Primary Sjögren’s syndrome in Moroccan patients: characteristics, fatigue and quality of life

Abstract

Our aim was to evaluate fatigue and quality of life (QoL) in Moroccan patients with primary Sjögren's syndrome (PSS) and determine their correlates with disease-related parameters. Fifty-seven consecutive patients with PSS according to the American-European Consensus group (AEGG) criteria were included. Demographic, clinical, biological and immunological characteristics for all patients were collected. Xerostomia was demonstrated by histological grading of lower lip glandular biopsy. A Schirmer test was performed to measure lachrymal flow. Oral, ocular, skin, vaginal and tracheal dryness were evaluated by using a visual analogue scale (VAS). Fatigue was assessed by the Multidimensional assessment of fatigue (MAF) and the QoL by using the generic instrument: SF-36. 90% of our patients were women. The mean age of patients was 53.73 ± 7.69 years, and the mean disease duration was 5.38 ± 4.11 years. The mean oral dryness was 68.38 ± 20.29, and the mean ocular dryness was 51.91 ± 14.03. The mean total score of the MAF was 26.73 ± 8.33, and 87.5% of our patients experienced severe fatigue. Also, physical and mental domains of QoL were altered in a significant way, and the severity of fatigue had a negative impact on SF-36 scores. MAF and SF-36 scores were correlated with the delay of diagnosis, the intensity of xerostomia and the activity of joint involvement. A low socioeconomic and educational level had a negative impact on fatigue scores and QoL. Histological grading of lower lip glandular biopsy, immunological status and the severity of systemic involvement had no correlations with fatigue scores or the alteration of QoL. Patients receiving antidepressant have lesser fatigue and those receiving Methotrexate have better SF-36 scores. In our data, there was a high prevalence of fatigue in Moroccan patients with PSS associated with altered QoL. Severe fatigue and reduced QoL seem to be related to the severity of joint involvement, xerostomia and both educational and socioeconomic levels. Also, treatment with methotrexate and antidepressant seems to improve patients' living and QoL. An appropriate therapeutic intervention for depression and articular manifestations in PSS should be applied to improve patients' living.

Cognition, depression, fatigue, and quality of life in primary Sjögren's syndrome: correlations

“…In 57 case series of Ibn Yacoub et al. (), it was found that compared to general population, lower performance was found in all SF‐36 scores, including physical problems, role functioning emotional, vitality, and general health scales. In the study of Baturone et al.…”

“…In PSS cases without neurological involvement, it was found that there was a significant hypoperfusion at left frontal, left parietal, left temporal, right frontal, and right hippocampal cortex, and also it was shown that there was a strong correlation between the hypoperfusion specified at frontal, parietal, temporal, cingulate, and hippocampal areas, and the dysfunction of the executive functions (Le Guern et al., ). When the brain MRI was normal, it was found that the presence of hypoperfusion in parietal, temporal, and frontal lobes was 56.3% in PSS cases with neuropsychiatric symptoms and findings and 17.6% in PSS cases with no neuropsychiatric symptoms and findings at the brain Tc‐ECD SPECT and this result increased the sensitivity of the brain Tc‐ECD SPECT (Ibn Yacoub et al., ). It was revealed that in PSS cases, there was a correlation between cognitive dysfunction and decreased NAA level and decreased NAA/Cr rate at the subcortical frontal and basal ganglia's white matter and presence of the increased vascular resistance in MCA circulation and this was explained by the subclinical vascular inflammation and endotheliitis in PSS (Morreale et al., ).…”

“…Decreased quality of life has already been revealed in patients with PSS by using the Short‐Form 36. It were showed that all eight scales of the SF‐36 significantly decreased in patients with PSS (Baturone et al., ; Champey et al., ; Ibn Yacoub et al., ; Inal, Kitapcioglu, Karabulut, Keser, & Kabasakal, ; Lendrem et al., ; Meijer et al., ; Segal et al., ; Strömbeck et al., ). In 57 case series of Ibn Yacoub et al.…”

“…It is shown that fatigue and depression are the variables affecting the quality of life that is measured by SF‐36 (Champey et al., ; Meijer et al., ; Segal et al., ). Depression is reported as a factor related to a decreased quality of life in patients with PSS (Ibn Yacoub et al., ). Champey et al.…”

“…Higher cognitive function disorders in the cases with anti‐SSA antibody positivity support the role of immune mechanism (Chang, Shiau, Wang, Ho, & Kao, ; Harboe et al., ; Morreale et al., ; Yoshikawa et al., ). Additionally, it is observed that depression and fatigue severity increase (Lafitte et al., ; Martinez et al., ; Segal et al., ; Strömbeck, Ekdahl, Manthorpe, & Jacobsson, ) but quality of life impairs (Baturone et al., ; Champey et al., ; Ibn Yacoub, Rostom, Laatiris, & Hajjaj‐Hassouni, ; Lendrem et al., ; Meijer et al., ; Segal et al., ) in cases with PSS compared to healthy controls.…”