Interdisciplinary, Comprehensive Oral and Ocular Evaluation of Patients with Primary Sjögren's Syndrome

Abstract

A comprehensive evaluation of oral and ocular symptoms and findings in primary Sjögren's syndrome (pSS) patients may provide valuable information for management. Medical history was obtained from female pSS patients, and sex- and age-matched non-SS patients with sicca symptoms (non-SS sicca controls) as well as healthy subjects without sicca complaints (healthy controls). Oral (Summated Xerostomia Inventory, SXI) and ocular (McMonnies Dry Eye questionnaire, MDEIS, and Ocular Surface Disease Index, OSDI) subjective complaints were recorded. Objective findings including clinical oral dryness scores (CODS), unstimulated and stimulated saliva secretion rates (UWS/SWS), Schirmer I test, tear osmolarity, tear film break-up time (TFBUT), and ocular surface staining (OSS) were determined. The pSS and non-SS sicca controls were extensively troubled by subjective dryness, while the pSS group had higher CODS, significantly lower saliva and tear secretion, shorter TFBUT and higher OSS than both control groups. Furthermore, candida counts were significantly higher in the pSS patients. In the pSS group, subjective oral dryness significantly correlated with ocular dryness (MDEIS: r = 0.5, OSDI: r = 0.413) and SWS was significantly correlated with Schirmer I (r = 0.419). The findings imply that interdisciplinary subjective and objective evaluation of patients with xerostomia and xerophthalmia not only have implications for patient care, but also may guide clinicians in differentiating between pSS and non-SS sicca patients.

Figure 1

Oral examination results for the pSS, non-SS sicca and healthy control groups are shown in the log scale. CODS – Clinical Oral Dryness Score; UWS – unstimulated whole saliva secretion rate (ml/min); SWS – stimulated whole saliva secretion rate (ml/min). *Level of significance between the groups: p < 0.05 in all parameters. Exact values of variables given in the following order: pSS, non-SS sicca controls, healthy controls. CODS (4.9; 3.7; 0.6), Candida score (1.5; 0.7; 0.5), UWS (0.08; 0.10; 0.29), SWS (0.58; 0.90; 1.50).

Figure 2

Ocular examination results for the pSS, non-SS sicca and healthy control groups are shown in the log scale. MDEIS – McMonnies Dry Eye Questionnaire, OSDI – Ocular Surface Disease Index, TFBUT – tear film break-up time, Schirmer I test, OSS – ocular surface staining. Intergroup difference is significant at *p < 0.05 level between all groups in all examination results. Exact values of variables given in the following order: pSS; non-SS sicca; HC. MDEIS (17.6; 18.9; 4.1), OSDI (34.8; 54.1; 4.8), TFBUT (2.4; 4.4; 5.4), ST (4.8; 11.6; 16.2), OSS (3.9; 1.1; 0.8).