Objective
to investigate the relationships between self-reported cognitive abilities, psychological symptoms and neuropsychological outcomes in PSS.
Methods
PSS patients and healthy controls completed a comprehensive neuropsychometric battery and questionnaires: the Centers for Epidemiological Scale-Depression, the Profile of Fatigue- mental domain (Prof-M) for cognitive symptoms, Fatigue Severity Scale and the Short-Form McGill Pain Questionnaire.
Results
Female PSS patients (N=39) were similar to controls (N=17) in estimated pre-morbid intellectual function, age and education. Depression (p=.002), cognitive symptoms (p=.001), fatigue (p=.000003) and pain (p=.024) scores were greater in the patient group. PSS patients demonstrated inferior performance relative to controls in psychomotor processing (p=.027) and verbal reasoning (p=.007). PSS patients with and without depression had similar performance on multiple tests, but depressed patients had significantly lower scores for executive function (p=.041). Cognitive symptoms correlated with verbal memory (p=.048), whereas pain correlated with executive function measures (Stroop, p=.017) and working memory (Trails B, p=.036). In the regression model, depression and verbal memory were independent predictors that accounted for 61 % of the variance in cognitive symptoms.
Conclusion
The Prof-M is a simple self-report measure which could be useful in screening PSS subjects who may benefit from detailed psychometric evaluation. Our results are consistent with the hypothesis that depression and verbal memory impairment are overlapping but independent aspects of neural involvement in PSS. While pain and depression are significant confounders of cognitive function in PSS, this study suggests that impaired verbal reasoning ability in PSS is not attributable to pain or depression.
Objectives
To compare clinical characteristics and patient-reported outcomes in seropositive versus seronegative primary Sjogren’s syndrome patients (pSS) and to investigate the effect of serological status on the prevalence of chronic pain, comorbidity and health quality.
Methods
Pain severity and neuropathic pain symptoms, comorbidity and health status were assessed in 108 pSS patients. Differences between patient groups were assessed by t-test and chi-square tests and adjusted pain-affect associations. The effect of predictor variables on pain severity was examined with multivariate regression.
Results
Pain severity was greater (p=.003) and physical function (p=.023) reduced in the seronegative patients. Prevalence of neuropathic pain, depression, anxiety and disability were similar between groups. Chronic pain, defined as daily pain for greater than 3 months, was reported by 65% of seropositive (N=65) and 75% of seronegative patients (N=40). After adjustment for age, sleep quality and psychological distress, the difference in pain severity between seropositive and seronegative patients remained significant.
Conclusion
Chronic pain is pervasive in both seropositive and seronegative pSS patients, while pain severity and functional impairment is greater in seronegative patients. Neuropathic pain is equally prevalent and is the predominant pain phenotype in patients with moderate to severe pain. Accurate assessment of pain phenotypes is needed for more effective management of chronic pain in pSS. The focus of future research should be to standardize assessment of pain and to identify the factors contributing to more severe pain in seronegative patients.
In this exploratory study, frontal region WM microstructure alterations accompanied cognitive symptoms and were associated with mild cognitive impairment in PSS. While additional study is warranted to assess the specificity and stability of these results, DTI could provide novel insight into the pathological processes accompanying the subtle cognitive dysfunction commonly experienced by PSS patients.
Pain catastrophizing was a significant predictor of pain severity in both seropositive and seronegative pSS patients. This study suggests that behavioural interventions designed to reduce pain catastrophizing and negative appraisal of illness could be of benefit in pSS patients. Research is needed to test the effect of psycho-educational therapies on key patient-reported outcomes, particularly pain, depression, and fatigue, in pSS.
The case discussed involves a 69-year-old Thai woman who underwent orthotopic heart transplantation 9 months before this event. She presented with fever without localizing signs or symptoms. However, her chest images revealed mass-like consolidation in the left upper lobe. Blood culture and lung tissue identified Rhodococcus equi.She was successfully treated with a combination of antimicrobial therapy, optimization of immunosuppressants, and surgical resection.
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