Go Ask Your Patients! PSS-QoL Reported Perception of Dryness Correlates With Lacrimal and Salivary Flow in Primary Sjögren's Syndrome

Abstract

Introduction/Objectives: 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. 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 analyzed. 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). 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) κ 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 = −0.390, 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. Whereas patients with only subjective signs of dryness had lower immunological activity.Discussion: 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.

Impairment of oral health and its impact on the quality of life of patients with Sjögren's syndrome

“…Despite previous results showing weak association between subjective symptoms and objective testing for dry mouth, 32 other more recent studies have shown that patients' perception of dryness correlates with objective measurements of salivary gland function, including when it is assessed by XI. 10,33 These controversial results could be due the difficulties in assessing individual perception. 33 Moreover, median UWSF was lower among patients with a FS of 3 and 4 than among patients with a FS of 0 to 2.…”

“…10,33 These controversial results could be due the difficulties in assessing individual perception. 33 Moreover, median UWSF was lower among patients with a FS of 3 and 4 than among patients with a FS of 0 to 2. These findings are different than previous studies that showed no significant association between the degree of inflammation (FS) and hypofunction of the salivary glands, and reinforce the importance of FS as criteria for the diagnosis of SS.…”

Saliva Free Light Chains in Patients with Neuro-Sjögren

“…A correlation between increasing ESSPRI scores and a decrease in non-stimulated total salivary flow has been reported in the literature [ 34 ]. Interestingly, ESSPRI dryness did not correlated with tear or salivary flow, but ESSPRI pain did [ 35 ]. Therefore, the authors noted that the ESSPRI dryness score may not reflect the true assessment of dryness [ 35 ].…”

“…Interestingly, ESSPRI dryness did not correlated with tear or salivary flow, but ESSPRI pain did [ 35 ]. Therefore, the authors noted that the ESSPRI dryness score may not reflect the true assessment of dryness [ 35 ]. In contrast, a more complex relationship and a more general concept of dryness under the influence of pain and fatigue should be assumed [ 34 , 35 ].…”

“…Therefore, the authors noted that the ESSPRI dryness score may not reflect the true assessment of dryness [ 35 ]. In contrast, a more complex relationship and a more general concept of dryness under the influence of pain and fatigue should be assumed [ 34 , 35 ]. Other studies investigating FLC in patients with SS reported significant correlations with the ESSDAI total score, as well as specific domains of the score with serum IgG, KFLC, and LFLC, but none of the salivary biomarkers [ 12 , 13 , 14 , 15 , 16 , 17 ].…”