Background/Purpose: Fatigue is one of the dominant symptoms of patients with Primary Sjogren’s syndrome (pSS). However, whether fatigue is specific to pSS compared to secondary SS (sSS) has not been investigated to date. The severity and risk factors that can affect fatigue may differ in groups between pSS and sSS. In this study, we aimed to evaluate the differences in subjective manifestations including fatigue, dryness, and pain between patients with pSS and sSS, and to determine the risk factors associated with fatigue.

Methods: This single-center, prospective study enrolled patients with pSS and sSS who met the 2016 American College of Rheumatology/European League Against Rheumatism (ACR/ EULAR) classification criteria and were aged ≥19 years. Patients were evaluated using questionnaire with Functional Assessment of Chronic Illness Therapy- Fatigue (FACIT-Fatigue) scale (Version 4), having thirteen items associated with fatigue evaluation with numeric scale of 0 to 4. Additionally, EULAR Sjogren Syndrome Patients Reported Index (ESSPRI), which have numerical scale from 0 to 10 for measurement of musculoskeletal pain, fatigue and dryness, were assessed. The following data were collected from all patients: disease duration, smoking history, autoantibodies, laboratory data, Schirmer’s test, whole unstimulated salivary flow rate, focus score, salivary gland ultrasound, organ involvement, medication, and other comorbidities including fibromyalgia and hypothyroidism. A linear regression analysis was performed to determine the factors associated with fatigue.

Results: A total of 72 patients with pSS and 78 sSS patients were included in this study. Patients with pSS had significantly higher scores of FACIT-fatigue scales (7.95 vs 5.88, p< 0.01) and ESSPRI (5.56 vs 4.49, p< 0.01) compared to those with sSS. Among the thirteen questions of FACIT-fatigue scales, nine questions were proved to be significantly higher in patients with pSS while four (questionnaire number 5-8 related to physical activity) were not. Each score of ESSPRI was also higher in pSS than sSS: fatigue (6.08 vs 5.10), pain (4.35 vs 3.32), dryness (6.24 vs 5.05) (all p< 0.05). In univariate regression analysis, only presence of arthritis (β=2.36, p< 0.05) was associated with the FACIT-Fatigue scale. Age, other clinical findings, laboratory findings, severity of glandular involvement, organ involvement, and medication were not associated with fatigue.

Conclusion: Our study confirmed patients with pSS manifest higher subjective discomfort with fatigue, pain, and dryness than those with sSS. Arthritis was an only risk factor associated fatigue in pSS patients, suggesting management of arthritis could improve fatigue.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fatigue-and-associated-factors-in-patients-with-primary-sjogrens-syndrome-compared-to-secondary-sjogrens-syndrome/