Background:Dryness, fatigue, and pain are common clinical manifestations assessed by EULAR Sjogren’s Syndrome Patient Reported Index (ESSPRI)-Dryness, -Fatigue, -Pain scores in patients with primary Sjögren’s syndrome (pSS). In addition, depression is also seen in these patients owing to the pattern of the chronic disease.Objectives:The aim of the study was to assess the complex interactions among Depression status, Illness Perception, and prominent clinical manifestations evaluated by the ESSPRI (Dryness, Fatigue, and Pain) in patients with pSS.Methods:In this cross-sectional study, 111 patients with pSS (M/F: 5/106; mean age: 52.9 ± 12.01 years) were included. The data were collected by clinical examination and a questionnaire regarding patient reported outcome measures (PROMs). Unstimulated (U-WSFR) and stimulated (S-WSFR) whole saliva flow rates of patients were calculated as ml/min. Hospital Anxiety and Depression Scale (HADS), Illness Perception Questionnaire-R (IPQ-R) and EULAR Sjogren’s Syndrome Patient Reported Index were filled by patients. Increases in HADS score and subgroup scores of ESSPRI (Dryness, Fatigue and Pain) and IPQ-R dimensions regarding Identity, Consequences, and Emotional reflected poor conditions for patients. In addition, patients scored their disease activity (0: inactive-100: the worst activity) by using 100-mm visual analogue scale (VAS). After preliminary analysis, a mediation analysis was used to evaluate the relations among these variables.Results:In the study, ESSPRI-Dryness score (6,27±2,79) was associated with U-WSFR (0,40±0,57) and S-WSFR (1,04±0,86),(r:-0,4 p=0.000; r:-0,3 p=0.004). Moreover, patients reported disease activity score (48,78±26,67) was related to U-WSFR (r: -0,3 p=0.026) as well as Consequence (19,12±5,47) and Emotional (19,54±7,02) scores of IPQ-R questionnaire (r: 0,3 p=0.035; r: 0,3 p=0.014).In IPQ-R questionnaire, Identity score (8,04±3,1) reflecting number of symptoms that patients experienced due to their illness was correlated with scores of ESSPRI-Fatigue (5,29±2,97), ESSPRI-Pain (5,18±3,01), HADS-Anxiety (11,67±5,55), HADS-Depression (9,2±4,98) in the study (p<0.05).In the mediation analysis, Identity score was directly mediated by ESSPRI-Fatigue score (p=0.0093) and indirectly mediated by HADS-Depression score (p=0.0011).A bootstrap analysis with 5000 replications was applied to estimate mediation effect to generate 95% CI. Percentile bootstrap of HADS-Depression was found to be an effective mediator for Identity score based on 5000 bootstrap sample.Conclusion:Both depression status and fatigue affected Identity score reflecting the number of symptoms poorly. Considering this complex relationship in disease activity assessment may positively affect disease outcomes.Disclosure of Interests:None declared

Background:Both oral functions and oral health-related quality of life (OHRQoL) are poorly affected by low salivary flow rate in patients with primary Sjögren’s syndrome (pSS).Objectives:The aim of the study was to evaluate the effects of oral dryness and OHRQoL on daily life in patients with primary Sjögren’s syndrome (pSS).Methods:In this cross-sectional study, 86 patients with pSS (M/F: 5/81; mean age: 52.4 ± 11.6 years) were included. The data were collected by clinical examination and a questionnaire regarding patient-reported outcome measures (PROMs). Patient filled PROMs regarding Oral Health Impact Profile-14 (OHIP-14) for OHRQoL, Work Productivity and Activity Impairment scale (WPAI) for Daily life and the EULAR Sjogren’s Syndrome Patient Reported Index (ESSPRI) for their symptoms. Unstimulated whole saliva flow rates (U-WSFR) of patients were calculated as ml/min. Increases in PROMs and decreases in U-WSFR reflected poor conditions. After preliminary analysis, a mediation analysis was used to evaluate the relations among variables.Results:WPAI-Daily activity impairment score was higher in patients with low U-WSFR (≤0,1 ml/min) than the others (67±29,8 vs 52,5±28,6) (p=0.042). Both U-WSFR (0,43±0,57 ml/min) and ESSPRI-Dryness score (6.31 ± 2.71) were correlated with scores of OHIP-14 (25,96±17,13)(r:- 0,38 p=0.000; r: 0,37 p=0.000) and WPAI-Daily activity impairment (57,96±29,71)(r: -0,36 p=0.004; r: 0,53 p=0.000). Moreover, scores of ESSPRI-Pain (5,16±3,12) and ESSPRI-Fatigue (5,41±2,97) were also related to WPAI-Daily activity impairment score (r: 0,41 p=0.001; r:0,49 p=0.000, respectively).In the mediation analysis, WPAI-Daily activity impairment score (57.9 ± 29.7) was directly mediated by ESSPRI-Dryness score (p=0.0010) and indirectly mediated by OHIP-14 score (25.9 ± 17.1) (p=0.0357). After mediation analysis, a bootstrap analysis with 5000 replications was applied to estimate the mediation effect to generate 95% CI. Percentile bootstrap of OHIP-14 score was found to be an effective mediator for Daily activity impairment based on 5000 bootstrap samples.Conclusion:Both oral dryness and poor OHRQoL in patients with pSS affected daily activity impairment. Therefore, the patients’ needs for improving oral health were critical components of treatment plans to improve the daily activity of SjS patients.Disclosure of Interests:None declared

Background:Since oral ulcer is a common clinical manifestation, oral health-related quality of life (OHRQoL) is affected by the presence of oral ulcer poorly in patients with Behcet’s disease (BD).Objectives:The aim of the study was to examine associated factors for poor OHRQoL status to improve treatment outcomes in patients with BD.Methods:In this retrospective study, 339 BD patients (F/M: 179/160, mean age: 36,13±9,81 years) included. Data were collected by a structured questionnaire regarding treatment expectation, Oral Health Impact Profile-14 (OHIP-14) questionnaire for OHRQoL, oral ulcer activity, and disease severity score. Treatment expectation was coded by a 5-point Likert type scale (1: symptoms were completely cured vs 5: symptoms were worsened). OHIP-14 score was between “0 point (the best score)” and “56 points (the worst score)”. The disease severity score was calculated according to the organ involvement. Then, patients were categorised as mucocutaneous involvement (n=181) and severe organ involvement (n=158). After preliminary analysis, a Moderated Mediation analysis was carried out.Results:Oral ulcer activity was seen in 63,4% of the group (n=215). OHIP-14 score (22,05±16,47) was correlated with Treatment expectations (2,35±0,98) (r: 0,36 p=0.000) in the group. Poor scores of OHIP-14 and Treatment expectations were found in patients with active oral ulcers (mucocutaneous involvement: 27,56±14,55; 2,68±0,87, vs severe organ involvement: 28,51±17,25; 2,43±0,99) compared to those of inactive patients (mucocutaneous involvement: 13,38±12,23; 1,81±0,73 vs severe organ involvement: 8,79±10,19; 1,85±1,02) (p=0.000 for all). Patients with active oral ulcers were younger (35,09±9,52) than the others (39,57±10,06) in the mucocutaneous involvement group (p=0.0011) whereas a similar relation was not seen in the severe organ involvement (p=0.233).In the moderated mediation analysis, it was found that OHIP-14 score was increased by the presence of oral ulcer in the direct path (p=0.0000) and the negative Expectation of the treatment as a first mediator (p = 0.0001) in the indirect path. Oral ulcer activity was associated with younger patients (p=0.0039). This effect was seen especially in patients with mucocutaneous involvement that had a moderator effect (p=0.0040). In addition, age was found to be a second mediator for the poor OHIP-14 score (p = 0.0053). Mediators and the moderator were found to effective for OHIP-14 score a bootstrap analysis with 5000 replications.Conclusion:OHRQoL was affected by oral ulcer activity and poor treatment expectations. Age was also found to be another critical factor for OHRQoL.Disclosure of Interests:None declared

Background:Sjögren’s syndrome (SjS) is a chronic systemic autoimmune disease targets primarily the salivary and lacrimal glands, the severe dryness of the mouth and eyes are common manifestations in patients. Therefore, daily life could be affected by these manifestations in patients with SjS.Objectives:The aim of the study was to assess associations among daily activity impairment and scores of EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI) and major salivary gland ultrasonography (SGUS) in primary SjS.Methods:In this cross-sectional study, 41 patients with primary SjS (F/M:39/2; mean age: 52,1±10,5) were included. The mean disease duration was 9.5±6,6 years in the group.Data were collected by clinical examinations and a questionnaire regarding two patients reported outcome measures (PROMs). Firstly, Work Productivity and Activity Impairment (WPAI) questionnaire assessed paid and unpaid work during the last seven days. Scores of WPAI subgroups as absenteeism, presenteeism, overall work impairment as well as daily activity impairment were calculated by using 6 items. Secondly, dryness, fatigue and pain in ESSPRI scale were evaluated by visual analogue scale (VAS; 0-10 points) in SjS. High scores in both PROMs indicates that disease manifestations affect patient ‘life poorly.In addition, structural damage of parotid and submandibular salivary glands were examined by using Milic and Hocevar USG scoring methods. Unstimulated whole salivary flow rate (U-WSFR; as ml/min) were also used to interpret the functional status of major salivary glands. High SGUS score and low U-WSFR reflects that disease activity affects major glands poorly.Results:Daily activity impairment was calculated as 63,9±31,1 in patients with primary SjS. High scores in ESSPRI-dryness, ESSPRI-fatigue and ESSPRI-pain were also observed in the group (7,5±2,4; 6,4±2,8 and 6,1±3,1, respectively). Daily activity impairment was correlated with scores of ESSPRI-dryness (r:0,55 p=0.000), ESSPRI-fatigue (r:0,38 p=0.014) and ESSPRI-pain (r:0,56 p=0.000) as well as parenchymal inhomogeneity USG scores of right and left parotid glands (r:0,49 p=0.032; r:0,51 p=0.025).U-WSFR (0.20±0.20 ml/min) was moderately correlated with parenchymal inhomogeneity USG scores of major salivary glands (p<0.05). ESSPRI-dryness score was significantly higher in patients with low U-WSFRs (≤ 0.1 ml/min) than the others (87,5±16,3 vs 68,3±25,1, respectively)(p=0.021).Conclusion:Firstly, subgroup scores of ESSPRI and low U-WSFR associated to daily activity impairment in patients with primary SjS. Secondly, parenchymal inhomogeneity scores of both parotid glands could give an important clue to clinicians for the disease-related damage. Finally, WPAI with 6-item could be thought as an useful tool to understand the effect of the disease manifestations on patients’ daily life.Disclosure of Interests: :None declared