Women with Primary Sjögren´s Syndrome Assessment and Treatment A Physiotherapeutic Perspective

Abstract: Primary Sjögren´s syndrome (primary SS) is a systemic autoimmune rheumatic disease characterized by lymphocytic infiltrations in the exocrine glands leading to classic dryness complaints such as dry eyes and dry mouth. Non-exocrine complaints also occur, e.g. fatigue, myalgia and arthralgia, as well as disturbed mood. The overall purpose of this work was, from a physiotherapeutic perspective, to investigate the consequences of the disease on body function, activity and participation in women with primary SS, in order to obtain a knowledge base suitable for physiotherapeutic interventions. The purpose was also to evaluate the effect of an exercise programme. The first study included 43 women with primary SS and 44 women with fibromyalgia (FMS), who, with the exception of one woman with primary SS, also participated in the second study together with 59 women with rheumatoid arthritis (RA). In these two studies musculoskeletal pain and learned helplessness (I) and health-related quality of life (HRQoL) (II) were evaluated. It was found that musculoskeletal pain was prevalent in most of the women with primary SS and that the prevalence of FMS was increased in this group compared with the general population. Patients with primary SS, classified according to the American-European Consensus Criteria, had less pain than patients classified according to the Copenhagen criteria. Learned helplessness did not differ between the women with primary SS and the women with FMS. HRQoL, according to SF-36, was decreased in the women with primary SS, FMS or RA compared with normal data for Swedish women. The women with primary SS tended to score better on the physical scales and worse on the mental scales than the women with RA. The women with FMS scored worse on all scales. Poor HRQoL was associated with a higher level of pain in the women with primary SS. The third study included 51 women with primary SS and 51 age- and gender- matched control subjects. Components of physical capacity, anxiety, depression and fatigue were investigated. The women with primary SS had a slightly to moderately decreased physical capacity and a higher level of anxiety, depression and fatigue than the control subjects. Aerobic capacity was associated with fatigue in the women with primary SS as were also anxiety, depression and activity limitation according to HAQ. In the fourth study a fatigue questionnaire, the Profile of Fatigue (ProF), specifically designed for patients with primary SS, was translated from English to Swedish and evaluated regarding reliability and validity. Seventy patients with primary SS and 48 control subjects participated in the validation process. Two experienced rheumatologists judged the content of the questionnaire. The ProF was found to be sufficiently reliable and valid for the assessment of fatigue in primary SS. In the fifth study, 21 women with primary SS (one women also had mild systemic erythematosus) were allocated to either a 12-week aerobic exercise programme or to a flexibility programme. Aerobic capacity, fatigue, anxiety, depression and HRQoL were evaluated. After 12 weeks, aerobic capacity, fatigue as measured with a visual analogue scale and depression were significantly improved in the aerobic exercise group compared with flexibility exercise group, while no differences were found in anxiety, HRQoL or fatigue as measured with the ProF. I found in these five studies that musculoskeletal pain was a common symptom in women with primary SS. HRQoL was reduced and was associated with pain intensity. Components of physical capacity were slightly to moderately decreased and associated with fatigue. Aerobic capacity, fatigue and depression were alleviated by an aerobic exercise programme. The ProF is reliable and valid for the measurement of fatigue in primary SS. The sensitivity to change and responsiveness are however unclear and further testing is required in this respect. From these findings I conclude that physiotherapeutic interventions such as methods for pain relief and aerobic exercise may be useful in the treatment of patients with primary SS.