巴西风湿病学会关于干燥综合征患者神经、认知和精神表现的建议。

Recommendations on neurologic, cognitive, and psychiatric manifestations in patients with Sjögren's disease by the Brazilian Society of Rheumatology.

作者信息

de Oliveira Fabiola Reis, Appenzeller Simone, Pasoto Sandra Gofinet, Fernandes Marilena Leal Mesquita Silvestre, Lemos Lopes Maria Lucia, de Magalhães Souza Fialho Sonia Cristina, Pinheiro Aysa Cesar, Dos Santos Laura Caldas, Valim Valeria, Serrano Erica Vieira, Ribeiro Sandra Lucia Euzébio, Libório-Kimura Tatiana Nayara, do Egypto Danielle Christinne Soares, Cantali Diego Ustárroz, Gennari Juliana D'Agostino, Miyamoto Samira Tatiyama, Capobianco Karina Gatz, Pugliesi Alisson Aliel Vigano, Civile Vinicius Tassoni, Pinto Ana Carolina Pereira Nunes, Rocha-Filho César Ramos, da Rocha Aline Pereira, Trevisani Virginia Fernandes Moça

机构信息

Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Av. Bandeirantes 3900, Vila Monte Alegre, Ribeirão Preto, SP, CEP: 14049-900, Brazil.

Departamento de Ortopedia, Reumatologia e Traumatologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, R. Tessália Vieira de Camargo, 126 - Cidade Universitária, Campinas, SP, CEP: 13083-887, Brazil.

出版信息

Adv Rheumatol. 2025 Feb 11;65(1):7. doi: 10.1186/s42358-025-00438-7.

DOI:10.1186/s42358-025-00438-7

PMID:39934881

Abstract

BACKGROUND

Neurological and psychiatric manifestations occur in patients with primary Sjogren's disease (SjD) with a wide-ranging clinical presentation, affecting quality of life, social participation, and prognosis. Despite this, neither central nor peripheral neurological symptoms are systematically evaluated in the context of autoimmunity or identified as manifestations of SjD. The EULAR Sjogren's Syndrome Disease Activity Index (ESSDAI) covers only part of them in the neurological domain.

METHODS

We performed a systematic review of the diagnosis and prevalence of central, peripheral, and autonomic nervous system manifestations in primary SjD, following the recommendations proposed by the Cochrane Collaboration Handbook. Observational studies were included when their main issue was the diagnosis and the prevalence of the manifestations individually. We employed a generalized linear mixed model (GLMM) method with a random-effects model, and the results were computed using logit transformation, implemented through the 'meta' and 'metafor' packages in the R software (version 3.6.1). To present these recommendations, agreement among experts was investigated using the Delphi method in in-person meetings.

RESULTS

We propose ten recommendations regarding the investigation and management of neurological involvement in SjD that had 100% agreement among participants.

CONCLUSION

These recommendations add to the literature on the clinical care of patients with SjD.

摘要

背景

原发性干燥综合征（SjD）患者会出现神经和精神方面的表现，临床表现范围广泛，影响生活质量、社会参与度和预后。尽管如此，无论是中枢神经系统症状还是周围神经系统症状，在自身免疫的背景下都没有得到系统评估，也未被确定为SjD的表现。欧洲抗风湿病联盟干燥综合征疾病活动指数（ESSDAI）在神经领域仅涵盖了其中一部分。

方法

我们按照Cochrane协作手册提出的建议，对原发性SjD中枢、周围和自主神经系统表现的诊断及患病率进行了系统评价。当观察性研究的主要问题是这些表现的诊断及各自的患病率时，将其纳入研究。我们采用了带有随机效应模型的广义线性混合模型（GLMM）方法，并通过R软件（版本3.6.1）中的“meta”和“metafor”软件包进行logit转换来计算结果。为了提出这些建议，我们在面对面会议中使用德尔菲法调查了专家之间的共识。