Peripheral neuropathy is a common complication of primary Sjögren syndrome and may be associated with a diminished health-related quality of life (HR-QoL), according to research results published in Rheumatology International.
Researchers sought to compare HR-QoL outcomes in patients with primary Sjögren syndrome, both with and without peripheral neuropathy. They also aimed to examine the associations between the neurologic complications and components of HR-QoL outcomes using the 36-item Short Form Health Survey (SF-36). Overall, 50 adult patients with primary Sjögren syndrome (median age, 57.5 years; 96% women) were included in the study.
Of the total cohort, 80% (n=40) reported subjective symptoms, including paresthesia or other symptoms that were suggestive of neuropathic pain on a periodic or permanently present basis. In total, 46% (n=23) of patients met the criteria for a diagnosis of peripheral neuropathy (PNS+); the remaining patients were referred to as PNS-.
Researchers indicated the most common peripheral nervous system manifestation to be sensorimotor neuropathy, which was present in 47% of patients who were PNS+. Mononeuropathy was present in 26%, pure axonal sensory neuropathy, axonal motor neuropathy, and small fiber neuropathy were each present in 4.3%, and cranial nerve involvement was present in 17.4% of patients who were PNS+; 1 patient experienced both cranial and sensorimotor neuropathy. Among 35% of patients who were PNS+, neurologic symptoms preceded patients’ diagnosis of primary Sjögren syndrome.
Investigators studied data from both groups of patients in terms of clinical characteristics and laboratory testing results, and observed similarity in age, disease duration, time from diagnosis, and time of symptom onset. Clinical manifestations, including parotid enlargement, respiratory tract involvement, lymphadenopathy, and hypocomplementemia were significantly more prevalent among patients who were PNS+ vs those who were PNS- (74% vs 44%; 65% vs 37%; 61% vs 19%; and 26% vs 7%, respectively). In addition, patients in the PNS+ vs PNS- group were statistically significantly more likely to frequently use cyclophosphamide because of extraglandular manifestations (17% vs 0%, respectively).
Both groups were also compared based on the results of the visual analog scale (VAS)-pain scale, SF-36, and an interview regarding pain type. Among patients who were PNS+ vs PNS-, median VAS-pain was 3 vs 0, respectively (range, 0-7; P =.229). Neuropathic type pain was often observed across both subgroups but was predominantly among patients who were PNS+ compared with those who were PNS- (70% vs 41%).
Across the 5 domains of the SF-36, patients who were PNS+ vs PNS- had significantly lower results in terms of physical and emotional roles, vitality, bodily pain, and general health (P ≤.05).
Study limitations included potential referral bias in patient selection, researchers’ inability to conduct neurophysiologic testing in individuals suspected of pure small-fiber neuropathy, and a lack of unambiguous differentiation between Sjögren syndrome-related neuropathy and other forms of neuropathy.
“Our study showed that peripheral nervous involvement is frequent in [patients with primary Sjögren syndrome] and it is correlated with worse HR-QoL,” the researchers concluded. “To get the complete picture of [patients with Sjögren syndrome], a holistic approach starting with a comprehensive assessment of disease activity…is needed.”
Jaskólska M, Chylinska M, Masiak A, et al. Peripheral neuropathy and health-related quality of life in patients with primary Sjögren’s syndrome: A preliminary report [published online March 14, 2020]. Rheumatol Int. doi:10.1007/s00296-020-04543-2