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Comparative Study
. 2017 Nov;69(11):1714-1723.
doi: 10.1002/acr.23165. Epub 2017 Oct 9.

Subjective and Objective Measures of Dryness Symptoms in Primary Sjögren's Syndrome: Capturing the Discrepancy

Oriana M Bezzina  1 , Peter Gallagher  1 , Sheryl Mitchell  2 , Simon J Bowman  3 , Bridget Griffiths  2 , Victoria Hindmarsh  2 , Ben Hargreaves  2 , Elizabeth J Price  4 , Colin T Pease  5 , Paul Emery  5 , Peter Lanyon  6 , Michele Bombardieri  7 , Nurhan Sutcliffe  8 , Costantino Pitzalis  7 , John Hunter  9 , Monica Gupta  9 , John McLaren  10 , Anne M Cooper  11 , Marian Regan  12 , Ian P Giles  13 , David A Isenberg  13 , Vadivelu Saravanan  14 , David Coady  15 , Bhaskar Dasgupta  16 , Neil J McHugh  17 , Steven A Young-Min  18 , Robert J Moots  19 , Nagui Gendi  20 , Mohammed Akil  21 , Kirsten MacKay  22 , W Fai Ng  23 , Lucy J Robinson  1 ; UK Primary Sjögren's Syndrome Registry
Collaborators, Affiliations
Comparative Study

Subjective and Objective Measures of Dryness Symptoms in Primary Sjögren's Syndrome: Capturing the Discrepancy

Oriana M Bezzina et al. Arthritis Care Res (Hoboken). 2017 Nov.

Abstract

Objective: To develop a novel method for capturing the discrepancy between objective tests and subjective dryness symptoms (a sensitivity scale) and to explore predictors of dryness sensitivity.

Methods: Archive data from the UK Primary Sjögren's Syndrome Registry (n = 688) were used. Patients were classified on a scale from -5 (stoical) to +5 (sensitive) depending on the degree of discrepancy between their objective and subjective symptoms classes. Sensitivity scores were correlated with demographic variables, disease-related factors, and symptoms of pain, fatigue, anxiety, and depression.

Results: Patients were on average relatively stoical for both types of dryness symptoms (mean ± SD ocular dryness -0.42 ± 2.2 and -1.24 ± 1.6 oral dryness). Twenty-seven percent of patients were classified as sensitive to ocular dryness and 9% to oral dryness. Hierarchical regression analyses identified the strongest predictor of ocular dryness sensitivity to be self-reported pain and that of oral dryness sensitivity to be self-reported fatigue.

Conclusion: Ocular and oral dryness sensitivity can be classified on a continuous scale. The 2 symptom types are predicted by different variables. A large number of factors remain to be explored that may impact symptom sensitivity in primary Sjögren's syndrome, and the proposed method could be used to identify relatively sensitive and stoical patients for future studies.

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Figures

Figure 1
Figure 1
Severity classification groups for objective results and subjective symptoms and the grid used to derive the sensitivity score. For example, an individual with severe objective test results (Schirmer <2.5 or saliva flow <1) but subjectively rating themselves 1 (mild) would have a discrepancy classification of −4, thereby lying at the stoical side of the distribution. An individual subjectively reporting their symptoms 9 (severe) while having a normal objective test results would score +5, at the most sensitive side of the distribution.
Figure 2
Figure 2
The sensitivity scale used in the study.
See this image and copyright information in PMC

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