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. 2024 Sep 28;26(1):169.
doi: 10.1186/s13075-024-03404-8.

Patients' recollection about the onset of Sjögren's disease - a mixed methods study on the patients' perspective

Angelika Lackner  1 , Barbara Dreo  1 , Josef Hermann  1 , Sabine Zenz  1 , Johannes Fessler  2 , Jens Thiel  1 , Martin Helmut Stradner  3
Affiliations

Patients' recollection about the onset of Sjögren's disease - a mixed methods study on the patients' perspective

Angelika Lackner et al. Arthritis Res Ther. .

Abstract

Background: Little is known about the symptoms at the onset of Sjögren's Disease (SjD) and it is unclear whether SjD starts with characteristic symptoms that could be differentiated from dryness of other origin (sicca syndrome). The aim of this study was to investigate patients' recollection of initial events and first symptoms of SjD. The second aim was to verify and quantify these aspects in a representative cohort.

Methods: All SjD patients fulfilled the EULAR/ACR 2016 classification criteria. In the first part of the study, consecutive SjD patients were recruited for individual, semi-structured interviews. All interviews were audio-recorded and transcribed verbatim, and an inductive thematic data analysis was performed. In the second part, the identified aspects of the qualitative analysis were grouped into a checklist with ten items.

Results: One-hundred and thirty-four patients participated in the study. 31 SjD patients completed the qualitative part. Major aspects emerged of how patients experienced the beginning and first symptoms of SjD: (1) "classic" SjD symptoms (fatigue, pain, dryness) (2), sicca symptoms started after initial swelling of parotid and/or lymph nodes (3), after hormonal transition or infections before the onset of SjD symptoms. In the second part of the study, the previous identified major aspects were verified in an independent cohort of 103 SjD patients. The main symptom before diagnosis was dryness (n = 77, 74.8%) with migratory joint pain (n = 51, 49.5%) and fatigue (n = 47, 45.6%). In 38.8% (n = 40), patients reported a swelling/inflammation of the parotid gland at the onset of disease.

Conclusions: We describe patients' recollection of the onset of SjD. Raising awareness of the symptoms identified among physicians and among the general public may allow earlier diagnosis of SjD.

Keywords: Disease onset; Early diagnosis; Early disease; Patients’ perspective; Qualitative study; Sjögren’s syndrome.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Frequencies of symptoms. Appearance or absence of symptoms depicted for each patient (column)
Fig. 2
Fig. 2
Symptoms and events at the onset of the disease. The frequencies of the symptoms and events are displayed according to the completed checklists
Fig. 3
Fig. 3
Distribution of symptoms at the onset of primary Sjögren Disease between age groups (onset before (red) or after (yellow) years of age). Patients were split to groups of patients more/less than 50 years of age. Younger patients experienced the first symptoms more often after a hormonal change. Patients with a disease onset after 50 years of age experienced a slowly, often unrecognized start of sicca complaints
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