Beyond dry eye: the greater extent of Sjögren’s systemic disease symptoms, impact of COVID-19 and perceptions towards Telemedicine identified through a patient co-designed study
Authors: Greenan Emily , Tynan Gráinne , Collins Deirdre , Murphy Conor , Flood Michelle , Gabhann-Dromgoole Joan Ni 
Published: April 2023

Background: Sjögren’s (“SHOW-grins”) is a chronic debilitating autoimmune disease characterised by dry eyes and dry mouth, secondary to reduced exocrine function of both the lacrimal and salivary glands. The persistent, severe and serious systemic complications of Sjögren’s are poorly understood and often unappreciated, resulting in significant morbidity and treatment burden. This study aimed to explore experiences of those living with Sjögren’s, specifically access to healthcare and attitude towards telemedicine. Additionally, we sought to collect information regarding the impact of the pandemic on their quality of life (QoL). Methods: Attendees (n=194) of an Irish Sjögren’s Webinar were invited to participate in two online surveys. The first survey gathered information related to demographics, disease, and experiences during the COVID-19 pandemic. A combination of bespoke items and validated questionnaires (EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI), COV19-QoL) was used. The second survey consisted of a shortened Telehealth Usability Questionnaire. Both were prepared in collaboration with a patient advocate.Results: Survey 1: n=76; response rate=39.2%. Thirty-one respondents (41.4%) to Survey 1 reported a delay of ≥5 years between the onset of symptoms and diagnosis. Dry mouth was the most common symptom experienced (76.8% n=63), followed by dry eye (74.4% n=61), fatigue (57.3%, n=47) and joint pain (53.7% n=44), but a range of other symptoms were also reported. COV19-QoL results indicated that the pandemic had a detrimental effect on participants’ overall QoL (4.0 ± 1.0) and physical health (4.0 ± 0.8) in particular. COV19-QoL and ESSPRI scores were moderately correlated (0.36, p=0.002). Over 70% of respondents had a medical appointment cancelled, delayed or rescheduled (n=60). Survey 2: n=57; response rate=29.4%. Those that had interacted with telemedicine reported largely positive experiences with the virtual model. Conclusion: Clinicians should be aware of the range of symptoms experienced by patients with Sjögren’s beyond those of sicca and fatigue. COVID-19 has negatively influenced the self-reported health and well-being of those with Sjögren’s, particularly those with higher symptom scores. It is vital that optimised telemedicine models are implemented to ensure continuity in the provision of healthcare for those with chronic illness such as Sjögren’s and in preparation for possible future pandemics. Patient or Public Contribution: A group of people living with Sjögren’s co-designed the structure and content of the webinar where the survey was shared. A PPI contributor also collaborated in the selection of questionnaires used in the study ensuring that the questions asked would best reflect the priorities of patients. They contributed to the writing of this manuscript as co-authors. Additionally, the research team and Sjögren’s patients who contributed to this work have gone on to establish Sjögren’s Research Ireland, a collaboration between patient advocates, researchers, and PPI facilitators.