Psychological and Somatic Predictors of Perceived and Measured Ocular Dryness of Patients with Primary Sjögren's Syndrome

JOHANNA E. VRIEZEKOLK, RINIE GEENEN, ANDRÉ HARTKAMP, GUIDO L.R. GODAERT, HENDRIKA BOOTSMA, AIKE A. KRUIZE, JOHANNES W.J. BIJLSMA, and RONALD H.W.M. DERKSEN

ABSTRACT.

Objective. To test if age, disease activity, pain, fatigue, and depression are associated with subjective and objective ocular dryness of patients with primary Sjögren's syndrome (pSS).

Methods. Sixty female patients with pSS and 60 age matched healthy controls filled out visual analog scale (VAS) scores of ocular dryness and pain, and questionnaires regarding fatigue (Multidimensional Fatigue Inventory) and depression (Zung). Lacrimal tear production was measured by Schirmer I test. As surrogate indicators of disease activity the erythrocyte sedimentation rate, hemoglobin concentration, and total serum immunoglobulin G were determined.

Results. Perceived ocular sicca symptoms were not related to Schirmer I test scores. The rate of tear production was related to age (r = –0.47, p < 0.001), disease activity (r = –0.27, p < 0.05), and pain (r = 0.42, p < 0.001). Age and pain together explained 42% of the variance of the Schirmer I test results.

Conclusion. Not unexpectedly, age and disease activity were associated with ocular dryness, but contrary to expectation, pain was associated with more instead of less tear production. We did not find evidence that pain, fatigue, or depression are associated with reduced tear production or perceived ocular dryness. (J Rheumatol 2005;32:2351-5)

Key Indexing Terms:

SJÖGREN'S SYNDROME
KERATOCONJUNCTIVITIS SICCA
PAIN
FATIGUE
DEPRESSION

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From the Department of Health Psychology, Utrecht University; Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht; and Department of Internal Medicine, Division of Rheumatology, University Hospital Groningen, Groningen, The Netherlands.

Supported by the Dutch Arthritis Association.

J.E. Vriezekolk, MSc, Department of Health Psychology, Utrecht University, currently Department of Rheumatology, Sint Maartenskliniek, Nijmegen; R. Geenen, PhD, Assistant Professor, Department of Health Psychology, Utrecht University; A. Hartkamp, MD, Rheumatologist, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht; G.L.R. Godaert, PhD, Associate Professor, Department of Health Psychology, Utrecht University; H. Bootsma, MD, PhD, Rheumatologist, University Hospital Groningen; A.A. Kruize, MD, PhD, Rheumatologist; J.W.J. Bijlsma, MD, PhD, Professor of Rheumatology; R.H.W.M. Derksen, MD, PhD, Associate Professor, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht.

Address reprint requests to R. Geenen, Department of Health Psychology, Utrecht University, PO Box 80140, 3508 TC Utrecht, The Netherlands. E-mail: R.Geenen@home.nl

Accepted for publication July 25, 2005.

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