Sjogren's Syndrome
Clinimetric methods in Sjögren's syndrome

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Objective

Clinimetric tools are useful in both clinical practice and research of Sjögren's syndrome. These instruments assist in the establishment of diagnosis and in the evaluation of disease status. We reviewed the available methods used to monitor sicca signs and symptoms, fatigue, quality of life as well as activity/chronicity in SS.

Methods

PubMed and MEDLINE database were searched for the keywords “keratoconjunctivitis sicca diagnosis,” “dry eye and dry mouth assessment,” “sialometry,” “sialochemistry,” “Sjögren's syndrome outcomes,” “Sjögren's syndrome activity,” “Sjögren's syndrome damage,” “fatigue scales in Sjögren's syndrome,” and “Sjögren's syndrome quality of life.” All relevant articles and pertinent secondary references were reviewed.

Results

As there is a moderate correlation between sicca symptoms and signs, the assessment of both is crucial. Most of the tests focus on oral and ocular dryness (vital dye staining, tear quantification, tear composition, sialometry, sialochemistry, etc.) and may not be disease specific. Symptoms such as dryness and fatigue have been evaluated with different instruments, being the PROFAD and ESSPRI disease-specific tools. Standardized measures for activity (SSDAI, SCAI, and ESSDAI) and chronicity (SSDDI and SSDI) indexes are currently used, however these methods still present limitations such as low external validity and cross-validation.

Conclusion

The heterogeneous nature of the disease and its slow progression, challenge the evaluation of these patients. The use of composite measures might increase our ability to diagnose and evaluate disease activity and cumulative irreversible organ injury in this disease. However the distinction among oral and ocular activity vs. damage is still a matter of research.

Section snippets

Methods

PubMed and MEDLINE databases were searched from date of inception until April 2012 for the keywords “keratoconjunctivitis sicca diagnosis,” “dry eye and dye mouth assessment,” “sialometry,” “sialochemistry,” “Sjögren's syndrome outcomes,” “Sjögren's syndrome activity,” “Sjögren's syndrome damage,” ”fatigue scales in Sjögren's syndrome,” and “Sjögren's syndrome quality of life.” The search was limited to reports in human subjects and in English language. Relevant articles and pertinent secondary

Results

The process of literature search and selection is depicted in Figure 1. The database search identified 564 articles that were screened for eligibility. Four hundred and sixty articles were excluded on the basis of abstract evaluation because they were irrelevant to study subject (either not related to SS or not describing clinimetic modalities). The remaining potentially relevant 104 articles were retrieved for detailed full text evaluation. We also searched by hand relevant secondary

Discussion

Various methods have been employed to assess the salivary and lacrimal involvement in SS, however a limited number of them have been subjected to evaluation to establish their clinical utility. In addition as there is a lack of a gold standard diagnostic test, combinations of different tests are commonly performed to help determining an accurate diagnosis. Some tools seem to be more appropriate for screening purposes (i.e. Schirmer test and wafer test) whereas others have a higher diagnostic

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