Background/Purpose: Primary Sjögren’s Syndrome (pSS) is an autoimmune disease which targets secretory glands and results in dryness. In addition pSS patients frequently experience symptoms of fatigue, pain, low mood and have difficulty performing daily activities and subsequently have poor quality of life. There is currently no curative treatment and medical interventions focus on the symptomatic management of dryness. The aim of this study is to identify independent predictors for each of the SF-36 domains in order to identify targets for future therapy interventions with pSS patients. The goal is to identify potential interventions to be delivered by non-medical health care professionals in order to improve the ability to perform daily activities, facilitate taking on life roles and improve quality of life.

Methods: 149 PSS patients diagnosed according to the American European Consensus Criteria were recruited from 12 sites across England. Participants completed the SF-36 questionnaire and measurements of anxiety and depression (Hospital Anxiety and Depression Scale HADs), functional status (ImprovedHAQ), pain (visual analogue scale (VAS), fatigue (VAS), mental fatigue (VAS), dryness (VAS), cognitive failures (Cognitive Failures Questionnaire) and recorded their age and disease duration. Significant correlates of each of the SF-36 domain were identified and multiple regression analysis performed for each of the domains to determine partial regression coefficients. Model robustness was determined by hierarchical regression analysis testing the sensitivity of the model to the order of inclusion.

Results: With one exception, PSS patients scored significantly worse than the norm-based scores for all domains of the SF-36, including Physical Functioning, Role Physical, Bodily Pain, Vitality, Social Functioning, Role Emotional and Mental Health (p<0.001). General Health was the exception and there was no significant difference between the pSS patients and the norm-based scores. All SF-36 domains correlated significantly with anxiety, depression, cognitive failures, mental fatigue, pain, fatigue and dryness (p<0.001). 

Fatigue and depression were the main predictors of poorer Role Physical and Social Functioning domain scores (all p≤0.006). Fatigue was a predictor of Bodily Pain (p<0.001) and pain was an independent predictor of poor Physical Functioning (p<0.001). Depression and pain were the main independent predictors of the Vitality domain (p≤0.006) and the General Health domain (p≤0.043). The main predictors of the Role Emotional domain were fatigue, anxiety and depression (p≤0.037) and of the Mental Health domain were disease duration and cognitive failures (p≤0.026).

Conclusion: This study demonstrates that fatigue and depression, followed by anxiety and pain are key predictors of the reduced ability to perform daily activities, take on life roles and quality of life. These factors should be addressed during therapeutic interventions with PSS patients presenting with these symptoms. This in turn could support PSS patients to carry out daily activities, take on social and physical life roles and improve their quality of life.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/doing-every-day-life-with-primary-sjgrens-syndrome-factors-predicting-difficulties-performing-daily-activities-and-taking-on-life-roles/