Patient Burden Of Sjogren'S: A Comprehensive Literature Review Revealing The Range And Heterogeneity Of Measures Used In Assessments Of Severity

Context The severity of Sjogren's syndrome has been evaluated using a wide variety of clinical measures and patient-reported outcomes (PROs). This may contribute to the lack of clarity concerning the burden of Sjogren's from the patient perspective.Objective To perform a comprehensive peer-reviewed literature analysis of the patient aspects of Sjogren's, focusing on PROs, to investigate the complexity underlying the evaluation of the syndrome and to elucidate the discordance between the different measures.Methods We searched Embase for articles published between January 2005 and September 2015. Research articles, clinical and diagnostic reviews, and validation studies with a focus on patient aspects of Sjogren's were selected as the primary information source.Results 157 articles met the eligibility criteria. A wide variety of assessment measures used to evaluate glandular, extraglandular and functional domains were observed. Many different, non-validated Visual Analogue Scales, with a wide range of anchor words, were used in the quantification of Sjogren's disease burden, impeding comparisons between studies. Relatively few clinical trials of drug therapies used validated scales: European League Against Rheumatism Sjogren's Syndrome Patient Reported Index was used most often for symptom assessment and 36 Item Short Form Survey for quality of life (QoL).Conclusion A wide range and diversity of measures are used to evaluate the patient burden of Sjogren's; most are not validated for use in this disease. PRO endpoints, validated specifically in Sjogren's, that demonstrate improvement are needed. These measures should focus on QoL aspects important to patients and will most likely involve gauging change in function rather than patient-reported symptoms.