Asymptomatic Atherosclerosis in Primary Sjögren Syndrome: Correlation Between Low Ankle Brachial Index and Autoantibodies Positivity.

BACKGROUND: Primary Sjögren syndrome is a chronic inflammatory autoimmune disease. The delay in diagnosis allows the establishment of a chronic inflammatory state, which makes primary Sjögren syndrome an interesting model for the study of atherosclerosis. OBJECTIVES: The aim of this study was to evaluate subclinical atherosclerosis in 49 patients with Sjögren syndrome using noninvasive methods. METHODS: We assessed traditional risk factors such as hypertension, diabetes, dyslipidemia, smoking, and family history of atherosclerosis. Patients with prior cardiovascular events and a history of atherosclerosis were excluded. Clinical and laboratory features were recorded, as well as the European League Against Rheumatism Sjögren's Syndrome Activity Index calculation. The atherosclerosis evaluation was done by carotid intima-media thickness, measured by ultrasonography, and ankle-brachial index (ABI). RESULTS: Fifteen patients (31%) had at least 1 traditional risk factor, and 65.3% had a European League Against Rheumatism Sjögren's Syndrome Activity Index score from mild to moderate. Only 2 patients had increased carotid intima-media thickness. However, 59% presented ABI alterations. Multiple correspondence analysis showed a clear correlation between low ABI and the positivity of autoantibodies (antinuclear antibodies, anti-SSA, rheumatoid factor). CONCLUSIONS: The subgroup of patients with positive autoantibodies showed low ABI, which may represent a higher risk of early atherosclerosis and indicate the need for more careful monitoring in this group.

The effects of resistance training in patients with primary Sjogren's syndrome.

INTRODUCTION: Resistance training (RT) is well tolerated and has shown promise for decreasing fatigue. However, the effects of RT have never been examined in primary Sjogren's syndrome (pSS). OBJECTIVE: To assess the feasibility, effectiveness, and safety of a resistance exercise program on fatigue in patients with pSS. METHODS: This is a parallel, single-blind randomized trial. Women aged 18 years or older, diagnosed with pSS according to the American-European criteria, were included. We randomized 59 participants to a resistance training group (RT) or a control group (CG). Participants in the RT group performed a 16-week resistance exercise program. The sessions consisted of three sets of resistance exercises (10 repetitions each) at 60 to 80% of 1 repetition maximum, designed to improve whole-body strength. The participants in the CG received their usual pharmacological treatment and instructions regarding disease control, pain management, sleep hygiene, and activities of daily living. To compare intergroup and intragroup variability, a one-factor repeated-measures analysis of variance (ANOVA) was used. RESULTS: RT effectively improved fatigue, pain, functional capacity, emotional aspects, vitality, and subjective perception of disease activity by the patient. No between-group differences were found in the ESSPRI mental score, ESSDAI, SF-36-Physical Aspects, SF-36-General Health, SF-36-Social aspects, and SF-36-Mental Health after the training period. CONCLUSION: An RT program was safe and effective in improving fatigue, pain, functional capacity, emotional aspects, vitality, and subjective perception of disease activity by the patient in women with pSS. Key Points • This is the first study to evaluate the effects of a resistance training program on fatigue in patients with primary Sjogren's syndrome. • A resistance training program was shown to be effective in improving fatigue in patients with primary Sjogren's syndrome. • A resistance training program is well-tolerated, has good compliance, and is not associated with serious adverse effects in patients with primary Sjogren's syndrome.

Cardiovascular Effect of Physical Exercise on Primary Sjogren's Syndrome (pSS): Randomized Trial.

Objective: To evaluate the effects of an exercise program on aerobic capacity, echocardiographic parameters, metabolic profile, quality of life and safety in patients with primary Sjogren's syndrome in a randomized trial. Methods: 60 women with pSS were evaluated from the SF-36 Short-Form Health Survey (SF-36) and EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) questionnaires. The participants performed ergospirometry and echocardiography; blood samples were collected to evaluate the metabolic profile. Patients were randomly divided into 2 groups: a training group that participated in the supervised training program and a control group. All variables were analyzed at baseline and after 28 weeks for both groups and we performed an intention-to-treat analysis. The training program consisted of 16 weeks of resistance exercises and, after, the exercise became aerobic. Patients and coaches were not blinded, contrary to the evaluators of all examinations/procedures and data analysts. Statistical analysis included Wilcoxon's rank sum test, chi-square test, and ANOVA test. P values < 0.05 were considered to be statistically significant. Results: The 2 groups were homogeneous at baseline. The training group showed a significant improvement in oxygen maximum volume (VO2max) and anaerobic threshold (AT). Comparison of the training group and control group after 28 weeks showed a significant difference relating to VO2max and in AT. We did not find statistically significant diference in echocardiographic parameters, metabolic profile and in questionnaires SF-36 and ESSDAI. Conclusions: This study showed significant improvement in aerobic capacity and glycated hemoglobin after a supervised training program in patients with pSS with safety.

Correlation of sleep quality with fatigue and disease activity among patients with primary Sjögren's syndrome: a cross-sectional study.

BACKGROUND: Fatigue is a frequent symptom in patients with primary Sjögren's syndrome (pSS) and can be a cause of or be associated with sleep disorders. OBJECTIVE: To assess the sleep quality of pSS patients and its relationship with fatigue and disease activity. DESIGN AND SETTING: Analytical observational study conducted at an exercise psychobiology laboratory. METHODS: Sleep quality was evaluated using the Pittsburg sleep quality index (PSQI) and actigraphy. Fatigue was evaluated through the Profile of Fatigue and Discomfort - Sicca Symptoms Inventory (PROFAD-SSI-SF) and a visual analogue scale for fatigue (VAS-fatigue). Disease activity was evaluated using a visual analogue scale for pain (VAS-pain), EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) and Disease Activity Index (ESSDAI). We summarized the data through descriptive statistics. RESULTS: A total of 50 female patients with pSS, of average age 56.4 years, were included in the study; 80% presented low disease activity. The total PSQI score showed that 74% had poor sleep. The actigraphy showed mean sleep latency of 26.2 minutes and mean nightly awakening of 48.2 minutes (duration of wakings after sleep onset, WASO). There were correlations between PSQI and VAS-pain, VAS-fatigue, PROFAD-SSI and ESSPRI. Actigraphy showed a correlation between the duration of WASO and ESSDAI. CONCLUSION: The present study provides important information regarding correlations between sleep disorders and disease activity. There is a need for proper control over disease activity and for development of strategies to help patients to sleep better in order to diminish their fatigue.

Correlation of sleep quality with fatigue and disease activity among patients with primary Sjögrens syndrome: a cross-sectional study

ABSTRACT BACKGROUND: Fatigue is a frequent symptom in patients with primary Sjögren's syndrome (pSS) and can be a cause of or be associated with sleep disorders. OBJECTIVE: To assess the sleep quality of pSS patients and its relationship with fatigue and disease activity. DESIGN AND SETTING: Analytical observational study conducted at an exercise psychobiology laboratory. METHODS: Sleep quality was evaluated using the Pittsburg sleep quality index (PSQI) and actigraphy. Fatigue was evaluated through the Profile of Fatigue and Discomfort - Sicca Symptoms Inventory (PROFAD-SSI-SF) and a visual analogue scale for fatigue (VAS-fatigue). Disease activity was evaluated using a visual analogue scale for pain (VAS-pain), EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) and Disease Activity Index (ESSDAI). We summarized the data through descriptive statistics. RESULTS: A total of 50 female patients with pSS, of average age 56.4 years, were included in the study; 80% presented low disease activity. The total PSQI score showed that 74% had poor sleep. The actigraphy showed mean sleep latency of 26.2 minutes and mean nightly awakening of 48.2 minutes (duration of wakings after sleep onset, WASO). There were correlations between PSQI and VAS-pain, VAS-fatigue, PROFAD-SSI and ESSPRI. Actigraphy showed a correlation between the duration of WASO and ESSDAI. CONCLUSION: The present study provides important information regarding correlations between sleep disorders and disease activity. There is a need for proper control over disease activity and for development of strategies to help patients to sleep better in order to diminish their fatigue.

Programa de autogerenciamento da dor crônica no idoso: estudo piloto / Self-management of chronic pain in the elderly: pilot study

JUSTIFICATIVA E OBJETIVOS: O programa de autogerenciamento da dor (AGD) inclui educação sobre dor, treinamento para identificação e modificação de pensamentos negativos, estabelecimento de metas, exercícios de relaxamento e terapias físicas com o objetivo de reduzir a dor, melhorar o humor e o funcionamento psicossocial. O objetivo foi avaliar o desenho metodológico e sua viabilidade em estudar a eficácia do AGD no tratamento da dor crônica em idosos e, secundariamente, avaliar sua eficácia comparando-o a um método educativo controle.MÉTODO: Foram avaliados os aspectos sociodemográficos, aspectos sobre a dor crônica e sua mensuração, impacto em funcionalidade, qualidade de vida, cognição e emoção utilizando-se: avaliação sociodemográfica, escala analógica visual (EAV) de dor, "Geriatric pain measurement" (GPM), escala de Katz e de Lawton (avaliação de funcionalidade), mini-exame do estado mental (MEEM), Geriatric Depressive Scale (GDS) e SF-36. RESULTADOS: Foram incluídos 20 indivíduos (12 no G1/intervenção e 8 no G2/controle), todos do gênero feminino, com idade média 73,7 no G1 e 78,2 no G2. A intensidade média de dor ao início do estudo foi 18,6 mm no G1, e 16,6 mm no G2, quando utilizada a EAV e pontuação média de 21,8 no G1 e 19,7 no G2, utilizando-se o GPM. Ao final do estudo a intensidade média de dor segundo a EAV foi 16,7 mm no G1 (p = 0,342) e 41,2 mm no G2 (p = 0,006). A pontuação com o GPM foi 19,7 no G1 (p = 0,400) e 25,8 no G2 (p = 0,346). As pontuações pela escala Katz foi 5,8 no início e 5,9 no final do estudo no G1 com 5,4 no início e 5,6 no final no G2 (p = 0,198). Pela escala de Lawton houve melhora funcional estaticamente significante no G1 (p = 0,040), o mesmo não ocorrendo no G2 (p = 0,148) e a diferença entre os grupos foi significante (p = 0,032). Os valores médios obtidos com os tratamentos propostos pela SF-36 não diferiram significativamente entre os grupos. CONCLUSÃO: A intervenção de AGD melhorou a independência funcional do idoso, para as atividades instrumentais de vida diária, e demonstrou tendência em melhorar a intensidade da dor e qualidade de vida.

BACKGROUND AND OBJECTIVES: The pain self-management program (PSM) includes education about pain, training to identify and change negative thinking, establishment of goals, relaxation exercises and physical therapies aiming at decreasing pain and improving mood and psychosocial functioning. This study aimed at evaluating the methodological performance and the feasibility of studying PSM effectiveness to treat chronic pain in the elderly and, secondarily, at evaluating its effectiveness as compared to a control educational method.METHOD: Social-demographic aspects, chronic pain and its evaluation, impact on functionality, quality of life, cognition and emotion were evaluated using: socio-demographic evaluation, pain visual analog scale (VAS), Geriatric pain measurement (GPM), Katz and Lawton scales (functionality evaluation), mental state mini exam (MSME), Geriatric Depressive Scale (GDS) and SF-36.RESULTS: Participated in this study 20 females (12 in the G1/intervention and 8 in G2/control groups), mean age of 73.7 in G1 and of 78.2 in G2. Mean pain intensity in the beginning of the study was 18.6 mm in G1 and 16.6 mm in G2, when VAS was used, and 21.8 in G1 and 19.7 in G2 with GPM. At the end of the study, mean pain intensity according to VAS was 16.7 mm for G1 (p = -.342) and 41.2 for G2 (p = 0.006). GPM scores were 19.7 for G1 (p = 0.400) and 25.8 for G2 (p = 0.346). Katz scale scores were 5.8 in the beginning and 5.9 at the end of the study for G1 and 5.4 in the beginning and 5.6 at the end for G2 (p = 0.198). Lawton scale showed statistically significant functional improvement for G1 (p = 0.040), the same not being true for G2 (p = 0,148) with significant difference between groups (p = 0.032). Mean values obtained with SF-36 were not statistically significant between groups.CONCLUSION: PSM intervention has improved functional independence of the elderly for daily life activities and has shown a trend to decrease intensity and improve quality of pain.