
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Affiliation(s)
- E J Price
- Kennedy Institute of Rheumatology, London, UK
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Abstract
Drug-induced lupus is a syndrome resembling mild systemic lupus erythematosus which can complicate treatment with certain apparently unrelated therapies. The most common individual agents are procainamide and hydralazine. Drugs less frequently associated with the disease are chlorpromazine, isoniazid, methyldopa, penicillamine, quinidine and sulfasalazine. Whole drug groups have also been implicated, such as the anticonvulsants, beta-blockers, sulfonamides and some of the newer 'biological' agents. The syndrome is characterised by arthralgia, myalgia, pleurisy, rashes and fever in association with antinuclear antibodies in the serum. More serious features of idiopathic lupus such as nephritis and cerebral disease are rare in drug-induced disease. The pathogenesis is unknown but in some cases is thought to be due to interactions between the drug and DNA or histones, rendering them immunogenic. For the biological agents, including interferons and antibodies to tumour necrosis factor-alpha, it has been suggested that it is due to disruption of the cytokine network. Although extremely rare, recognition of drug-induced lupus is important because it reverts within a few weeks of stopping the drug. It is possible that understanding its pathogenesis may shed light on its more serious relative, systemic lupus erythematosus.
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Affiliation(s)
- E J Price
- Kennedy Institute of Rheumatology, Hammersmith, London, England
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Abstract
We have examined the hypothesis that interferon-gamma (IFN-gamma) and its interaction with epithelium may play a role in the perpetuation of inflammation in Sjögren's syndrome (SS). Labial salivary gland primary cell cultures from 16 patients with primary SS (pSS) and eight cultures from patients with SS symptoms but histologically normal biopsies were examined for expression of HLA-DR and cytoplasmic La (SS-B). Epithelial HLA-DR expression was found in 80% of cultures from pSS patients and 38% of those from patients not fulfilling diagnostic criteria. Cytoplasmic La was detected in 50 and 38% of cultures, respectively. Treatment of 14 of the cultures with IFN-gamma increased HLA-SR and cytoplasmic La expression above that of untreated cultures. Depletion of IFN-gamma using neutralizing antibody had the reverse effect. These findings suggest that the perpetuation of chronic inflammation of pSS may be due to the induction of HLA-DR and La antigen expression on epithelial cells by IFN-gamma.
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Affiliation(s)
- S M Brookes
- Kennedy Institute of Rheumatology, Hammersmith, London
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Meeks GR, Bass RF, Hollis RS, Price EJ, Lehman T. Obstetrics and gynecology grand rounds: clinical case management. Complications resulting from cesarean section. J Miss State Med Assoc 1981; 22:228-30. [PMID: 7277490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Rubinstein MH, Price EJ. In vivo evaluation of the effect of five disintegrants on the bioavailability of frusemide from 40mg tablets [proceedings]. J Pharm Pharmacol 1977; 29 Suppl:5P. [PMID: 22681 DOI: 10.1111/j.2042-7158.1977.tb11473.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Toya RE, Kretchmar AL, Price EJ. Altered lipid and serine metabolism in graft-versus-host disease. Radiat Res 1971; 46:547-56. [PMID: 4397286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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