Background/Purpose: The ESSPRI is a validated index for measuring symptoms (pain, fatigue and dryness) in primary Sjögren’s syndrome (pSS). Herein we evaluated its association with disease and non-disease related variables, and its variation though the follow-up.

Methods: We included consecutive patients with pSS according to the ACR/EULAR classification criteria who attended a referral tertiary center during 2016-2018. We excluded patients with another connective disease. A single rheumatologist interviewed the patients and registered the following variables: demographics, scholarship, smoking, menopause, body mass index, disease duration, comorbidities such as diabetes mellitus, hypothyroidism, depression, and fibromyalgia as well as the Charlson comorbidity index. We also asked about the current use of hormonal replacement, diuretics, anticholinergics antihistamines, prednisone and immunosuppressors. We evaluated the non-stimulated whole salivary flow (NSWSF), Schirmer-I test, and scored the ESSDAI and the ESSPRI.  In addition, in a subset of patients, we scored a second ESSPRI during a follow-up time within 6-36 months. We used descriptive statistics, X2 test, T student test, Mann–Whitney U test and Wilcoxon signed-rank test as appropriated. We used logistic regression analysis reporting OR and 95% CI. A two-tailed P< 0.05 was considered statistically significant. All analyses were performed using the SPSS.

Results: We included 130 patients, most of them were women (98.4%), mean age 57 years±13.4 and median disease duration of 9.3 years. Ocular and oral symptoms were present in 93.8% and 88.4%, respectively. The median ESSPRI score was 6, being the median score 6 for fatigue, 4 for pain and 8 for dryness. Eighty patients (61.5%) had an ESSPRI score >5 points. When we compared this group vs. the group with an ESSPRI ≤5 (n=50), the first group had a higher frequency of fibromyalgia (12.5% vs. 2%, p=0.05) and depression (30% vs. 10%, p=0.008) as well as a lower NSWSF (0.2 ml/15 min vs. 1.1 ml/15 min, p=0.05). We did not observe differences among the rest of the variables. At the logistic regression analysis, the variables that remained associated were depression (OR 3.7, 95% CI 1.23-11.3, p=0.02) and NSWSF (OR 0.59, 95% CI 0.36-0.97, p=0.03).

In 62 patients, we performed a second ESSPRI assessment after a median time of 25 months (6-41). Now, the median ESSPRI score was 5.1, being the median score 5 for fatigue, 4 for pain and 6 for dryness. When we compared the basal and the follow up ESSPRI results, we found a statistically difference between the overall ESSPRI score (p=0.01), the fatigue (p=0.02) and dryness (p=0.004) domains, but not for pain. Among the patients with a second ESSPRI score, 44 (70%) patients increased their ESSPRI in ≥1 points. None of the studied variables were associated with this change in the ESSPRI.

Conclusion: We observed that the ESSPRI was associated with low NSWSF, but also with non-disease related variables such as depression. Most of the patients experienced a variation of this score though the follow- up, nevertheless the variables that might influence its change remains to be elucidated.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-influencing-the-esspri-index-in-primary-sjogrens-syndrome/