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Rheumatology 2003; 42: 914-915
© 2003 British Society for Rheumatology
Letters to the Editor |
Dry eyes and mouth syndrome or sicca, asthenia and polyalgia syndrome?
Service de Rhumatologie et
1 Service de Psychiatrie, Hôpital de Bicêtre (Assistance Publique-Hôpitaux de Paris), Université Paris XI, INSERM EMI 0109, 94275 Le Kremlin Bicêtre, France
SIR, We read with great interest the recent paper by Price and Venables who proposed a new term—dry eyes and mouth syndrome (DEMS)—to apply to patients presenting with sicca symptoms but not fulfilling international criteria of Sjögren's syndrome (SS) [1]. These patients are very common in rheumatology consultations. As the authors say, these patients complain of sicca symptoms, but also very frequently of polyalgia and chronic fatigue (two symptoms also present in SS), but do not exhibit any immunological abnormality. Thus, for practitioners who believe that fibromyalgia or chronic fatigue syndrome is a well-defined disease, differential diagnosis with these two entities may be difficult. However, sicca symptoms have not been frequently described in such diseases.
For these reasons, we recently proposed the term: sicca, asthenia and polyalgia syndrome (SAPS), to apply to the patients described by Price and Venables [2]. This acronym has the advantage in taking into account the frequency of fatigue and pain associated with sicca in these patients. We propose to define SAPS by: (i) two out of three of the following visual analogic scales ≥50/100 mm: eyes or mouth dryness, asthenia, pain in lower or upper limbs; (ii) absence of nodular infiltrate on lip biopsy (Chisholm score <3); (iii) absence of anti-SSA (Ro) or anti-SSB (La) antibodies; and (iv) absence of any well-defined corrective tissue disease. We recently described 43 patients fulfilling these criteria and demonstrated that their quality of life, assessed by the SF36 questionnaire, was as decreased as in patients with primary SS [2] defined by European/American criteria [3].
Thus, we do agree with Price and Venables that it is important to individualize these patients who are very common and whose quality of life is very poor. We think that our work is still preliminary and that SAPS or DEMS is heterogeneous. Some of these patients probably have an incomplete form of primary SS, or will develop primary SS in the future. But we hypothesize that, in most of these patients, the symptoms may be of psychosomatic origin. The possibility of objective signs of sicca (abnormal Schirmer test and decrease of salivary flow) as well as the presence of a measurable psychiatric abnormality (personality disorder, coping abnormality, anxiety, depression) is under investigation. It is difficult to recognize these patients since depression could also be more common in autoimmune SS patients, but it is important since SAPS patients must not be treated with immunosuppressive drugs including steroids. Moreover, psychotherapy and/or anxiolytic or antidepressive drugs may improve symptoms in such patients.
Notes
Correspondence to: X. Mariette, Service de Rhumatologie, Hôpital de Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France. E-mail: xavier.mariette{at}bct.ap-hop-paris.fr 
References
- Price EJ, Venables PJW. Dry eyes and mouth syndrome—A subgroup of patients presenting with sicca symptoms. Rheumatology 2002;41:416–22.
[Abstract/Free Full Text] - Caudmont C, Desmoulins F, Bergé E, Mariette X. Diminution importante de la qualité de vie chez les patients porteurs d'un syndrome de Sjögren ou d'un syndrome sec. Rev Rhum 2001;68:990 (C64).
- Vitali C, Bombardieri S, Jonsonn R et al. Classification criteria for Sjögren's syndrome: a revised version of the European criteria proposed by the American–European Consensus Group. Ann Rheum Dis 2002;61:554–8.
[Abstract/Free Full Text]
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