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Fatigue, Dryness, and Quality of Life as Clinical Trial Outcomes in Primary Sjögren’s Syndrome

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Sjögren’s Syndrome

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Abstract

Although dryness symptoms are regarded as the defining features of Sjögren’s syndrome (SS), fatigue is also a common and often disabling symptom for many patients. The biologic mechanisms of fatigue in SS or in other rheumatic diseases are poorly understood. Low mood associated with having a chronic disease plays a part. Attempts to show correlations between fatigue levels and the levels of cytokines or other biologic parameters or with clinical measures of “disease activity” have not generated a clear answer. Much fatigue research has focused on the measurement and classification of fatigue features and a number of fatigue questionnaires have been developed. Although we can now, therefore, “measure” fatigue levels, there is no proven therapy for fatigue in SS, and considerable debate as to whether a biological or a psychosocial approach is more appropriate. Our understanding of dryness symptoms has been complicated by the lack of correlation between the level of symptoms and the degree of objective dryness measured by standard tests in groups of patients. This has generated a lack of certainty as to what is the goal of therapy in SS—improvement in symptoms or in physical measures of tear and/or salivary flow or histological features in the exocrine glands, or some combination of all of these. What is clear from a number of studies is that patients with SS have reduced levels of health-related quality of life comparable to that of rheumatoid arthritis or systemic lupus erythematosus. Despite these limitations, however, there has been considerable progress in symptom assessment, and this should lay the groundwork for clinical trials of therapeutic agents over the next few years.

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Acknowledgments

A variation of this article has also been published in Rheumatic Disease Clinics of North America 2008. Figures in this article have been reprinted with permission from Annals of the Rheumatic Diseases and the Journal of Rheumatology and Rheumatology (Oxford).

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  1. Department of Rheumatology, University Hospitals Birmingham, Birmingham, England

    Simon J. Bowman

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  1. Research Foundation, Rheumatology Clinic, Scripps Memorial Hospital &, Caminito Sinnecock 6565, La Jolla, 92037, California, USA

    Robert I. Fox

  2. Research Foundation, Rheumatology Clinic, Scripps Memorial Hospital &, Caminito Sinnecock 6565, La Jolla, 92037, California, USA

    Carla M. Fox

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Bowman, S.J. (2011). Fatigue, Dryness, and Quality of Life as Clinical Trial Outcomes in Primary Sjögren’s Syndrome. In: Fox, R., Fox, C. (eds) Sjögren’s Syndrome. Springer, New York, NY. https://doi.org/10.1007/978-1-60327-957-4_21

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