J Rheum Dis.  2019 Jul;26(3):191-199. 10.4078/jrd.2019.26.3.191.

Longitudinal Changes in the European League Against Rheumatism Sjögren's Syndrome Patient Reported Index in Real-Life Practice

• Kim JH
• Ha YJ
• Kang EH
• Song YW
• Lee YJ

• KMID: 2451511
• DOI: http://doi.org/10.4078/jrd.2019.26.3.191

Abstract

OBJECTIVE
To investigate longitudinal changes in the European League Against Rheumatism (EULAR) Sjögren's syndrome patient reported index (ESSPRI) and to study the clinical features associated with favorable ESSPRI changes in primary Sjögren's syndrome (pSS).
METHODS
At baseline and after a median period of 6.6 years, 41 pSS patients were evaluated using the ESSPRI, EULAR Sjögren's syndrome disease activity index (ESSDAI), short-form 36, xerostomia inventory (XI), and visual analog scale (VAS) scores for symptoms. The favorable subgroup included patients who were stable or showed improved to satisfactory symptom status (ESSPRI<5) and the unfavorable subgroup included those with stable or worsening to an unsatisfactory symptom status (ESSPRI ≥5).
RESULTS
Median ESSPRI increased from 4.11 to 5.33 (p<0.05), although XI scores (p=0.01) and oral dryness (p<0.05) were significantly decreased. Serum immunoglobulin G level was significantly reduced (p<0.001) but ESSDAI scores were unchanged. Six (14.6%) patients showed clinical improvement in ESSDAI, and 11 (26.8%) showed improvement in ESSPRI. On comparing the favorable (n=17) and unfavorable (n=24) subgroups, the former exhibited significantly lower VAS scores for sicca and depression and XI and ESSPRI scores at baseline (all p<0.05) and more lacrimal flow (p<0.05). The favorable subgroup received a significantly lower cumulative dose of pilocarpine and glucocorticoids (both p<0.05).
CONCLUSION
About 25% of pSS patients showed clinically significant ESSPRI improvement and about 40% showed a favorable ESSPRI course. Because the favorable subgroup had more lacrimal flow and less sicca symptoms at baseline, long-term patient-derived outcomes could depend on residual exocrine function at pSS diagnosis.

Keyword

Sjögren's syndrome; Patient outcome assessment; Quality of life; Xerostomia; Xerophthalmia

MeSH Terms

Depression
Diagnosis
Glucocorticoids
Humans
Immunoglobulin G
Patient Outcome Assessment
Pilocarpine
Quality of Life
Rheumatic Diseases*
Visual Analog Scale
Xerophthalmia
Xerostomia
Glucocorticoids
Immunoglobulin G
Pilocarpine

Figure

• 

  Figure 1 Flow of primary Sjögren’s syndrome patients during the follow-up period based on European League Against Rheumatism Sjögren’s syndrome patient reported index (ESSPRI) status.

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