Sleepiness or fatigue? Can we detect treatable causes of tiredness in primary Sjogren's syndrome?

Theander, Lisa; Strömbeck, Britta; Mandl, Thomas; Theander, Elke

doi:10.1093/rheumatology/keq023

Cited by 57 publications

(69 citation statements)

References 24 publications

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“…42 Increased rates of neuroticism, psychoticism, obsessiveness, hypochondriasis, paranoid ideation, somatization, obsessive-compulsive symptoms, sleep disturbances and defective coping strategies have been reported. 7,[43][44][45][46][47] Non-Hodgkin lymphoma is a well-recognized complication of Sjögren syndrome. 6,39 Peripheral neuropathy, glomerulonephritis, lymphopenia, vasculitis or purpuric lesions, low C4 levels, cryoglobulinemia and the presence of germinal centres in salivary gland biopsy samples are well-recognized adverse predictors of lymphoma.…”

Section: E580mentioning

confidence: 99%

Sjögren syndrome

Mavragani

Moutsopoulos

2014

CMAJ

159

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S jögren syndrome is a chronic, systemic disorder of an autoimmune nature. It is characterized by lymphocytic infiltration of the exocrine (mainly salivary and lacrimal) glands and by remarkable B-cell hyperactivity. The latter is manifested by hyper gam maglobulinemia and the presence of serum autoantibodies, including antinuclear antibodies, rheumatoid factor, cryoprecipitable immunoglobulins and antibodies against two ribonucleoproteinic complexes named Ro/SSA and La/SSB; these antibodies are considered hallmarks of the disease. 1,2Although their exact role is not known, recent data suggest that antibodies against the Ro52 component of the Ro/SSA antigen (a 52kD protein that inhibits proinflammatory responses) might inhibit its regulatory function.3 The condition is nine times more common among women than among men, with peak onset during menopause.1 A recent review suggests that the prevalence ranges from 0.1% to 4.8%, 1 with rates increasing with advanced age.4,5 Heterogeneity in inclusion criteria, ethnic origin, sample size and sex distribution between studies contributed to the observed variability.Although Sjögren syndrome is classically considered to be localized disease of the exo crine glands, mainly manifested with oral and ocular dryness, it also has a wide range of systemic clinical manifestations that affect essentially any organ system, and a small number of cases are complicated by the development of non-Hodgkin lymphoma.1,6 Secondary Sjögren syndrome is associated with an established connective-tissue disease.As is the case for many autoimmune diseases, the primary etiopathogenetic events are not known. The current hypothesis is that an interplay between environmental contributors (e.g., viruses, stress, hormones) and the patient's genetic background can lead to inflammatory responses against epithelial tissues. In this review, we summarize the current evidence, mostly from observational, open-label and randomized clinical trials, for the clinical manifestations, diagnosis and management of Sjögren syndrome (Box 1). What are the clinical features of Sjögren syndrome?The clinical features of Sjögren syndrome can be largely divided into those related to exocrine dysfunction (glandular) and those that affect organs other than the exocrine glands (extraglandular or systemic). The latter can be further divided into nonspecific features, those characterized by periepithelial infiltrates in parenchymal organs and those that result from immunocomplex deposition as a result of B-cell hyperactivity. 7,8 Most patients with Sjögren syndrome (about 90%) have an indolent benign course; however, a small but important number of cases (5%-10%) are complicated by immunocomplex pathology and lymphoid neoplasia, both of which are associated with high mortality (a 3.25-fold increase compared with the general population). 6,7,9

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Section: E580mentioning

confidence: 99%

Sjögren syndrome

Mavragani

Moutsopoulos

2014

CMAJ

159

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“…13 14 Other non-specific symptoms closely associated with fatigue are sleep disturbances, anxiety, and depression, with a prevalence of nearly 15%, 20%, and 40% of patients with primary Sjögren syndrome, respectively. [14][15][16] Chronic pain is often associated with polyarthralgia and myalgia, which are reported by more than 50% of patients.…”

Section: General Symptomsmentioning

confidence: 99%

Primary Sjögren syndrome

2012

BMJ

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“…In addition, side-effect of drugs (Meijer et al,2010; Norheim et al, 2012), sleep disturbance (Theander et al, 2010) and social circumstance (Ibn Yacoub et al, 2012) also have impact on it. Correlated factors of pSS-related fatigue are multiple; however, pathogenesis is as yet unknown.…”

Section: Introductionmentioning

confidence: 99%

Fatigue in patients with Sjögren’s syndrome and intervention of traditional herbal medicine

Li¹,

Zhang²

2016

Afr. J. Trad. Compl. Alt. Med.

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Background: Fatigue is the main complaint exiting in patients with primary Sjögren's Syndrome (pSS) but rarely addressed.Patients described it as an uncontrollable symptom of lack of energy, which has negative impacts on health related quality of life. To date, many studies have demonstrated that cytokines, depression, sleep and endocrine disturbance interrelated with pSS-related fatigue. However, the pathogenesis remains unclear. With a long history, Traditional Chinese Medicine (TCM) as alternative therapy has become increasingly popular among patients with various kinds of disease, especially in pSS. Based on the unique principle of therapy, practitioners have achieved a satisfactory effect on relieving disease-related symptoms with Chinese Herbal Medicine (CHM). Materials and Methods:In this article, we succinctly reviewed the highly correlated factors to pSS-related fatigue from the standpoint of western medicine. Then, from TCM perspective, we illustrated that theoretic mechanisms lead to fatigue in patients with pSS.Results: According to the theory of TCM, we concluded that CHM as complementary and alternative medicines are attractive options to alleviate pSS-related fatigue. Conclusion:In clinic, physicians should remember to inquire whether their patients are worn out easily. Combination of Yin-tonifying and Qi-tonifying CHM may be the optimal options to pSS-related fatigue. Key words：Sjögren's IntroductionFatigue is one of common symptoms in series of diseases, such as the various cancers (Stone et al., 2008), rheumatic diseases (Overman et al., 2015) and neurological diseases (Brola et al., 2007). Among patients with rheumatic diseases, including Rheumatoid Arthritis (RA), scleroderma, fibromyalgia, and Sjögren's Syndrome etc., prevalence of fatigue has been reported about 65% (Overman et al., 2015), compared with about 20% to 30% of general population (Loge et al., 1998;van't et al., 2010].Approximately, it ranges from 60% to 70% of patients with pSS suffering from fatigue (Segal et al., 2008; Haldorsen et al., 2011 The basis of pathologies is attributed to lymphocytic infiltration leading to exocrine glands dysfunction, especially lachrymal and salivary glands, and severe systemic symptoms involvement.The main symptoms were showed persistent dryness of mouth and eyes, and extra-glandular symptoms such as arthritis, vasculitis, and pain etc. Previous studies indicated that fatigue was more common and serious in patients with pSS than healthy controls (Barendregt et al.1998;van Leeuwen et al., 2015; Godaert et al., 2002), but as a clinical outcome of pSS, it is often ignored (Chaudhuri et al., 2004;Dupond, 2011).Some investigators suggest fatigue in pSS is not same as normal notion of tiredness, it is accurately described as fluctuant and ever-present lack of vitality, beyond individual's own control (Mengshoel et al., 2014), reducing health-related quality of life and work ability (Segal et al., 2009;Westhoff et al., 2011). Some patients with pSS usually complained that "little interest or ...

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Sleepiness or fatigue? Can we detect treatable causes of tiredness in primary Sjogren's syndrome?

Cited by 57 publications

References 24 publications

Sjögren syndrome

Sjögren syndrome

Primary Sjögren syndrome

Fatigue in patients with Sjögren’s syndrome and intervention of traditional herbal medicine

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