Gebreegziabher Elisabeth A, Bunya Vatinee Y, Baer Alan N, Jordan Richard C, Akpek Esen K, Rose-Nussbaumer Jennifer, Criswell Lindsey A, Shiboski Caroline H, Lietman Thomas M, Gonzales John A
Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA.
Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Pain Pract. 2021 Jul;21(6):630-637. doi: 10.1111/papr.13000. Epub 2021 Feb 17.
To evaluate how ocular, oral, and bodily neuropathic pain symptoms, which characterize small fiber neuropathies, are associated with Sjögren's syndrome (SS) classification based on the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria.
Participants enrolled in the Sjögren's International Collaborative Clinical Alliance (SICCA) registry had ocular, rheumatologic, oral, and labial salivary gland (LSG) biopsy examinations, blood and saliva samples collected, and completed questionnaires at baseline. We used mixed effects modeling with age, country, gender, and depression being fixed effects and study site, a random effect, to determine if neuropathic pain indicators (assessed via questionnaires) were associated with being classified as SS.
A total of 3,514 participants were enrolled into SICCA, with 1,541 (52.9%) meeting the 2016 ACR/EULAR classification criteria for SS. There was a negative association between being classified as SS and experiencing bodily neuropathic pain features of needle-like pain, prickling/tingling sensation, ocular neuropathic pain of constant burning, and constant light sensitivity, and having a presumptive diagnosis of neuropathic oral pain.
We found that those classified as SS had lower scores/reports of painful neuropathies compared with those classified as non-SS. Non-SS patients with dry eye disease or symptoms could benefit from pain assessment as they may experience painful small-fiber neuropathies (SFNs). Pain questionnaires may help identify pain associated with SFNs in patients with SS and non-SS dry eye. Future studies would be helpful to correlate self-reports of pain to objective measures of SFNs in those with SS, non-SS dry eye, and healthy controls.
评估以小纤维神经病变为特征的眼部、口腔和身体神经性疼痛症状如何与基于美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）标准的干燥综合征（SS）分类相关联。
参与干燥综合征国际协作临床联盟（SICCA）登记的参与者进行了眼部、风湿病学、口腔和唇腺（LSG）活检检查，采集了血液和唾液样本，并在基线时完成了问卷调查。我们使用混合效应模型，将年龄、国家、性别和抑郁作为固定效应，研究地点作为随机效应，以确定神经性疼痛指标（通过问卷调查评估）是否与被分类为SS相关。
共有3514名参与者纳入SICCA，其中1541名（52.9%）符合2016年ACR/EULAR的SS分类标准。被分类为SS与出现身体神经性疼痛特征（如针状疼痛、刺痛/麻刺感）、眼部持续性灼痛和持续性光敏感的神经性疼痛，以及有神经性口腔疼痛的推定诊断之间存在负相关。
我们发现，与被分类为非SS的患者相比，被分类为SS的患者神经性疼痛的评分/报告较低。患有干眼症或有相关症状的非SS患者可能会从疼痛评估中受益，因为他们可能会经历疼痛性小纤维神经病变（SFN）。疼痛问卷可能有助于识别SS和非SS干眼症患者中与SFN相关的疼痛。未来的研究将有助于将疼痛的自我报告与SS患者、非SS干眼症患者和健康对照者的SFN客观测量结果相关联。
