Arends Suzanne, Meiners Petra M, Moerman Rada V, Kroese Frans G M, Brouwer Elisabeth, Spijkervet Frederik K L, Vissink Arjan, Bootsma Hendrika
Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, the Netherlands.
Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, the Netherlands.
Clin Exp Rheumatol. 2017 Mar-Apr;35(2):255-261. Epub 2016 Dec 28.
Besides ocular and oral dryness, fatigue is a major symptom in patients with primary Sjögren's syndrome (pSS). Our aim was to investigate the importance of fatigue in relation to other symptoms experienced as well as to evaluate the effect of rituximab treatment on fatigue in pSS patients with active disease.
This analysis was based on data from our open-label rituximab study in 28 pSS patients. Symptoms of dryness, physical fatigue, pain, and mental fatigue were scored on 0-10 scales (according to ESSPRI). Systemic disease activity was assessed with ESSDAI.
At baseline, 24 (86%) patients rated physical fatigue as the complaint most eligible for improvement (median importance of 10), followed by pain, dryness, and mental fatigue. After rituximab treatment, physical fatigue showed maximum improvement of 2.5 points and 31% in median values at group level, and 10 (36%) patients reached physical fatigue score<5 representing patient-acceptable symptom state (PASS). In comparison, systemic disease activity improved 5.5 points and 73% at group level, and 22 (79%) patients reached ESSDAI<5 representing low disease activity. GEE analysis over time revealed that physical fatigue was significantly associated with absolute number of B cells, dryness and mental fatigue, but not with ESSDAI, IgG levels and IgM-RF.
Physical fatigue characterises patient experience of pSS. Rituximab treatment resulted in significant improvement of patient-reported symptoms. However, the large majority of patients still experienced physical fatigue at an unsatisfactory level, above the cut-off value for PASS. Therefore, attention for optimal management of this prominent symptom is warranted.
除眼干和口干外，疲劳是原发性干燥综合征（pSS）患者的主要症状。我们的目的是研究疲劳相对于其他症状的重要性，并评估利妥昔单抗治疗对活动性疾病的pSS患者疲劳的影响。
本分析基于我们对28例pSS患者进行的开放标签利妥昔单抗研究的数据。干燥、身体疲劳、疼痛和精神疲劳症状采用0-10分制评分（根据欧洲抗风湿病联盟干燥综合征疾病活动指数[ESSPRI]）。采用欧洲抗风湿病联盟干燥综合征系统性疾病活动指数（ESSDAI）评估全身疾病活动度。
在基线时，24例（86%）患者将身体疲劳评为最需要改善的症状（中位数重要性为10分），其次是疼痛、干燥和精神疲劳。利妥昔单抗治疗后，身体疲劳在组水平上中位数最大改善2.5分，改善率为31%，10例（36%）患者身体疲劳评分<5分，代表患者可接受的症状状态（PASS）。相比之下，全身疾病活动度在组水平上改善了5.5分，改善率为73%，22例（79%）患者ESSDAI<5分，代表低疾病活动度。随时间的广义估计方程（GEE）分析显示，身体疲劳与B细胞绝对计数、干燥和精神疲劳显著相关，但与ESSDAI、IgG水平和IgM类风湿因子（IgM-RF）无关。
身体疲劳是pSS患者的主要症状。利妥昔单抗治疗使患者报告的症状有显著改善。然而，绝大多数患者仍经历着不能令人满意的身体疲劳水平，高于PASS的临界值。因此，有必要关注对这一突出症状的最佳管理。
