fetching data ...

AB0534 (2018)
Proportion of sjogren’s syndrome patients referred to oral specialists at a rheumatology tertiary centre and factors associated with their referral
G. Levinson1, U. Ahmed1, C. Ciurtin1,2
1UCL
2Department of Rheumatology, UCLH, London, UK

 

Background: Ideally all patients with Sjögren’s Syndrome (SS) and symptoms of mouth dryness should be assessed by an oral specialist (OS) team at 3–6 monthly intervals for optimisation of their treatment for xerostomia and minimisation of the risk of dental loss1. However, in reality specialist input is not always offered.

Objectives: To determine the proportion of SS patients at a rheumatology tertiary centre who were referred to OS and evaluate if any factors were associated with referral.

Methods: We retrospectively collected data about 105 patients with primary or secondary SS who attended outpatient clinics in October – November 2016, including duration of symptoms and years since diagnosis, presence of SS associated symptoms, medications trialled to date, and serological, imaging and histological patient features. We have also assessed proportion of patients referred to OS, as well as the medication recommended by the OS. p<0.05 was considered significant.

Results: In our cohort, 58.1% of SS patients were referred to an OS. We compared patient demographics and various disease features (table 1) in SS patients who were referred to OS and those who were not.

Abstract AB0534 – Table 1

SS patients seen by oral specialists
n=61

SS patients never referred to oral specialists
n=44

P value

Gender F (%)

93

98

0.17

Age (years) mean±SD

60.1±16.7

50.1±15.3

0.023

Disease duration

(years) mean±SD)

9.7±7.9

7.4±5/2

0.57

Symptoms duration

(years) mean±SD)

11.0±8.47

10.0±5.80

0.2

Medication

Oral prednisolone

N (%)

13.1

27.3

0.069

Hydroxychloroquine/Chroloquine

N (%)

65.6

68.2

0.78

Azathioprine

N (%)

12.5

15.4

0.75

Methotrexate

N (%)

8.82

24

0.12

Saliva substitutes

N (%)

59.5

32

0.034

Associated Symptoms

Oral dryness (VAS>5/10)

N (%)

95.1

72.7

0.0012

Glandular enlargement

N (%)

27.9

13.6

0.082

Maximum ESSDAI score

Median (interquartile range)

7 (4–12)

6 (4–10.75)

0.36

Serology, Histology and Imaging

Anti Ro antibodies

N (%)

79.2

78.4

0.92

Anti La antibodies

N (%)

61.4

58.1

0.77

Positive salivary gland biopsy

N (%)

100

83.3

0.20

Ultrasound scan of salivary glands showing definite features of SS

N (%)

86.4

66.7

0.38

The parameters that correlated with the referral to OS were oral dryness (VAS>5/10) (p=0.0012) and the use of saliva substitutes (p=0.034).

The most common OS treatment recommendations were for use of Duraphat 5000 ppm (50.8%), Salivix pastilles (44.3%), mouth wash (41%) and Glandosane (36%), apart from frequent sips of water recommended in all patients.

Conclusions: 58.1% of SS patients at a tertiary rheumatology centre were referred to OS. The factors that correlated with onward referral to the OS from the Rheumatologist in SS patients were oral dryness and treatment with saliva substitutes. This suggests that Rheumatologists adequately treat xerostomia and refer to OS appropriately when patients remain symptomatic. Further research is needed to assess whether there is a difference in outcome for patients referred to an OS versus those who are not.

Reference:

  1. Price E, Rauz S, Tappuni A, Sutcliffe N, Hackett K, Barone F, et al. The British Society for Rheumatology guideline for the management of adults with primary Sjögren’s Syndrome. Rheumatology 2017;56(10):1828–1828.

Disclosure of Interest: None declared

DOI: 10.1136/annrheumdis-2018-eular.2272


Citation: Ann Rheum Dis, volume 77, supplement Suppl, year 2018, page A1424
Session: SLE, Sjögren’s and APS – treatment