POS1251 ORAL HEALTH-RELATED QUALITY OF LIFE IN SJÖGREN’S SYNDROME PATIENTS WITH UNSTIMULATED WHOLE SALIVARY FLOWS ≥0.1 ML/MIN FOR WHOM NO THERAPEUTIC APPROACHES ARE PROVIDED IN THE EULAR RECOMMENDATIONS
Authors: N. Azuma, M. Iwatani, Y. Yokoyama, N. Hashimoto, M. Tamura, T. Hashimoto, M. Morimoto, A. Nishioka, M. Kitano, S. Tsunoda, H. Sano, K. Matsui
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Based on the idea that therapeutic approach for oral dryness in patients with Sjögren's syndrome (SS) should be driven by salivary glandular function, rather than the patient's subjective feelings, the EULAR recommendations for the management of Sjögren's syndrome with topical and systemic therapies recommend that salivary glandular function be evaluated by measuring whole salivary flows before starting therapeutic interventions and that different therapeutic approaches be provided depending on the measured salivary flow rates. Although the recommendations do not indicate a preferred therapeutic approach for SS patients with unstimulated whole salivary flows (UWSF) ≥0.1 mL/min, in clinical practice, SS patients with preserved salivary flow rates often complain of oral dryness. <h3>Objectives:</h3> To evaluate the oral health-related quality of life (OHRQoL) in SS patients with UWSF ≥0.1 ml/min. <h3>Methods:</h3> Forty-five SS patients (35 with primary SS; 43 women and 2 men; mean age, 62.4 years; mean disease duration, 6.6 years) and 23 non-SS individuals (control; 18 women and 5 men; mean age, 56.1 years) participated in this study. All SS patients met the 1999 revised Japanese Ministry of Health criteria for diagnosis of SS. Individuals with factors that can affect saliva secretion, intraoral lesion formation, or OHRQoL were excluded. The UWSF of SS patients were measured by the spitting method (mL/15 min). OHRQoL was quantitatively assessed using the Japanese version of the short-form Oral Health Impact Profile (OHIP-14; maximum possible score, 56 points), a self-administered questionnaire, at an average of 7.2 months after the UWSF measurement in SS patients and as needed in non-SS individuals. Since the assessment of dryness symptoms by ESSPRI includes more than just oral dryness, it was not used for the OHRQoL assessment in this study. <h3>Results:</h3> In SS patients, the mean UWSF was 1.1 mL/15 min; 34 (75.6%) had a UWSF &lt;0.1 mL/min, and 11 (24.4%) had ≥0.1 mL/min. Their mean OHIP-14 score was 15.9. There was no significant difference in the percentage of patients who perceived oral dryness between the UWSF &lt;0.1 ml/min and ≥0.1 ml/min groups (97.1% vs 81.8%, p=0.143). The OHIP-14 score also did not differ significantly between the two groups (16.6 vs 13.6, p=0.227). The OHIP-14 score of even the UWSF ≥0.1 mL/min group was significantly higher than that of the non-SS group (13.6 vs. 7.1, p=0.029). Among the OHIP-14 questions, the UWSF ≥0.1 mL/min group scored significantly higher than the non-SS group for "self-conscious," "diet unsatisfactory," "difficult to relax," and "felt life less satisfying." In addition, the UWSF ≥0.1 mL/min group tended to score higher for "trouble pronouncing words," "uncomfortable to eat foods," "been embarrassed," "irritable with other people," and "unable to function." <h3>Conclusion:</h3> This study revealed that SS patients – even with UWSF ≥0.1 mL/min – had lower OHRQoL. Because of the wide normal range of salivary flow rates and high interindividual variability, it is considered difficult to determine whether an individual's salivary flow rate is abnormal. Signs of oral dryness are said to appear when the salivary flow rate decreases by 40–50%. Therefore, it is more important whether there is a change in salivary flow rate over time than whether an individual has a high or low salivary flow rate. Even if the salivary flow rate is preserved in a single measurement, the possibility of having oral dryness due to a decrease in the salivary flow rate from the normal value for that patient should be considered. <h3>REFERENCES:</h3> [1] Ramos-Casals M, et al. Ann Rheum Dis 2020;79:3-18. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Naoto Azuma: None declared, Maki Iwatani: None declared, Yuichi Yokoyama: None declared, Naoaki Hashimoto: None declared, Masao Tamura: None declared, Teppei Hashimoto: None declared, Mai Morimoto: None declared, Aki Nishioka: None declared, Masayasu Kitano: None declared, Shinichiro Tsunoda: None declared, Hajime Sano: None declared, Kiyoshi Matsui KM has received scholarship grant from Chugai Pharmaceutical Co., Ltd. and Asahi Kasei Pharma Corporation.