Patients with non-Sjögren’s sicca report poorer general and oral health-related quality of life than patients with Sjögren’s syndrome: a cross-sectional study

Abstract

Understanding the impact of the disease on quality of life is crucial in patient management. in this cross-sectional study, general and oral health-related quality of life questionnaires, and thorough examinations of oral and ocular dryness were performed in age-and sex-matched patients with primary Sjögren's syndrome (pSS group), non-Sjögren's syndrome sicca (non-SS group) and healthy controls. General and oral health-related quality of life were investigated with the 36-Item Short Form Health Survey and the 14-Item Oral Health Impact Profile questionnaires, respectively. Subjective symptoms of xerostomia and ocular dryness were recorded using the Summated Xerostomia inventory and ocular Surface Disease index, respectively. clinical examinations included evaluation of clinical oral dryness scores, candida counts, unstimulated and stimulated saliva secretory rates, tear osmolarity, tear film break-up time, Schirmer I test and ocular surface staining. Both patient groups had pronounced signs and symptoms of xerostomia and ocular dryness. even though the non-SS patients had less severe clinical signs than the pSS patients, they demonstrated much poorer general and oral health-related quality of life. in conclusion, non-SS patients require more attention in order to improve their quality of life. Sjögren's syndrome (SS) is a systemic, autoimmune connective tissue disease presenting a wide range of sicca symptoms, mainly dry mouth and dry eyes that result from permanently impaired salivary and lacrimal gland function 1. Sjögren's syndrome is also associated with extraglandular renal, pulmonary, and neurological manifestations in about 30% of patients 2. Around 5% of patients may develop lymphoma which is the most severe complication 2,3. Sjögren's syndrome is defined as primary SS (pSS) when occurring in the absence of an underlying rheumatic disorder, and as secondary SS (sSS) when associated with another connective tissue disorder 4,5. The large and diverse group of patients that have sicca symptoms consists of patients with various disorders who receive medical treatments that cause hypofunction of salivary and/or lacrimal glands. However, some patients have sicca symptoms in the absence of known diseases or medication, but without the distinctive features of pSS, namely Ro/SSA and/or La/SSB autoantibodies and lymphocyte infiltration in their minor salivary glands 6. In the present paper, this diverse group of patients was named the non-SS group, in order to highlight the fact that although they present with SS-like symptomatology they do not fulfil the diagnostic criteria for SS 7-20. The oral manifestations of SS can include subjective symptoms of dry mouth (xerostomia), burning sensation on the tongue, reduced sense of taste, and difficulties in swallowing food 21. Clinical findings of dry mouth include dry and fissured tongue, lack of saliva pool and bubbly saliva, tooth decay, and candidiasis 22. The subjective symptoms of dry eyes in SS can manifest as reduced vision, ocular discomfort, scratchiness, and pai...

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“…However, feeling of ocular and oral dryness is not always associated to a real reduction of lacrimal and salivary flow or to its severity. Indeed, a recent study demonstrated that non-SS sicca syndrome patients complain a worst quality of life in comparison to SS patients despite having significantly less pronounced clinical characteristics of dry mouth and slightly better saliva production rates (53). Inflammatory mechanisms have been hypothesised to contribute to dry eye symptoms.…”