4 research outputs found
Fatigue in primary Sjogren's syndrome
OBJECTIVE: To assess fatigue in relation to depression, blood pressure,
and plasma catecholamines in patients with primary Sjogren's syndrome
(SS), in comparison with healthy controls and patients with rheumatoid
arthritis. METHODS: For the assessment of fatigue the Multidimensional
Fatigue Inventory (MFI) was used, a 20 item questionnaire, covering the
following dimensions: general fatigue, physical fatigue, mental fatigue,
reduced motivation, and reduced activity. Furthermore, the Zung depression
scale was used to quantify aspects of depression. Forty nine female
primary SS patients, 44 female patients with rheumatoid arthritis (RA),
and 32 healthy women filled in both questionnaires. In addition, supine
values of blood pressure and plasma catecholamines were measured in the
patients with primary SS. RESULTS: Primary SS patients were more fatigued
compared with the healthy controls on all the five dimensions of the MFI.
When the analyses were repeated using depression as a covariate, group
differences disappeared for the dimensions of reduced motivation and
mental fatigue. In the primary SS patients, significant positive
correlations between depression and the dimensions of reduced motivation
and mental fatigue were found. Comparing patients with primary SS with
those with RA, using depression as covariate, no statistically significant
differences were found between these groups. No relation between fatigue
and blood pressure was found, but a negative correlation was observed
between the general fatigue subscale of the MFI and plasma noradrenaline.
CONCLUSION: Patients with primary SS report more fatigue than healthy
controls on all the dimensions of the MFI and when controlling for
depression significant differences remain on the dimensions of general
fatigue, physical fatigue, and reduced activity. The negative correlations
between levels of noradrenaline and general fatigue in patients with
primary SS may imply the involvement of the autonomic nervous system in
chronic fatigue
Parasympathetic failure does not contribute to ocular dryness in primary Sjogren's syndrome
OBJECTIVE: To investigate the sympathetic and parasympathetic
cardiovascular function in primary Sjogren's syndrome (SS) and to
investigate the possible relation with ocular dryness. METHODS: 41 (40
women) patients with primary SS, mean age 50 years (range 20-80) with a
mean disease duration of eight years (range 1-30), were studied. In each
patient direct arterial blood pressure (BP), heart rate (HR) and
respiration were measured continuously for two hours. The function of the
autonomic circulatory regulation was evaluated by measuring the heart rate
response to deep breathing (6 cycles/min) and by means of the Valsalva
manoeuvre and the responses of BP, HR and plasma noradrenaline
(norepinephrine) concentrations to a 10 minute 60 degree head up tilt
test. Pupillography was done to evaluate ocular autonomic function.
RESULTS: The HR-Valsalva ratio was abnormal in 24% of the patients, and
the HR variability during forced respiration was abnormal in 56% of the
patients. The HR responses to both the Valsalva manoeuvre and deep
breathing, as indicators of parasympathetic function, were abnormally low
in 6 of 41 (15%) patients. In only two patients the decrease in systolic
BP in response to the head up tilt test, as indicator of sympathetic
function, was more than 20 mm Hg. However, increment of plasma
noradrenaline concentration during head up tilt test and the overshoot of
BP in phase IV of the Valsalva manoeuvre, as indicators of sympathetic
function, were normal in both patients. Thus, no evidence for sympathetic
dysfunction was found, whereas evidence for parasympathetic failure
occurred sometimes. Autonomic pupillary function in patients with primary
SS and healthy controls, as well as the Schirmer test in patients with or
without evidence for parasympathetic dysfunction as based on the results
of the Valsalva and deep breathing tests, were not significantly
different. CONCLUSION: Parasympathetic, but not sympathetic dysfunction
seems to occur in a subgroup of primary SS. Results show that this does
not necessarily contribute to the typical ocular dryness in this
condition
Involvement of the peripheral nervous system in primary Sjogren's syndrome
BACKGROUND: Involvement of the peripheral nervous system in patients with
primary Sjogren's syndrome (SS) has been reported, but its prevalence in
neurologically asymptomatic patients is not well known. OBJECTIVE: To
assess clinical and neurophysiological features of the peripheral nervous
system in patients with primary SS. PATIENTS AND METHODS: 39 (38 female)
consecutive patients with primary SS, aged 20-81 years (mean 50), with a
disease duration of 1-30 years (mean 8) were studied. The peripheral
nervous system was evaluated by a questionnaire, physical examination,
quantified sensory neurological examination, and neurophysiological
measurements (nerve conduction studies). To assess autonomic
cardiovascular function an orthostatic challenge test, a Valsalva
manoeuvre, a forced respiration test, and pupillography were done.
RESULTS: Abnormalities as indicated in the questionnaire were found in
8/39 (21%) patients, while an abnormal neurological examination was found
in 7/39 (18%) patients. Abnormalities in quantified sensory neurological
examination were found in 22/38 (58%) patients. In 9/39 (23%) patients,
neurophysiological signs compatible with a sensory polyneuropathy were
found. No differences were found in the autonomic test results, disease
duration, serological parameters, or erythrocyte sedimentation rate
between the patients with primary SS with and those without evidence of
peripheral nervous involvement. CONCLUSION: Subclinical abnormalities of
the peripheral nervous system may occur in patients with primary SS
selected from a department of rheumatology, but clinically relevant
involvement of the peripheral nervous system in this patient group is
rare
Do we need to lower the cut point of the 2010 ACR/EULAR classification criteria for diagnosing rheumatoid arthritis?
__Objective__ In this study we aimed to evaluate the effect of lowering the cut point of the 2010 criteria to identify more patients with RA among early inflammatory arthritis patients.
__Methods__ We included early arthritis patients from the Rotterdam Early Arthritis Cohort with at least one joint with clinical synovitis and symptoms for <1 year, with no other explanation for their symptoms. The demographic and clinical characteristics of each patient were recorded at baseline. Patients were classified as case or non-case at the 1-year follow-up by the definition used in the development of the 2010 criteria (MTX initiati