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

Abstract

Objective. The EULAR Sjögren's Syndrome Patient-Reported Index (ESSPRI) is a validated tool for measuring pain, fatigue and dryness in primary Sjögren'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), SchirmerI 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.