Rheumatology International

, Volume 32, Issue 9, pp 2637–2643 | Cite as

Primary Sjögren’s syndrome in Moroccan patients: characteristics, fatigue and quality of life

  • Yousra Ibn Yacoub
  • Samira Rostom
  • Assia Laatiris
  • Najia Hajjaj-Hassouni
Original Article


Our aim was to evaluate fatigue and quality of life (QoL) in Moroccan patients with primary Sjögren’s syndrome (PSS) and determine their correlates with disease-related parameters. Fifty-seven consecutive patients with PSS according to the American-European Consensus group (AEGG) criteria were included. Demographic, clinical, biological and immunological characteristics for all patients were collected. Xerostomia was demonstrated by histological grading of lower lip glandular biopsy. A Schirmer test was performed to measure lachrymal flow. Oral, ocular, skin, vaginal and tracheal dryness were evaluated by using a visual analogue scale (VAS). Fatigue was assessed by the Multidimensional assessment of fatigue (MAF) and the QoL by using the generic instrument: SF-36. 90% of our patients were women. The mean age of patients was 53.73 ± 7.69 years, and the mean disease duration was 5.38 ± 4.11 years. The mean oral dryness was 68.38 ± 20.29, and the mean ocular dryness was 51.91 ± 14.03. The mean total score of the MAF was 26.73 ± 8.33, and 87.5% of our patients experienced severe fatigue. Also, physical and mental domains of QoL were altered in a significant way, and the severity of fatigue had a negative impact on SF-36 scores. MAF and SF-36 scores were correlated with the delay of diagnosis, the intensity of xerostomia and the activity of joint involvement. A low socioeconomic and educational level had a negative impact on fatigue scores and QoL. Histological grading of lower lip glandular biopsy, immunological status and the severity of systemic involvement had no correlations with fatigue scores or the alteration of QoL. Patients receiving antidepressant have lesser fatigue and those receiving Methotrexate have better SF-36 scores. In our data, there was a high prevalence of fatigue in Moroccan patients with PSS associated with altered QoL. Severe fatigue and reduced QoL seem to be related to the severity of joint involvement, xerostomia and both educational and socioeconomic levels. Also, treatment with methotrexate and antidepressant seems to improve patients’ living and QoL. An appropriate therapeutic intervention for depression and articular manifestations in PSS should be applied to improve patients’ living.


Primary Sjögren’s syndrome Fatigue Quality of life 


Conflict of interest



  1. 1.
    Carsons S (2001) A review and update of Sjögren’s syndrome: manifestations, diagnosis, and treatment. Am J Manag Care 7(14 Suppl):433–443Google Scholar
  2. 2.
    Segal B, Thomas W, Rogers T, Leon JM, Hughes P, Patel D, Patel K, Novitzke J, Rohrer M, Gopalakrishnan R, Myers S, Nazmul-Hossain A, Emamian E, Huang A, Rhodus N, Moser K (2008) Prevalence, severity, and predictors of fatigue in subjects with primary Sjögren’s syndrome. Arthritis Rheum 59(12):1780–1787PubMedCrossRefGoogle Scholar
  3. 3.
    Fox RI (2005) Sjögren’s syndrome. Lancet 366(9482):321–331PubMedCrossRefGoogle Scholar
  4. 4.
    Fox RI, Stern M, Michelson P (2000) Update in Sjögren syndrome. Curr Opin Rheumatol 12(5):391–398PubMedCrossRefGoogle Scholar
  5. 5.
    Thomas E, Hay EM, Hajeer A, Silman AJ (1998) Sjögren’s syndrome: a community-based study of prevalence and impact. Br J Rheumatol 37(10):1069–1076PubMedCrossRefGoogle Scholar
  6. 6.
    Oxholm P, Asmussen K (1995) Classification of disease manifestations in primary Sjögren’s syndrome: present status and a new proposal. Clin Rheumatol 14(Suppl 1):3–7PubMedGoogle Scholar
  7. 7.
    Tensing EK, Solovieva SA, Tervahartiala T, Nordström DC, Laine M, Niissalo S, Konttinen YT (2001) Fatigue and health profile in sicca syndrome of Sjögren’s and non-Sjögren’s syndrome origin. Clin Exp Rheumatol 19(3):313–316PubMedGoogle Scholar
  8. 8.
    Bowman SJ (2002) Collaborative research into outcome measures in Sjögren’s syndrome. Update on disease assessment. Scand J Rheumatol Suppl 116:23–27PubMedCrossRefGoogle Scholar
  9. 9.
    Harboe E, Tjensvoll AB, Vefring HK, Gøransson LG, Kvaløy JT, Omdal R (2009) Fatigue in primary Sjögren’s syndrome–a link to sickness behaviour in animals? Brain Behav Immun 23(8):1104–1108PubMedCrossRefGoogle Scholar
  10. 10.
    Segal B, Bowman SJ, Fox PC, Vivino FB, Murukutla N, Brodscholl J, Ogale S, McLean L (2009) Primary Sjögren’s Syndrome: health experiences and predictors of health quality among patients in the United States. Health Qual Life Outcomes 7:46PubMedCrossRefGoogle Scholar
  11. 11.
    Bowman SJ (2008) Patient-reported outcomes including fatigue in primary Sjögren’s syndrome. Rheum Dis Clin North Am 34(4):949–962PubMedCrossRefGoogle Scholar
  12. 12.
    Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, Daniels TE, Fox PC, Fox RI, Kassan SS, Pillemer SR, Talal N, Weisman MH, European Study Group on Classification Criteria for Sjögren’s Syndrome (2002) Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis 61(6):554–558PubMedCrossRefGoogle Scholar
  13. 13.
    Neuberger GB (2003) Measures of fatigue. Arthritis Rheum 49:175–183CrossRefGoogle Scholar
  14. 14.
    Bowman SJ, Booth DA, Platts RG, UK Sjögren’s Interest Group (2004) Measurement of fatigue and discomfort in primary Sjogren’s syndrome using a new questionnaire tool. Rheumatology (Oxford) 43(6):758–764CrossRefGoogle Scholar
  15. 15.
    Khoudri I, Ali Zeggwagh A, Abidi K, Madani N (2007) Abouqal R Measurement properties of the short form 36 and health-related quality of life after intensive care in Morocco. Acta Anaesthesiol Scand 51(2):189–197PubMedCrossRefGoogle Scholar
  16. 16.
    Strömbeck B, Theander E, Jacobsson LT (2005) Assessment of fatigue in primary Sjögren’s syndrome: the Swedish version of the Profile of Fatigue. Scand J Rheumatol 34(6):455–459PubMedCrossRefGoogle Scholar
  17. 17.
    Lwin CT, Bishay M, Platts RG, Booth DA, Bowman SJ (2003) The assessment of fatigue in primary Sjögren’s syndrome. Scand J Rheumatol 32(1):33–37PubMedCrossRefGoogle Scholar
  18. 18.
    Barendregt PJ, Visser MR, Smets EM, Tulen JH, van den Meiracker AH, Boomsma F, Markusse HM (1998) Fatigue in primary Sjögren’s syndrome. Ann Rheum Dis 57(5):291–295PubMedCrossRefGoogle Scholar
  19. 19.
    Giles I, Isenberg D (2000) Fatigue in primary Sjögren’s syndrome: is there a link with the fibromyalgia syndrome? Ann Rheum Dis 59(11):875–878PubMedCrossRefGoogle Scholar
  20. 20.
    Godaert GL, Hartkamp A, Geenen R, Garssen A, Kruize AA, Bijlsma JW, Derksen RH (2002) Fatigue in daily life in patients with primary Sjögren’s syndrome and systemic lupus erythematosus. Ann N Y Acad Sci 966:320–326PubMedCrossRefGoogle Scholar
  21. 21.
    Smets EM, Garssen B, Bonke B, De Haes JC (1995) The multidimensional fatigue inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 39:315–325PubMedCrossRefGoogle Scholar
  22. 22.
    d’Elia HF, Rehnberg E, Kvist G, Ericsson A, Konttinen Y, Mannerkorpi K (2008) Fatigue and blood pressure in primary Sjogren’s syndrome. Scand J Rheumatol 37(4):284–292PubMedCrossRefGoogle Scholar
  23. 23.
    Dass S, Bowman SJ, Vital EM, Ikeda K, Pease CT, Hamburger J, Richards A, Rauz S, Emery P (2008) Reduction of fatigue in Sjögren syndrome with rituximab: results of a randomised, double-blind, placebo-controlled pilot study. Ann Rheum Dis 67(11):1541–1544PubMedCrossRefGoogle Scholar
  24. 24.
    Calabrese LH, Davis ME, Wilke WS (1994) Chronic fatigue syndrome and a disorder resembling Sjögren’s syndrome: preliminary report. Clin Infect Dis 18(Suppl 1):28–31CrossRefGoogle Scholar
  25. 25.
    Bax HI, Vriesendorp TM, Kallenberg CG, Kalk WW (2002) Fatigue and immune activity in Sjögren’s syndrome. Ann Rheum Dis 61(3):284PubMedCrossRefGoogle Scholar
  26. 26.
    Barry RJ, Sutcliffe N, Isenberg DA, Price E, Goldblatt F, Adler M, Canavan A, Hamburger J, Richards A, Regan M, Gadsby K, Rigby S, Jones A, Mathew R, Mulherin D, Stevenson A, Nightingale P, Rauz S, Bowman SJ (2008) The Sjögren’s Syndrome Damage Index—a damage index for use in clinical trials and observational studies in primary Sjögren’s syndrome. Rheumatology (Oxford) 47(8):1193–1198CrossRefGoogle Scholar
  27. 27.
    Champey J, Corruble E, Gottenberg JE, Buhl C, Meyer T, Caudmont C, Bergé E, Pellet J, Hardy P, Mariette X (2006) Quality of life and psychological status in patients with primary Sjögren’s syndrome and sicca symptoms without autoimmune features. Arthritis Rheum 55(3):451–457PubMedCrossRefGoogle Scholar
  28. 28.
    Strömbeck B, Ekdahl C, Manthorpe R, Wikström I, Jacobsson L (2000) Health-related quality of life in primary Sjögren’s syndrome, rheumatoid arthritis and fibromyalgia compared to normal population data using SF-36. Scand J Rheumatol 29(1):20–28PubMedCrossRefGoogle Scholar
  29. 29.
    Vriezekolk JE, Geenen R, Hartkamp A, Godaert GL, Bootsma H, Kruize AA, Bijlsma JW, Derksen RH (2005) Psychological and somatic predictors of perceived and measured ocular dryness of patients with primary Sjögren’s syndrome. J Rheumatol 32(12):2351–2355PubMedGoogle Scholar
  30. 30.
    Inal V, Kitapcioglu G, Karabulut G, Keser G, Kabasakal Y (2010) Evaluation of quality of life in relation to anxiety and depression in primary Sjögren’s syndrome. Mod Rheumatol [Epub ahead of print]Google Scholar
  31. 31.
    Kamel UF, Maddison P, Whitaker R (2009) Impact of primary Sjogren’s syndrome on smell and taste: effect on quality of life. Rheumatology (Oxford) 48(12):1512–1514CrossRefGoogle Scholar
  32. 32.
    Meijer JM, Meiners PM, Huddleston Slater JJ, Spijkervet FK, Kallenberg CG, Vissink A, Bootsma H (2009) Health-related quality of life, employment and disability in patients with Sjogren’s syndrome. Rheumatology (Oxford) 48(9):1077–1082CrossRefGoogle Scholar
  33. 33.
    Rostron J, Rogers S, Longman L, Kaney S, Field EA (2002) Health-related quality of life in patients with primary Sjögren’s syndrome and xerostomia: a comparative study. Gerodontology 19(1):53–59PubMedCrossRefGoogle Scholar
  34. 34.
    Turan Y, Duruöz MT, Cerrahoglu L (2007) Quality of life in patients with ankylosing spondylitis: a pilot study. Rheumatol Int 27:895–899PubMedCrossRefGoogle Scholar
  35. 35.
    Salaffi F, Carotti M, Gasparini S, Intorcia M, Grassi W (2009) The health-related quality of life in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis: a comparison with a selected sample of healthy people. Health Qual Life Outcomes 7:25PubMedCrossRefGoogle Scholar
  36. 36.
    Stewart CM, Berg KM, Cha S, Reeves WH (2008) Salivary dysfunction and quality of life in Sjögren syndrome: a critical oral-systemic connection. J Am Dent Assoc 139(3):291–299PubMedGoogle Scholar
  37. 37.
    Fauchais AL, Ouattara B, Gondran G, Lalloué F, Petit D, Ly K, Lambert M, Launay D, Loustaud-Ratti V, Bezanahari H, Liozon E, Hachulla E, Jauberteau MO, Vidal E, Hatron PY (2010) Articular manifestations in primary Sjögren’s syndrome: clinical significance and prognosis of 188 patients. Rheumatology (Oxford) 49(6):1164–1172CrossRefGoogle Scholar
  38. 38.
    Georges C, Chassany O, Mouthon L, Tiev K, Marjanovic Z, Meyer O, Toledano C, Ilie D, Guillevin L, Sereni D, Cabane J, Farge D (2004) Quality of life assessment with the MOS-SF36 in patients with systemic sclerosis. Rev Med Interne 25(1):16–21PubMedCrossRefGoogle Scholar
  39. 39.
    Pollard LC, Choy EH, Gonzalez J, Khoshaba B, Scott DL (2006) Fatigue in rheumatoid arthritis reflects pain, not disease activity. Rheumatology (Oxford) 45(7):885–889CrossRefGoogle Scholar
  40. 40.
    Strand V, Scott DL, Emery P, Kalden JR, Smolen JS, Cannon GW, Tugwell P, Crawford B (2005) Leflunomide Rheumatoid Arthritis Investigators Groups, Physical function and health related quality of life: analysis of 2-year data from randomized, controlled studies of leflunomide, sulfasalazine, or methotrexate in patients with active rheumatoid arthritis. J Rheumatol 32(4):590–601PubMedGoogle Scholar
  41. 41.
    Söderlin MK, Lindroth Y, Jacobsson LT (2007) Trends in medication and health-related quality of life in a population-based rheumatoid arthritis register in Malmo, Sweden. Rheumatology (Oxford) 46(8):1355–1358CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Yousra Ibn Yacoub
    • 1
  • Samira Rostom
    • 1
  • Assia Laatiris
    • 1
  • Najia Hajjaj-Hassouni
    • 1
  1. 1.Department of Rheumatology (Pr N. Hajjaj-Hassouni)El Ayachi Hospital, University Hospital of Rabat-SaleSaleMorocco

Personalised recommendations