Background:The patient perspective is an essential outcome parameter in the quest for effective therapy in primary Sjögren’s Syndrome (PSS). The EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI) is recommended by EULAR to quantify patient’s symptom burden and has been used in several clinical trials. Surprisingly, the patient’s perception of dryness quantified with ESSPRI does not correlate with objective measures of salivary or lacrimal flow.Objectives:Thus, we evaluated a newly developed assessment tool-the Primary Sjögren’s Syndrome Quality of Life Questionnaire (PSS-QoL) - for quantifying symptoms of dryness in comparison with the ESSPRI and objective measurements of salivary and lacrimal flow.Methods:Data of patients from the PSS registry of the Medical University of Graz fulfilling the 2016 ACR/EULAR classification criteria for PSS were analysed. The patient perspective was analyzed by PSS-QoL, ESSPRI, Xerostomia Inventory (XI) and Ocular Surface Disease Index (OSDI). Sicca signs were measured with Schirmer’s test, unstimulated salivary flow test (USF) and stimulated salivary flow test (SSF). Patients were categorized into groups based on the presence of subjective and/or objective dryness: 1) objective dryness only, 2) subjective dryness only, and 3) both, subjective and objective dryness. ESSDAI (EULAR Sjögren’s Syndrome Disease Activity Index) and EGA (Evaluator Global Assessment, numeric rating scale from 0 to 10) were obtained. In addition, free light chains (FLC) ĸ and λ, rheumatoid factor (RF) IgM and IgA were determined.Results:Data from 123 PSS patients were analyzed; 91.9% (n=113) were female, with a mean disease duration of 6.2 (±5.3) years and mean age of 60.1 (±12.4) years. PSS-QoL-dryness revealed significant negative correlations with Schirmer’s test (r=-0.31, p<0.05) and SSF-test (r=-0.39, p<0.01). In contrast, we found no significant correlation between ESSPRI-dryness and any objective dryness test. Lower perceived dryness was associated with higher immunological activity determined by increased levels of IgG, FLC and RF-IgA. Patients with objective signs and subjective symptoms of dryness had higher clinical and immunological disease activity compared to patients with subjective symptoms only (table 1).Table 1.Comparison of perceived dryness-groups with clinical parametersPSS-QoL MouthpPSS-QoL Eyespsubjobj/subjsubjobj/subjEGA1.0 [0-5]2.0 [0-7]<0.051.0 [0-3]2.0 [0-7]<0.05ESSDAI1.0 [0-144.0 [0-15<0.053.0 [0-74.0 [0-15nsESSPRI-pain3.0 [0-9]3.0 [0-10]ns4.0 [1-8]3.0 [0-10]<0.05RF-IgM19.0 [5-524]31.0 [7-417]ns10.0[5-33]26.0[7-524]<0.01FLC-λ15.1 [7.0-68.3]20.1 [2.6-124.0]<0.0113.4 [7.0-54.5]18.7[2.6-124.0]<0.01IgG11.9 [6.5-37.2]16.1 [7.4-33.8]ns12.8 [6.5-20.6]14.8[7.4-37.2]nsC40.2 [0.01-0.41]0.17 [0.00-0.43]<0.010.2 [0.09-0.41]0.18 [0.00-0.43]nsRF-IgA11.0 [1-500]103 [0-500]<0.014.5 [1-465]63 [0-500]<0.01C4=Complementfactor 4; EGA=Evaluators Global Assessment; ESSDAI=EULAR Sjögren Syndrome Disease Activity Index; ESSPRI=EULAR Sjögren Syndrome Patient Reported Index; FLC-λ=Free light chain Lambda; IgG=Immunoglobulin G; obj/subj=objective and subjective dryness-group; PSS-QoL=Primary Sjögren Syndrome Quality of Life Questionnaire; RF-IgA=rheumatoid factor Immunoglobulin A; RF-IgM=rheumatoid factor Immunoglobulin M; subj=subjective dryness-group.Conclusion:Patients’ perception of dryness assessed by PSS-QoL correlates with objective measurements of salivary gland function while ESSPRI-dryness did not. Based on the PSS-QoL and objective measures of dryness two distinct groups of PSS patients could be distinguished, which may have implications in daily practice and future clinical studies.Disclosure of Interests:None declared
Purpose Severe dry eye is often observed in patients suffering from Sjögren’s syndrome (SS) or chronic graft‐versus‐host‐disease (cGVHD). Although the underlying pathomechanisms differ, deficient tear production, as well as meibomian gland dysfunction (MGD) are present in both. Non‐contact Meibography can achieve a non‐invasive investigation of the meibomian glands inside the tarsal plates of the eyelids. The purpose of this study was to evaluate the correlation of non‐contact Meibography to dry eye symptoms in patients suffering from SS or cGVHD. Methods We examined 37 patients suffering from SS and 11 patients with cGVHD of our dry eye unit. Subjective dry eye symptoms were evaluated with a visual analogue scale and the Ocular Surface Disease Index© (OSDI). Clinical signs of MGD were graded from 0 to 3 according to the Report of the TFOS Workshop on MGD. Non‐contact Meibography was performed by a Heidelberg Retina Angiograph 1, featuring two infrared diode lasers. Partial or complete loss of the meibomian glands was scored according to the meiboscore of Arita and colleagues. Results The mean age of the study population was 55.3 ± 13.4 years and 91.7% were women. The Meiboscore correlated significantly with the subjective symptoms assessed by visual analogue scale. The grading of the lid margins correlated significantly with the Meiboscore. Conclusion Non‐contact Meibography is a valuable tool in the diagnosis of MGD. Standard ophthalmic angiography cameras equipped with infrared diodes can easily perform it. The meiboscore correlates with the intensity of subjective symptoms and lid margin changes in patients suffering from SS or cGVHD.
Purpose During pollen‐seasons allergy‐like symptoms can also be observed in proven non allergy sufferers. Pollen proteases are thought to be responsible for consecutive conjunctival irritation. We investigated the influence of a well known aggressive pollen species, birch pollen (Betula pendula) on human conjunctival cell cultures. This study is an approach to SNAC (seasonal non allergic conjunctivitis) syndrome. Methods Human cultivated conjunctival cells, so called CHANG‐cells, were incubated with extracts of birch pollen. Zymography was carried out in order to investigate the proteolytic activity of the pollen. Cytomorphological changes were analysed using the CASY1 Cell Counter. Via MTS‐assay the cell viability was quantified. The viability of the cells, which were incubated with pollen extract, was compared to the viability of the control cells and the results were statistically evaluated. Results Depending on the pollen extract concentration and the incubation period, the treatment of CHANG‐cells with pollen extract of birch induced a highly significant decrease of the cell viability. Conclusion Cell damage by pollen proteases is an approach to explain conjunctival irritation in proven non‐allergic persons during the pollen season. A reason why not all persons are affected by the SNAC syndrome at the same extent, could be differences in the concentrations of antiproteases present on the ocular surface.
Purpose Meibomian‐Gland‐Dysfunction (MGD) is one of the main causes for the development of a hyperevaporative dry eye. Non‐contact Meibography can achieve a non‐invasive investigation of the meibomian glands inside the tarsal plates of the eyelids. The purpose of this study was to evaluate non‐contact Meibography as a tool for follow‐up studies in dry eye patients. Methods We examined 50 patients suffering from dry eye disease of the dry eye unit of the Ophthalmological Department of the Medical University of Graz. Subjective dry eye symptoms and objective signs of dry eye were evaluated. Non‐contact Meibography was performed by a Heidelberg Retina Angiograph 1, featuring two infrared diode lasers. Partial or complete loss of the meibomian glands was scored according to meiboscore of Arita and colleagues. After one year non‐contact Meibography was reassessed. Changes in the meiboscore were evaluated. Results The mean age of the study population was 57.9 ± 14.1 years and 64.7 % were women. There was no statistically significant change in the mean meiboscore. Conclusion Non‐contact Meibography is a valuable tool in the diagnosis of MGD. Morphological changes and a possible drop out of Meibomian glands can easily be assessed. The ideal follow‐up interval to detect changes in the meiboscore has yet to be determined.
Purpose The meibomian glands inside the tarsal plates of the eyelids contribute to the superficial lipid layer of the tear film. These lipids reduce evaporation of tears, enhance tear film stability, protect the ocular surface and provide a clear optical image. Meibomian gland dysfunction (MGD) is a common condition and can lead to evaporative dry eye. The purpose of this study was to characterize patients in an Austrian dry eye unit with MGD. Methods Between 2004 and 2010, 1372 consecutive patients with ocular discomfort from the dry eye unit of the Ophthalmological Department, Medical University Graz, were analysed retrospectively. Subjective symptoms were evaluated with a visual analogue scale. Fluorescein‐break up time, Schirmer test without local anaesthesia, fluorescein and lissamine green staining of the ocular surface and evaluation of the lid margins were performed. MGD patients were defined as follows: presence of teleangiectasia, irregularity of the lid margins, altered expressibility of meibomian glands and poor quality of expressed meibomian gland secretions. Results Overall 70.2% of all patients suffered from MGD. The mean age of these patients was 55.3 ± 16.6 years and 70.9% were women. 52.1% of the MGD patients had Schirmer test values equal or below 10mm/5min and 30.1% of the MGD patients had Schirmer test values equal or below 5mm/5min. Sjögren's syndrome according to the American‐European Consensus Group was found in 4% of the MGD patients. The intensity of subjective symptoms did not differ among these patients. Conclusion MGD is a major cause of ocular discomfort as evaluated in a large clinic‐based population of Austria. Tear deficiency is often accompanied with this disorder.
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