204. A Systematic Review of Non-Pharmacological Interventions for Primary Sjögren’s Syndrome

Abstract

Background: People with primary SS (PSS) suffer with a range of symptoms including dryness, pain, fatigue, autonomic dysfunction, low mood and functional impairment. Non-pharmacological interventions such as physiotherapy, occupational therapy, complimentary therapies, devices and psychotherapy aim to relieve symptoms and improve function. We conducted a systematic review of these interventions' efficacy and registered the protocol in advance with PROSPERO (CRD42013004997). Methods: Search strategy: Databases were searched from inception to July 2013 with a pre-defined list of search terms: Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Medline, Embase, PsychINFO, Cinahl, AMED, CCTR, WHO ICTRP, UCLRN and the National Research Register Archive and reviewed the reference lists of included studies. Selection criteria: Studies were included if they were randomized controlled trials (RCTs) of any non-pharmacological interventions for adults with PSS. Any comparator was allowed. Titles and abstracts of studies were considered according to the inclusion/exclusion criteria. Full texts were reviewed independently by two authors for inclusion or exclusion. Data abstraction: Two review authors separately extracted the data the included studies on a standardized form. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Outcomes fell within the main domains addressed by the World Health Organisation International Classification of Functioning. Results: 996 studies were identified of which 17 full text articles were screened and 5 studies were included in this review with a total of 130 participants randomized. The included studies investigated effectiveness of an oral lubricating device for dry mouth, acupuncture for dry mouth, lacrimal punctum plugs for dry eyes and psychodynamic group therapy for coping with symptoms. Frost showed that salivary flow and speed of speech improved with the oral lubricating device but this small study (n=29) was at high risk of bias. Mansour investigated punctum plugs but had no extractable data whereas Qui compared punctum plugs to artificial tears reported improvements in most outcomes in both groups, but significantly better results in the punctum plugs group on tear volume and stabilizing tear film. The Qui study was of good quality but too small (n=42) for these results to be regarded as definitive. Poulson showed no advantage of psychodynamic therapy over the untreated control group in a small (n=18) poor quality study. Conclusion: Although one study showed punctum plugs to be better at improving dry eyes it was too small for the findings to be conclusive. Therefore overall we identified no evidence to support any nonpharmacological interventions to improve PSS. The area needs good quality large RCTs that are reported according to CONSORT guidelines.