Impact of the oral repercussions of Sjogren's Syndrome on patient's quality of life: a systematic review and meta-analysis.

This study aimed to perform a systematic review to evaluate the impact of the oral repercussions of Sjogren's Syndrome (SS) on the quality of life (QoL) of patients living with this disease. To conduct this work, we followed the PRISMA guidelines. The included studies evaluated oral repercussions of SS and their correlation with QoL. The risk of bias was assessed with the JBI tools for each type of study design. Our findings resulted in 26 articles met the eligibility criteria. Seventeen articles (65.3%) used the OHIP-14 questionnaire to evaluate oral health-related QoL (OHRQoL) and showed that the oral repercussions of SS had a negative impact. Ten studies applied other QoL instruments, in which 5 found a correlation between oral repercussions of SS and poorer OHRQoL, 3 showed no correlation, and 2 were unclear. Due to significant heterogeneity, the meta-analysis was limited to 8 of the 17 studies that used the OHIP-14. The results showed statistically significant poorer OHRQoL in individuals with SS compared to healthy controls. In conclusion, oral repercussions of SS negatively affect QoL. However, future studies should focus on standardized methodology to provide more homogenous and comparable evidence.

Spirituality is associated with immune parameters and disease activity in primary Sjögren's syndrome: a cross-sectional study.

The role of spirituality in health and disease is a complex and emerging area of research. Incorporating spirituality into the bio-psycho-social model of health and disease leading to the bio-psycho-social-spiritual model provides a more comprehensive framework. In this context, chronic disorders like primary Sjögren's syndrome (pSS) are of interest due to their intricate interactions between biological, psychological, and spiritual factors. This study explored the relationship between spirituality, immune parameters, and disease activity in pSS patients. Data from 108 patients were analyzed, including self-assessed spirituality (answering to direct questions and completing the Spiritual Transcendence Scale), immunological parameters and disease activity scores. The findings revealed several associations. Individuals with spiritual attitudes or engaged in regular prayer/meditation showed lower serum levels of autoantibodies specific to pSS and lower disease activity scores. Spiritual engagement was also linked to decreased perceived skin and tracheal dryness, suggesting potential benefits for physical symptoms. These findings suggest that spirituality may play a significant role in modulating immune responses and disease activity in pSS patients. The study underscores the importance of considering spirituality as an integral part of the holistic approach to health and disease, further expanding the understanding of the interconnectedness of biological, psychological, and spiritual dimensions.

Brazilian version of the "Primary Sjögren's Syndrome - Quality of Life questionnaire (PSS-QoL)": translation, cross-cultural adaptation and validation.

BACKGROUND: The Primary Sjögren's Syndrome Quality of Life questionnaire (PSS-QoL) is the first specific instrument to assess health-related quality of life (HRQoL) in Sjögren's disease (SjD). The aim is to translate and cross-culturally adapt the PSS-QoL into Brazilian Portuguese and to evaluate its psychometric properties. METHODS: The original English version was translated into Brazilian Portuguese by two native Brazilians who were proficient in the English language. The retranslation was conducted by two native Americans proficient in Brazilian Portuguese. A committee undertook an analysis of the translated and retranslated versions, resulting in the generation of the first Brazilian version, which was submitted to the cross-cultural adaptation phase. In this phase, 50 participants with SjD responded to the instrument in Stages I and II, resulting in the generation of the second and final Brazilian version. To assess the psychometric properties, demographic and clinical data were collected from 75 patients. The HRQoL questionnaires (final Brazilian version of the PSS-QoL, Short Form-36 Health Survey (SF-36) and EuroQoL-5 dimension (EQ-5D)) were completed. Construct validity was analyzed using the Pearson or Spearman correlation coefficient. Reliability was analyzed using Cronbach's alpha and the intraclass correlation coefficient (ICC). RESULTS: Eight questions and one response item were revised due to an incomprehension rate of greater than 15% among the participants in the cross-cultural adaptation phase. The final Brazilian version of the PSS-QoL was validated, revealing a high correlation between the total score and functional capacity (r= -0.713, p < 0.001), and vitality (r= -0.770, p < 0. 001) and mental health (r= -0.742, p < 0.001) domains of the SF-36 and a moderate correlation with the other domains of the SF-36 and a moderate correlation with the EQ-5D-tto (r= -0.573, p < 0.001), and EQ-5D-VAS (r= -0.559, p < 0.001). The intraobserver (ICC = 0.939; Cronbach's alpha = 0.964) and interobserver (ICC = 0.965; Cronbach's alpha = 0.964) reliability of the total score showed very high consistency. CONCLUSION: The Brazilian version of the PSS-QoL has been demonstrated to be a valid and reproducible instrument for the assessment of HRQoL in patients with SjD.

Central sensitization significantly deteriorates functionality and the interpretation of self-reported disease activity in primary Sjögren's syndrome.

BACKGROUND: Central sensitization has a major role in health-related parameters in musculoskeletal conditions. There is still a lack of understanding regarding the impact of central sensitization on the interpretation of disease activity and functional disability in primary Sjögren's syndrome (pSS). METHODS: The Central Sensitization Inventory (CSI) was used to screen for central sensitization. Disease-related parameters, including objective tests, medication use, the EULAR SS Patient Reported Index (ESSPRI), and the EULAR SS Disease Activity Index (ESSDAI), were assessed. Functionality, quality of life, sleep, and mental health were evaluated by the Health Assessment Questionnaire-Disability Index (HAQ-DI), Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), Jenkins Sleep Evaluation Scale (JSS), and Hospital Anxiety and Depression Scale (HADS), respectively. The effect of central sensitization on functionality and disease activity measures was assessed by regression analyses. RESULTS: The frequency of central sensitization was 65% in patients with pSS (n = 60). Patients with central sensitization had higher HAQ-DI, ESSPRI, HADS, and JSS and lower SF-36 subdomain scores (p < 0.05 for all). A significant positive correlation was observed between the CSI score and the ESSPRI, JSS, HAQ-DI, and HADS scores (Spearman's rho ranging from 0.342 to 0.739). The multiple regression analysis indicated that CSI was independently associated with HAQ-DI (adjusted R2 = 0.19, B = 0.01) and ESSPRI (adjusted R2 = 0.45, B = 0.08) (p < 0.001 for all). CONCLUSION: This study confirms that central sensitization has a major impact on functionality and the interpretation of self-reported disease activity in pSS. When devising strategies for the management of patients with pSS, it is crucial to consider these close relationships. Key Points • The frequency of central sensitization accompanying primary Sjögren's syndrome is considerable. • Central sensitization was independently associated with functionality and self-reported disease activity assessment. • This close association leads to challenges in functionality, evaluating treatment response, and planning or switching between therapies in primary Sjögren's syndrome.

Does stress response axis activation differ between patients with autoimmune disease and healthy people?

Many studies have shown that patients with autoimmune disease present a hypoactive hypothalamic-pituitary-adrenal (HPA) axis, but the results are controversial. Our objective was to study differences in stress response axis activity between patients with autoimmune disease and healthy people. The study sample consisted of 97 women divided into four groups: 37 healthy women (HW), 21 with systemic lupus erythematosus (SLE), 21 with Sjögren's syndrome (SS), and 18 with systemic sclerosis (SSc). After being exposed to a stress task, participants' skin conductance and salivary cortisol levels were measured in order to assess their response to psychological stress. Diurnal cortisol concentrations were assessed by measuring salivary cortisol in samples collected five times over one day. In addition, self-administered questionnaires were used to assess psychological variables. A time × group interaction effect was found (p = 0.003) in salivary cortisol secretion in response to stressful challenge. The healthy group presented normal activation, the SS and SLE groups showed no activation, and the SSc group presented a similar activation pattern to the HW group, except at the time of recovery. Total cortisol production (AUCg) was higher in the SSc group than in the HW group (p = 0.001). Differences were also observed in the cortisol AUCg collected over one day between healthy women and patients with SLE (p = 0.004) as well as with SSc (p = 0.001): women with SLE and SSc presented higher total hormone production than healthy women. Patients with autoimmune disease present a different HPA axis response, which may contribute to the harmful effects of stress in these diseases.

Are the women with Sjögren's Syndrome satisfied with their sexual activity? / As mulheres com síndrome de Sjögren estão satisfeitas com sua atividade sexual?

ABSTRACT Objective: Females with Sjögren's Syndrome (SS) often experience vaginal dryness and dyspareunia, along with glandular and extraglandular symptoms. We aimed to evaluate sexual function and life quality in women with SS. Methods: Forty-six premenopausal women with SS and 47 age-matched controls were studied. Age, duration of the disease, medications, and comorbid diseases were noted. Participants completed 36-Item Short Form Health Survey (SF-36) and Female Sexual Function Index (FSFI). Patients were asked about vaginal discharge and itching in the last month, and if they informed their rheumatologists about any sexual problems. Gynecologic examinations were performed and vaginal smears were taken on each participant. Results: The median total scores of FSFI were significantly lower in the SS group than the controls [17.12 (2.4-27.8) and 27.4 (16.9-36.0), respectively, p < 0.001]. In the SS group, 37 (80.4%) and in the control group 18 (38.3%) of patients were sexually dissatisfied (p < 0.001). Vaginal dryness and lubricant use were significantly increased in patients with SS compared to controls (p < 0.001). Life quality scores were significantly lower in patients with SS than the controls (p < 0.001). Vaginal dryness was negatively correlated with FSFI total (r = −0.312, p = 0.035) and subscores except desire and arousal. Physical functioning, role physical and role emotional scores were positively correlated with total FSFI scores (r = 0.449, p = 0.002, r = 0.371, p = 0.011, r = 0.299, p = 0.043, respectively). Conclusions: Women with SS experience less satisfaction with sexual activity, which can be affected by age, vaginal dryness, physical pain, and impaired function due to the disease. Therefore, rheumatologists should pay attention to these symptoms and management.

RESUMO Objetivo: As mulheres com síndrome de Sjögren (SS) muitas vezes experimentam secura vaginal e dispareunia, juntamente com sintomas glandulares e extraglandulares. Este estudo objetivou avaliar a função sexual e a qualidade de vida de mulheres com SS. Métodos: Estudaram-se 46 mulheres pré-menopáusicas com SS e 47 controles pareados por idade. Avaliaram-se a idade, a duração da doença, os medicamentos usados e as comorbidades. As participantes preencheram o questionário de qualidade de vida 36-Item Short Form Health Survey(SF-36) e o Female Sexual Function Index (FSFI). As pacientes foram perguntadas quanto à presença de corrimento e prurido vaginal no último mês e se haviam informado a seus reumatologistas sobre quaisquer problemas sexuais. Fizeram-se exames ginecológicos e esfregaços vaginais de todas as participantes. Resultados: A mediana do escore total do FSFI foi significativamente menor no grupo SS do que no grupo controle [17,12 (2,4 a 27,8) e 27,4 (16,9 a 36), respectivamente, p < 0,001]. Nos grupos SS e controle, 37 (80,4%) e 18 (38,3%) das pacientes estavam sexualmente insatisfeitas, respectivamente (p < 0,001). A presença de secura vaginal e o uso de lubrificantes foram significativamente mais frequentes em pacientes com SS em relação aos controles (p < 0,001). Os índices de qualidade de vida foram significativamente menores nas pacientes com SS do que nos controles (p < 0,001). A secura vaginal esteve negativamente correlacionada com o FSFI total (r = −0,312 p = 0,035) e com todos os seus subescores, exceto desejo e excitação. Os escores de capacidade funcional, aspecto físico e aspecto emocional se correlacionaram positivamente com a pontuação total do FSFI (r = 0,449, p = 0,002; r = 0,371, p = 0,011; r = 0,299, p = 0,043, respectivamente). Conclusões: As mulheres com SS têm menor satisfação com a atividade sexual, o que pode ser afetado pela idade, secura vaginal, dor física e função prejudicada em razão da doença. Portanto, os reumatologista devem prestar atenção a esses sintomas e seu tratamento.

A short neuropsychological evaluation of patients with primary Sjogren's syndrome / Avaliacao neuropsicologica breve em pacientes com sindrome de Sjogren primaria

Objective: To investigate cognitive deficits in patients with primary Sjögren’s syndrome (PSS). Method: Eighteen patients with PSS, aged between 25 and 61 years, were subjected to a short neuropsychological battery and compared with 18 patients with multiple sclerosis and 18 healthy controls. Results: The analysis of variance (ANOVA) revealed that the clinical groups had significantly worse performance than the control group on the Rey Auditory Verbal Learning Test 3; (F 2,53 =3.500, p=0.038) and 7 (F 2,53 =5.068, p=0.010). The clinical groups had elevated levels of depression on the Beck Depression Inventory (BDI); (p=0.003). The analysis of the data from the Trail Making Test B-A revealed a significant difference between the clinical and control groups (p=0.023). The analysis of covariance with BDI score as a covariate, did not change the outcome. Conclusion: Our study revealed cognitive deficits in patients with PSS detectable by a short neuropsychological battery. .

Objetivo: Investigar déficits cognitivos em pacientes com síndrome de Sjögren primária (SSP) utilizando bateria neuropsicológica breve. Método: Dezoito pacientes com SSP e idade entre 25 e 61 anos, foram submetidos a uma bateria neuropsicológica breve e os resultados comparados com 18 pacientes com esclerose múltipla e com 18 controles saudáveis. Resultados: A análise da variância revelou que os grupos clínicos apresentaram desempenho significativamente pior que os controles ao Rey Auditory Verbal Learning Test 3 (RAVLT 3; F 2,53 =3,500, p=0,038) e RAVLT 7 (F 2,53 =5,068, p=0,010). Os grupos clínicos apresentaram índices elevados de depressão pela Beck Depression Inventor y (BDI); (F 2,53 =0.003). O desempenho no Trail Making Test B-A revelou diferença significativa entre os grupos clínicos e o grupo controle (p=0,023). A análise de covariância tomando a BDI como covariante, não revelou mudanças nos resultados. Conclusão: Nosso estudo revelou comprometimento cognitivo em pacientes com SSP detectável por bateria neuropsicológica breve. .