Seasonal Effect on Fatigue, Pain and Dryness in Primary Sjögren's Syndrome

Pierre-Marie Duret; Nicolas Meyer; Alain Saraux; Valérie Devauchelle-Pensec; Raphaele Seror; Véronique Le-Guern; Claire Larroche; Aleth Perdriger; Jean Sibilia; Vianney Guardiolle; Xavier Mariette; Jacques-Eric Gottenberg


Arthritis Res Ther. 2020;22(39) 

In This Article


Seasonality in rheumatic diseases is an issue frequently perceived and voiced by patients. Several studies have identified weather-related flares in rheumatoid arthritis (RA).[1,2] Weather conditions might also influence pain and function in osteoarthritis,[3] and a seasonal pattern in gout incidence has been described.[4]

In addition, cyclic seasonal variations have been associated with disease onset and activity or worsening of symptoms in immune-mediated inflammatory diseases (IMIDs), in giant cell arteritis (GCA),[5] inflammatory myopathies,[6] systemic lupus erythematosus (SLE)[7] and ANCA-associated vasculitis.[8] Interestingly, seasonal variations are not associated with clinical outcomes in psoriatic arthritis.[9]

However, seasonality has not been investigated in primary Sjögren's syndrome (pSS) yet. Primary Sjögren's syndrome is the second most frequent systemic auto-immune disease, and it is clinically characterised by the disabling triad pain, dryness and fatigue and is immunologically associated with antinuclear antibodies, anti Ro/SSA and/or La/SSB and the presence, in up to one third of the patients, of ectopic lymphoid structures developed in the target organs of the disease, which are mainly salivary and lacrimal glands.[10]

Since fatigue, pain and dryness represent most of the disease burden shared by all patients with pSS, they compose the internationally validated ESSPRI (EULAR Sjögren's Syndrome Patient Reported Index) score,[11] an outcome criteria evaluated in all on-going clinical trials.

Although fatigue, pain and dryness represent a major concern for patients with pSS, there is no data available in the literature regarding the potential variations of these symptoms according to seasonality.

Based on previous reports that have demonstrated, in RA, a worsening of pain and fatigue in winter and an increase of dryness in spring in dry eye symptoms unrelated to pSS, it could be hypothesised that fall and winter are associated with increased fatigue and pain and spring and summer with exacerbation of ocular and oral dryness in pSS.

This study was therefore conducted to assess whether seasonal variations have an influence on pSS outcomes.