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

Disclosures

Arthritis Res Ther. 2020;22(39) 

In This Article

Results

Variations of Fatigue Pain and Dryness Intensity Between Seasons

A total of 632 patients were analysed. We collected and analysed a total of 2858 VASs observations through the four studies (the number of patients withdrawn due to missing VAS data is shown on Figure 1).

Table 1 shows the number of VASs for fatigue pain and dryness recorded in spring, summer, fall and winter and the variation of the ESSPRI score according to the season.

Mean (SD) pain VAS was 52.2 (27.9) on a 100-unit scale, 55.1 (28.1), 51.0 (28.7) and 51.7 (28.4) in spring, summer, fall and winter, respectively (p = 0.7541). Mean (SD) fatigue was 61.9 (23.2), 62.2 (25.2), 60.0 (25.5), and 61.9 (24.2), respectively (p = 0.7973). Mean (SD) dryness was 58.9 (21.8), 61.2 (22.9), 56.9 (22.8) and 57.9 (23.8), respectively (p = 0.4108). Moreover, the ESSPRI score, which is the mean of the three VASs values for a given patient, was 57.7 (24.3), 59.5 (24.5), 55.9 (25.7) and 57.2 (25.5) on a 100-unit scale, in spring, summer, fall and winter, respectively (p = 0.7288). None of these fluctuations was statistically significant (p > 0.05).

In addition, variations from month to month (Figure 2a) or season to season (Table 1; Figure 2b) of mean pain, fatigue and dryness were not significant either. Maximum between-months variation for pain was 7.2 on a 100-unit scale, 7.7/100 and 5.5/100 for dryness and fatigue, respectively. In addition, using cosine transform of time effect and different time lags, no time effect was observed in any model (data not shown).

Figure 2.

Pain, fatigue and dryness fluctuations across months and seasons. a Box plots of VAS variations between months from January (month: 1) to December (month: 12). b Box plots of VAS variations between seasons. Spring (Spr) is depicted in green, summer (Sum) in red, fall (Fal) in brown and winter (Wint) in blue

Moreover, multivariate analyses were performed in the ASSESS cohort to address the influence on objective assessments of dryness (Schirmer test and unstimulated salivary flow) of potential confounding factors, such as age of patients, symptomatic treatments of dryness and systemic immunomodulatory treatments. Adjusted odds ratios (aOR) on age and treatment regimens did not detect any statistically significant seasonal effect on Schirmer test, with aOR of having a pathological Schirmer test (≤5 mm) of 0.93 CI 95% [0.42–1.8] (p = 0.82), 0.95 CI 95% [0.43–2.14] (p = 0.89) and 0.75 CI 95% [0.38–1.53] (p = 0.35) in spring, summer and winter, respectively, in comparison to values collected in fall. Treatment regimens did not show any influence on salivary flow either, since aOR of having a pathological salivary flow (SF < 0.1 mL/min) was 1.23 CI 95% [0.49–2.64] (p = 0.58), 0.71 CI 95% [0.24–1.43] (p = 0.38) and 0.83 CI 95% [0.34–1.68] (p = 0.6), in spring, summer and winter, respectively, in comparison to values collected in fall (Additional file 1: Table S2).

The influence on PROs of age, symptomatic treatments of dryness and immunomodulatory treatments was also analysed in the ASSESS cohort. All the variations of pain, fatigue and dryness VASs and of the ESSPRI score over seasons, adjusted on age and treatment regimen were very limited and did not reach statistical significance. Adjusted pain VASs variations were 1.3 on a 100-unit scale, CI 95% [− 1.6; 4.4] (p = 0.4), 0/100 CI 95% [− 3; 2.9] (p = 0.99) and − 0.3/100 CI 95% [− 3; 2.4] (p = 0.83), in spring, summer and winter, respectively, in comparison to values collected in fall. Adjusted fatigue VASs variations were 1.3/100 CI 95% [− 1.3; 4] (p = 0.33), 0.4/100 [− 2.2; 3] (p = 0.79), and − 0.2/100 [− 2.7; 2.2] (p = 0.84) in spring, summer and winter, respectively, in comparison to values collected in fall. Adjusted dryness VASs variations were 1.3/100 CI 95% [− 1; 3.6] (p = 0.27), 2/100 CI 95% [− 0.3; 4.3] (p = 0.09) and 0.6/100 CI 95% [− 1.5; 2.8] (p = 0.55), respectively, in comparison to values collected in fall. Finally, adjusted ESSPRI score changes were of 1.2/100 CI 95% [− 0.8; 3.2] (p = 0.25), 0.6/100 CI 95% [− 1.4; 2.6] (p = 0.55) and − 0.2/100 CI 95% [− 2.1; 1.6] (p = 0.82), respectively, in comparison to values collected in fall (Additional file 1: Table S3).

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