ab1903

Fatigue and health profile in sicca syndrome of Sjögren's and non-Sjögren's syndrome origin

E.-K. Tensing¹, S.A. Solovieva^1,2, T. Tervahartiala³, D.C. Nordström⁴, M. Laine^1,2,3, S. Niissalo⁵, Y.T. Konttinen^1,2,3,6

¹Biomedicum Helsinki, Institute of Biomedicine/Anatomy, University of Helsinki; ²Department of Oral Medicine, Surgical Hospital, Helsinki University Hospital; ³Department of Oral Medicine, Institute of Dentistry, University of Helsinki; ⁴Department of Medicine, Helsinki University Central Hospital; ⁵Department of Oral Pathology, University of Helsinki; ⁶ORTON Research Institute, Invalid Foundation, Helsinki, Finland.

ABSTRACT
Objective
To assess the health status and fatigue in sicca patients with or without SjšgrenÕs syndrome (SS) and to test whether the immune-inflammatory activity or the extent of the disease predict fatigue in SS.

Methods
The Medical Outcomes Study Short-Form General Health Survey (MOS SF-36) was used in 1° SS (n = 90), 2° SS (n = 24), non-SS patients with sicca symptoms (n = 15) and healthy population controls (n = 126). Laboratory values and clinical findings were used to predict fatigue in SS.

Results
74% of the SS and 80% of the non-SS sicca patients felt themselves tired. Vitality score values were 40.2 ± 20.3 in 1° SS, 42.1 ± 20.6 in 2° SS and 29.0 ± 15.8 in non-SS. The health profiles were similar in 1° and 2° SS, worse (p < 0.001) than in normal controls, but in most aspects better than in non-SS sicca patients. In SS neither hemoglobin, ESR nor CRP predicted fatigue. Surprisingly, high serum IgG (p < 0.05), antinuclear antibodies (ANA) (p < 0.01) and SS-A antibodies (p < 0.05) values correlated positively with vitality. The number of disease manifestations correlated negatively with vitality (p < 0.004). The total number of disease manifestations, and ANA and/or SS-A autoantibodies were the best predictors of fatigue, but explained it only to 17-57%.

Conclusion
Patients with fatigue and perceived ill health but without fibromyalgia had sicca symptoms and low basal tear and salivary secretion rates, indicating that cortical events can lead to a SS-like sicca syndrome. Even in SS fatigue is only in part explained by clinical disease manifestations and laboratory tests assessing inflammation and autoimmunity. Fatigue in both SS and non-SS sicca syndrome more likely correlates to other features, such as neuroendocrine aspects of the disease.

Key words
Dry eyes, dry mouth, fatigue, Sjögren's syndrome, autoimmunity, inflammation, autoantibodies.

This study was supported by a Linda Gadd grant from Finska Lökaresällskapet and an evo-grant/Helsinki University Hospital.

Please address correspondence to: Professor Yrjö T. Konttinen, MD, Department of Oral Medicine, Surgical Hospital, Kasarmikatu 11-13, FIN-00029 HYKS, Finland.
E-mail: yrjo.konttinen@helsinki.fi