Background
The aim of this study is to analyze if the results of the Oral Health Impact Profile‐14 questionnaire (OHIP‐14) in patients with primary Sjögren's syndrome (pSS) are correlated with ...salivary flow and level of xerostomia.
Methods
This observational cross‐sectional study was conducted in 61 patients (60 women, one man, mean age 57.64 13.52) diagnosed of pSS according to the American‐European Criteria (2002). After recording demographic, medical and dental data (decayed‐missing‐filled teeth index DMFT), unstimulated (UWS) and stimulated (SWS) salivary flows were collected. Subsequently, UWS flow was categorized into two groups (<0.1 ml/min and ≥0.1 ml/min) and SWS into three groups (<0.1 ml/min, 0.1–0.7 ml/min and >0.7 ml/min). Patients also filled out a visual analog scale (VAS) for xerostomia and OHIP‐14 for self‐reported quality of life (QoL).
Results
Data showed positive and significant correlation between OHIP‐14 and xerostomia, based on VAS results (r = 0.52; p = 0.001). Furthermore, there was a negative correlation between UWS and OHIP‐14 scores (r = −0.34; p = 0.006) and VAS for xerostomia (r = −0.22; p = 0.09). No significant correlation was found between SWS and OHIP‐14 or VAS neither between DMFT and OHIP‐14. When assessing the level of QoL by the UWS and SWS flow categories a significant association was found for UWS (p = 0.001) but not for SWS (p = 0.11). The OHIP‐14 values were higher in the groups with lower salivary flow. The multiple linear regression to predict OHIP‐14 only selected VAS for xerostomia as a statistically significant predictor.
Conclusions
Increased level of xerostomia and reduced UWS flow decrease oral health‐related QoL in patients with pSS.
Background
Primary Sjogren's syndrome (pSS) is an autoimmune disease that leads to salivary and lacrimal gland dysfunction. The adaptive immune response associated with T helper‐2 lymphocytes appears ...to be altered in these patients. Therefore, the objective of this study was to determine the salivary levels of interleukin (IL)‐6, IL‐5, and IL‐4 in patients with pSS when compared to a healthy control (HC) group. The secondary objectives were to study whether ILs levels in pSS patients were associated with salivary flow, patient‐reported outcomes (PROMs) for xerostomia and oral health quality of life (Oral Health Impact Profile‐14 OHIP‐14), pSS classification criteria and presence of extraglandular manifestations.
Methods
A case‐control study was conducted in 36 patients with pSS and 35 HCs. Cytokine levels were measured using high‐sensitivity multiplex map human immunoassays. Unstimulated and stimulated whole saliva were collected and patients filled out questionnaires. The Mann‐Whitney U test, chi‐squared test, and Spearman correlation test were used.
Results
Interleukin‐6 was significantly higher in pSS patients than in HCs (P = .0001). IL‐6 was significantly higher in pSS patients with a positive salivary gland biopsy (P = .04), whole stimulated saliva hyposalivation (P = .02), and presence of musculoskeletal disorders (P = .03). There was a non‐significant positive correlation between IL‐6 levels and PROMs for xerostomia (r = .31; P = .06) and OHIP‐14 (r = .07; P = .68) in pSS patients. Levels of IL‐4 and IL‐5 were not detected in both pSS and HCs patients.
Conclusions
Salivary IL‐6 levels are significantly associated with pSS patients, and therefore, it is hypothesized that this biomarker may be useful in the diagnosis and follow‐up of this disease.
Investment in natural capital is increasingly necessary and urgent considering the increasing loss of global biodiversity and the associated social and economic losses. Ecosystem services are tools ...for quantifying the stock of natural capital and there is great concern about their assessment and valuation. However, there remains a substantial gap between the large amount of information available about ecosystem services and the information required to support decisions and this undermines the efficiency of their management. Multi-criteria analysis techniques can be very useful to efficiently develop decision-making processes to properly channel investment and optimize the costs associated with conservation. This paper proposes an innovative mixed methodology for multi-criteria analysis to assign priorities to ecosystem services in protected areas in terms of importance and vulnerability. The model was applied by a group of experts to prioritize 20 ecosystem services in the Ordesa and Monte Perdido National Park. In order to collect and analyze the individual valuations, a mixed method of Analytic Hierarchy Process (AHP) and Goal Programming (GP) was used, and to aggregate the valuation criteria, a Joint Relevance Index (JRI) was used, which presents the relative importance of each service in an aggregated way. The results show that conservation policies should be primarily directed towards lifecycle maintenance and water conditions. Depending on the vulnerability of the services, conservation policies should be channeled towards provisioning services related to wild animals and wild plants. Considering the relative importance of services in the park, priority should be oriented to lifecycle maintenance, water conditions and intellectual interaction with the environment.
To evaluate the response to hepatitis B virus (HBV) vaccine in patients on biological therapy. Adults with autoimmune inflammatory diseases on biological therapy such as anti-TNFα, rituximab, ...tocilizumab, abatacept, or anakinra were included. Hepatitis B surface antibody (anti-HBs) was measured by ELISA before and after vaccination. Seroconversion was considered when an anti-HBs titer > 10 mIU/mL was achieved. The effect of treatment on the immunoprotective state was studied. The response was compared with that obtained in patients on synthetic disease modifying anti-rheumatic drugs (DMARDs) and healthy controls. A total of 187 patients on biologicals, 48 on synthetic DMARDs, and 49 on healthy controls were analyzed. More than 80% of patients on biologics responded to the vaccine but required more boosters and second vaccine series. Patients who achieved seroconversion were younger than those who did not (47.10 ± 12.99 vs. 53.18 ± 10.54 years,
p
= 0.012). Being on etanercept or golimumab was associated with seroconversion, while being on rituximab was not. Seroconversion was achieved in 93.75% of patients on synthetic DMARDs and 97.96% of healthy controls. The seroconversion rate in the biologics group was lower than in the synthetic DMARD group (
p
= 0.043) and tended to be lower than in the healthy group (
p
= 0.056). In patients on biological therapy, a high rate of HBV vaccine response can be achieved when a complete vaccination schedule is administered. Vaccination while not on biological agents reduces the requirement for boosters and revaccination.
Key points:
• Patients on biological therapy can achieve high rates of immune response to HBV vaccine when complete vaccination schedules are administered.
• However, to achieve such a high seroconversion rate, more boosters and second vaccination series are required.
• This supports the proposal already made to provide HBV vaccination to all patients with an autoimmune inflammatory disease after the diagnosis is made and not when the use of a biological treatment is under consideration.
Objectives
To assess the effects of Xerostom® toothpaste and mouthwash in primary Sjögren's syndrome (pSS) patients with xerostomia.
Subjects and Methods
A double‐blinded, randomized study where ...patients were assigned at baseline test or control products. Patients used the products 3 times/day/28 days. We used a visual analogue scale (VAS) for xerostomia and an Oral Health Impact Profile‐14 (OHIP‐14), baseline and after treatment, to assess possible improvement.
Results
A total of 28 patients with pSS were included in this study, but only 24 finished it (all women, mean age 55.21 ± 11.87), and 13 patients received the test and 11 the control. VAS and OHIP‐14 scores decreased in both groups after treatment but significant differences between groups were not found. We do not detect VAS intragroup significant differences before and after treatment in test and control groups. A significant improvement in OHIP‐14 was identified in the treatment group, while no significant differences were observed in the control group. No adverse effects were present.
Conclusions
Xerostom® toothpaste and mouthrinse may alleviate and improve quality of life without associated side effects, but further research with a larger number of participants and follow‐up are necessary to establish the positive efficacy of these topical products in pSS patients.
Sustainable Rural Development is essential to maintain active local communities and avoid depopulation and degradation of rural areas. Proper assessment of development in these territories is ...necessary to improve decision-making and to inform public policy, while ensuring biodiversity conservation and ecosystem services supply. Rural areas include high ecological value systems but the vulnerability of environmental components in development indicators has not been sufficiently pinpointed. The main objective of this work was to propose a new sustainable rural development composite indicator (nSRDI) while considering an environmental dimension indicator based on ecosystem services vulnerability and social and economic dimension indicators established using a sequentially Benefit of the Doubt-Data Envelopment Analysis (BoD-DEA) model. It aimed also to test effects of weighting methods on nSRDI. The composite indicator was applied to 10 regions (comarcas) in the Huesca province, Spain, producing a ranking of regions accordingly. The indicator was further tested through the analysis of the effect of an equal and optimum weighting method on scores and rankings of regions. Results showed substantial differences in nSRDI scores/rankings when vulnerability was added to the process, suggesting that the environmental dimension and the perspective from which it is conceived and applied matters when addressing sustainable rural development.
Influenza vaccine is recommended for patients with autoimmune inflammatory rheumatic diseases who receive biological therapy. To evaluate if biological therapy impairs immunization after seasonal ...influenza vaccine.
Patients with inflammatory arthopathies, psoriasis, inflammatory bowel disease or connective tissue diseases who were receiving or were going to initiate biological therapy were included and vaccinated during 2014-2015 influenza season. ELISA was used to measure influenza antigen A and B antibodies, before and after vaccination. Demographic parameters, diagnosis and kind of treatment were recorded and their influence on the final serological status against influenza was studied.
253 subjects were analyzed. After vaccination, 77% of participants presented detectable antibodies against antigen A and 50.6% of them had detectable antibodies against antigen B. Final seropositivity rate against antigen B antibodies increased from baseline (50.6% vs 43.5%, p<0.001). Anti-TNF drugs were associated with better response and rituximab with the worst (79.2% vs 55.0% for final seropositivity against antigen A, p=0.020). Vaccine response in the rituximab group tended to improve when the interval between the drug administration and the vaccination was at least 12 weeks (seropositivity rate 80.0% in those with the longer interval vs 25.0% in the other group, p=0.054).
Among the patients on biological therapy vaccinated against influenza, anti-TNF therapy was identified as a predictive factor of final seropositivity. Rituximab presented a lower rate of final seropositivity, which could be increased with an accurate administration schedule.
BACKGROUNDCandidiasis is the most frequent mycotic infection of the oral cavity. The aim of this study was to investigate the presence of clinical oral candidiasis and Candida albicans yeast in a ...population diagnosed of primary Sjögren's syndrome (pSS) and to study the possible factors associated with this infection. MATERIAL AND METHODSAn observational cross-sectional study was conducted in 61 pSS patients (60 women, 1 man, mean age 57.64±13.52) where patient based information (demographic and medical, tobacco and alcohol consumption history), intraoral parameters (presence of dentures, clinical signs of candidiasis), salivary analytical information (number of Candida albicans as colony-forming units per millilitre (CFU/mL), salivary pH levels, unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) were collected. RESULTS13.1% of pSS patients presented oral signs of candidiasis. Denture stomatitis and angular cheilitis were the most common lesions. 87.5% of patients with clinical candidiasis presented reduced pH levels and salivary flow in both UWS and SWS. A significant statistical negative correlation was found between CFU/mL of Candida albicans and levels of UWS and SWS. A negative correlation was found between pH levels and CFU/mL, although not statistically significant. CONCLUSIONSA reduced salivary flow may predispose pSS patients to Candida albicans overgrowth, which may show with clinical signs. Preventive measures are of great importance to avoid and to treat this condition promptly.
Introduction
Primary Sjögren’s syndrome (pSS) is an autoimmune disease, characterized by lymphocytic infiltration of exocrine glands and other organs, resulting in dry eye, dry mouth and ...extraglandular systemic findings.
Objective
To explore the association of severe or very severe dry eye with extraocular involvement in patients diagnosed with primary Sjögren’s syndrome.
Methods
SJOGRENSER registry is a multicenter cross-sectional study of pSS patients. For the construction of our main variable, severe/very severe dry eye, we used those variables that represented a degree 3–4 of severity according to the 2007 Dry Eye Workshop classification. First, bivariate logistic regression models were used to identify the effect of each independent variable on severe/very severe dry eye. Secondly, multivariate analysis using regression model was used to establish the independent effect of patient characteristics.
Results
Four hundred and thirty-seven patients were included in SJOGRENSER registry; 94% of the patients complained of dry eye and 16% developed corneal ulcer. Schirmer’s test was pathological in 92% of the patients; 378 patients presented severe/very severe dry eye. Inflammatory articular involvement was significantly more frequent in patients with severe/very severe dry eye than in those without severe/very severe dry eye (82.5 vs 69.5%,
p
= 0,028). Inflammatory joint involvement was associated with severe/very severe dry eye in the multivariate analysis, OR 2.079 (95% CI 1.096–3.941).
Conclusion
Severe or very severe dry eye is associated with the presence of inflammatory joint involvement in patients with pSS. These results suggest that a directed anamnesis including systemic comorbidities, such as the presence of inflammatory joint involvement or dry mouth in patients with dry eye, would be useful to suspect a pSS.
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