title: Physical fatigue characterises patient experience of primary Sjögren's syndrome.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, the Netherlands. s.arends@umcg.nl.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Arends
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Petra M
authors.initials: PM
authors.lastname: Meiners
authors.affiliation: Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Rada V
authors.initials: RV
authors.lastname: Moerman
authors.affiliation: Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Frans G M
authors.initials: FG
authors.lastname: Kroese
authors.affiliation: Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Brouwer
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Frederik K L
authors.initials: FK
authors.lastname: Spijkervet
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Arjan
authors.initials: A
authors.lastname: Vissink
authors.affiliation: Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, the Netherlands.
authors.forename: Hendrika
authors.initials: H
authors.lastname: Bootsma
mesh_terms: D000328:Adult; D005221:Fatigue / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006304:Health Status; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction; D012074:Remission Induction; D000069283:Rituximab / Q000627:therapeutic use; D012720:Severity of Illness Index; D012859:Sjogren's Syndrome / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000069283:Rituximab