How's Your Sjögren's Patient? Dry Mouth Tells (Nearly) All

Gandía M, Morales-Espinoza EM, Martín-González RM, et al.  Factors Influencing Dry Mouth in Patients with Primary Sjögren Syndrome:Usefulness of the ESSPRI Index. Oral Health Dent Manag. (2014) 13:402-407

A good way to judge the severity of Sjögren syndrome (SS) might be simply to ask patients how dry their mouth feels, on a one-to-ten scale. According to this study from a dental journal, that single item on the EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) questionnaire tracks closely with the other important and troubling symptoms of the condition, including fatigue, pain, sleep loss, and anxiety and depression.

The intensity of xerostomia also correlates with cardiovascular risk factors, most strongly (in multivariate regression analysis) with hypercholesterolemia.

The nature and cause-effect relationship between the symptoms is not clear, but as 95% of patients with Sjögren syndrome have xerostomia, it appears worthy of particular attention.

The authors, who are immunologists, primary care physicians, and rheumatologists, asked 90 consecutive patients with primary SS at Hospital Clinic in Barcelona to complete ESSPRI. As well as fulfilling standard diagnostic criteria, patients had to have either positive autoanticodies or diagnosis by salivary biopsy to qualify for the study.

It compared mean values on the dry-mouth item in ESSPRI with:

•  other sicca features,
• general symptoms such as fatigue and pain,
• psychological and psychiatric features assessed using two standard questionnaires,
• four measures of health-related quality of life (HRQOL),
• extraglandular involvment masured by the 2010 EULAR SS disease activity index (ESSDAI),
• antibody results (ANA, RF, anti0Ro/SS-A and anti-La/SS-B), and • cardiovascular risk factors.

The intensity of oral dryness correlated significantly with the intensity of fatigue, both mental and general, and with pain, as well as with the quality of sleep. There were also significant correlations with hypertension, type II diabetes, and hypercholesterolemia, although only the latter correlation was independent as judged by multivariate regression analysis.

The link between the intensity of xerostomia and cardiovascular problems deserves closer attention for its treatment implications, these authors say. But at present, one of the best ways to minimize oral dryness and its consequences is to assure that a dentist is part of the management team to supply individualized oral care.