title: Acupuncture for Primary Sjögren Syndrome (pSS) on symptomatic improvements: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Currently, feasible medical treatments are hitherto not satisfying to relieve pSS symptoms, which concerns numbers of clinical doctors. Acupuncture seems to be an alternative to treat pSS and conduces to good symptomatic results. However further research is necessary. This trial is to investigate the efficacy of acupuncture on improving the key symptoms of pSS, which are dryness, pain and fatigue (DPF).
  
  
  METHODS
  The study is designed as a randomized controlled trial of two arms with a single centre. We compare acupuncture with sham acupuncture on symptomatic improvements of pSS. A total of 120 pSS patients, aged at least 18, with DPF, will be randomly assigned to acupuncture or sham acupuncture groups, where they will have needle intervention for 8 weeks with 16 weeks of follow-up. Subjects will be assessed each time before interventions during the 8-week intervention, in week 8 after all interventions and in week 12, 16, 20 and 24 for follow-up with different measurements. The primary outcome are the proportions of subjects that have 30% or greater reduction in at least 2 out of 3 items of DPF in Numeric Analog Scale (NAS) scores (0 = the best, 10 = the severest), calculated between the baseline and the average scores of week 2 to 8. The secondary outcome are related to individual items of NAS scores, EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI), Schirmer test score and unstimulated salivary flow, serum Immunoglobulin G, A and M levels, Medical Outcome Study Short Form 36 Short-Form Health Survey (SF-36), Salivary glands ultrasounds, Hospital Anxiety and Depression (HAD) scale score. The secondary outcome scores are to be collected at baseline, in week 8, 16, and 24. Besides, individual items of NAS will also be collected in week 12 and 20. Moreover, subjects' satisfaction and the proportion of the subjects who identified their allocation will also be measured and analyzed.
  
  
  CONCLUSIONS
  This study will be the first randomized and controlled pilot trial of acupuncture on alleviating the symptoms of pSS with relatively long-term follow-up. The result of the study might offer a new option to treat pSS and might be a clinical proof that acupuncture has beneficial effects on pSS.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT02691377 (February 20, 2016).
authors.affiliation: Rheumatology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
authors.forename: Quan
authors.initials: Q
authors.lastname: Jiang
authors.affiliation: Rheumatology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
authors.forename: Huadong
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Urology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
authors.forename: Ran
authors.initials: R
authors.lastname: Pang
authors.affiliation: College of Acupuncture & Moxibustion, Beijing University of Chinese Medicine (BUCM), Beijing, China.
authors.forename: Jinzhou
authors.initials: J
authors.lastname: Chen
authors.affiliation: Acupuncture Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
authors.forename: Zhishun
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Rheumatology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China. xyz_1102@126.com.
authors.forename: Xinyao
authors.initials: X
authors.lastname: Zhou
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods; D000293:Adolescent; D000328:Adult; D002985:Clinical Protocols; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D012107:Research Design; D012859:Sjogren's Syndrome / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acupuncture; Fatigue; Pain; Randomized controlled trial; Sjogren’s syndrome; Xerostomia