Factors influencing the EULAR Sjogren's Syndrome Patient-Reported Index in primary Sjogren's syndrome

Objective. The EULAR Sjogren's Syndrome Patient-Reported Index (ESSPRI) is a validated tool for measuring pain, fatigue and dryness in primary Sjogren's syndrome (pSS). We evaluated its association with disease and non-disease related variables, and its variation though the follow-up. Methods. We included 130 pSS patients who were interviewed to register demographics, schooling, smoking, menopause, body mass index, disease duration, use of hormonal replacement, associated sicca drugs, prednisone, immunosuppressors/antimalarials, comorbidities such as diabetes mellitus, hypothyroidism, depression, fibromyalgia and scored the Charlson comorbidity index. We assessed the non-stimulated whole salivary flow (NSWSF), Schirmer-I test, ESSDAI and ESSPRI scores. In a subset of patients, we scored a second ESSPRI. Results. Most patients were women, mean age 57 years and median disease duration 9.3 years. The median ESSPRI score was 6 (fatigue 6, pain 4, dryness 8). Eighty patients (61.5%) had an ESSPRI >= 5 points and were characterised by a higher prevalence of depression (OR 3.7, 95% 1.2-11.3) and lower NSWSF (OR 0.59, 95% CI 0.36-0.97). Among 62 patients with a second ESSPRI (median time 25 months), 44 (70%) experienced a decrement/increment >= 1 in the ESSPRI (16 were decrement). We did not find any of the studied variables associated with this variation, also including change in prednisone or immunosuppressors. Conclusion. An ESSPRI >= 5 ( unsatisfactory symptom state) was associated with low NSWSF and depression. Most of the patients experienced a clinically significant ESSPRI variation (increment or decrement), nevertheless, we were not able to identify any variable associated with this change. Further studies would be helpful to understand the underlying causes.

Automated summary

The study found that an ESSPRI score >= 5 (unsatisfactory symptom state) was associated with low salivary flow and depression. Most patients experienced clinically significant ESSPRI variation during follow-up, but researchers were unable to identify any variables associated with this change.