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Background: Ocular involvement in primary Sjögren’s Syndrome (pSS) has been traditionally assessed by Schirmer’s test, Tear Break Up Time (TBUT) and Ocular Staining Score (OSS) 1 . The role of Ocular Surface Disease Index (OSDI), Visual Function Questionnaire-25 (VFQ-25) and Numerical Rating Scale (NRS) in measuring ocular pain and discomfort in pSS have not been yet investigated in detail.
Objectives: To explore the prevalence of ocular pain in patients with pSS, and to investigate the potential correlations between dry eye, ocular pain, extraocular patient-reported outcomes and disease activity.
Methods: In this ongoing cross-sectional study, OSDI, VFQ-25 and NRS for ocular pain were administered to 19 consecutive patients with a definite diagnosis of pSS at our outpatient clinic. All patients signed an informed consent for the study. Pearson coefficients were obtained to assess correlation among EULAR Sjögren’s Syndrome (SS) disease activity index (ESSDAI), EULAR SS Patient Reported Index (ESSPRI), erythrocyte sedimentation rate (ESR), TBUT, OSDI, VFQ-25 and NRS.
Results: In the study, 19 consecutive patients have been enrolled so far. The sample demographics and disease-related features are representative of a typical pSS population (10% male sex, median age at diagnosis of 49 [IQR 24], median ESSDAI = 1 [IQR 6] being biological, haematological and glandular involvement the most represented). Prevalence of ocular pain of any grade (NRS>0) was 11/19 (58%); 6 patients (33%) reported severe ocular pain (NRS≥5). The correlation analysis was significantly strong for patient-reported dryness (ESSPRId), ocular surface-associated symptoms (OSDI), and stability of the tear film (TBUT) with NRS for ocular pain. Moreover, ocular pain also correlated with generalised pain (ESSPRIp) and fatigue (ESSPRIf), while a significant correlation was outlined for OSDI (but not TBUT) with ESSDAI and ESR. Detailed results are summarised in
Pearson r coefficients calculated for self-reported ocular pain (NRS), patient-reported outcomes (ESSPRI, OSDI, VFQ-25), physician-assessed dryness (TBUT), disease activity (ESSDAI) and erythrocyte sedimentation rate. *p<0.05 **p<0.01
| NRS | TBUT | ESSDAI | ESSPRId | ESSPRIp | ESSPRIf | OSDI | VFQ-25 | ESR | |
|---|---|---|---|---|---|---|---|---|---|
| NRS | -0.95** | +0.25 | +0.73* | +0.69* | +0.59* | +0.68* | -0.54 | +0.19 | |
| TBUT | -0.95** | +0.40 | -0.56 | -0.58 | -0.64 | -0.57 | +0.24 | -0.67 | |
| ESSDAI | +0.25 | +0.40 | +0.14 | +0.43 | +0.12 | +0.77** | -0.33 | +0.55* | |
| ESSPRId | +0.73* | -0.56 | +0.14 | +0.73** | +0.36 | +0.61* | -0.60* | +0.11 | |
| ESSPRIp | +0.69* | -0.58 | +0.43 | +0.73** | +0.53* | +0.51 | -0.63* | +0.32 | |
| ESSPRIf | +0.59* | -0.64 | +0.12 | +0.36 | +0.53* | +0.09 | -0.31 | +0.73 | |
| OSDI | +0.68* | -0.57 | +0.77** | +0.61* | +0.51 | +0.09 | -0.60* | +0.56* | |
| VFQ-25 | -0.54 | +0.24 | -0.33 | -0.60* | -0.63* | -0.31 | -0.60* | +0.05 | |
| ESR | +0.19 | -0.67 | +0.55* | +0.11 | +0.32 | +0.73 | +0.56* | +0.05 |
Acronyms : NRS - Numerical Rating Scale (for ocular pain); TBUT - Tear Break Up Time; ESSDAI - EULAR Sjögren’s Syndrome (SS) disease activity index; ESSPRI - EULAR Sjögren’s Syndrome Patient Reported Index (d= dryness; p=pain; f=fatigue); OSDI - Ocular Surface Disease Index; VFQ-25 - Visual Function Questionnaire-25; ESR: erythrocyte sedimentation rate.
Conclusion: Ocular pain may represent an additional criterion for pSS patient stratification. The unexpected association between ocular pain and extra-ocular symptoms is a novel datum which may suggest that nociceptive mediators could be involved in the genesis of symptoms in pSS 2 . Indeed, OSDI seemed to perform better than TBUT in assessing the sufferance of the ocular surface thus mirroring a systemic inflammatory activity.
REFERENCES:
[1]Ramos-Casals M et al, EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies , Ann Rheum Dis 2020.
[2]Gebreegziabher EA et al, Neuropathic Pain in the Eyes, Body, and Mouth: Insights from the Sjögren’s International Collaborative Clinical Alliance , Pain Pract 2021
Disclosure of Interests: None declared