Search tips
Search criteria 


Logo of annrheumdAnnals of the Rheumatic DiseasesVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. 1998 May; 57(5): 291–295.
PMCID: PMC1752605

Fatigue in primary Sjögren's syndrome


OBJECTIVE—To assess fatigue in relation to depression, blood pressure, and plasma catecholamines in patients with primary Sjögren's syndrome (SS), in comparison with healthy controls and patients with rheumatoid arthritis.
METHODS—For the assessment of fatigue the Multidimensional Fatigue Inventory (MFI) was used, a 20 item questionnaire, covering the following dimensions: general fatigue, physical fatigue, mental fatigue, reduced motivation, and reduced activity. Furthermore, the Zung depression scale was used to quantify aspects of depression. Forty nine female primary SS patients, 44 female patients with rheumatoid arthritis (RA), and 32 healthy women filled in both questionnaires. In addition, supine values of blood pressure and plasma catecholamines were measured in the patients with primary SS.
RESULTS—Primary SS patients were more fatigued compared with the healthy controls on all the five dimensions of the MFI. When the analyses were repeated using depression as a covariate, group differences disappeared for the dimensions of reduced motivation and mental fatigue. In the primary SS patients, significant positive correlations between depression and the dimensions of reduced motivation and mental fatigue were found. Comparing patients with primary SS with those with RA, using depression as covariate, no statistically significant differences were found between these groups. No relation between fatigue and blood pressure was found, but a negative correlation was observed between the general fatigue subscale of the MFI and plasma noradrenaline.
CONCLUSION—Patients with primary SS report more fatigue than healthy controls on all the dimensions of the MFI and when controlling for depression significant differences remain on the dimensions of general fatigue, physical fatigue, and reduced activity. The negative correlations between levels of noradrenaline and general fatigue in patients with primary SS may imply the involvement of the autonomic nervous system in chronic fatigue.

Keywords: Sjögren's syndrome; fatigue

Full Text

The Full Text of this article is available as a PDF (123K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Goldenberg DL. Fatigue in rheumatic disease. Bull Rheum Dis. 1995 Feb;44(1):4–8. [PubMed]
  • Belza BL. Comparison of self-reported fatigue in rheumatoid arthritis and controls. J Rheumatol. 1995 Apr;22(4):639–643. [PubMed]
  • Crosby LJ. Factors which contribute to fatigue associated with rheumatoid arthritis. J Adv Nurs. 1991 Aug;16(8):974–981. [PubMed]
  • Moutsopoulos HM, Chused TM, Mann DL, Klippel JH, Fauci AS, Frank MM, Lawley TJ, Hamburger MI. Sjögren's syndrome (Sicca syndrome): current issues. Ann Intern Med. 1980 Feb;92(2 Pt 1):212–226. [PubMed]
  • Gudbjörnsson B, Broman JE, Hetta J, Hällgren R. Sleep disturbances in patients with primary Sjögren's syndrome. Br J Rheumatol. 1993 Dec;32(12):1072–1076. [PubMed]
  • Thomas PK. The chronic fatigue syndrome: what do we know? BMJ. 1993 Jun 12;306(6892):1557–1558. [PMC free article] [PubMed]
  • Pagani M, Lucini D, Mela GS, Langewitz W, Malliani A. Sympathetic overactivity in subjects complaining of unexplained fatigue. Clin Sci (Lond) 1994 Dec;87(6):655–661. [PubMed]
  • Bou-Holaigah I, Rowe PC, Kan J, Calkins H. The relationship between neurally mediated hypotension and the chronic fatigue syndrome. JAMA. 1995 Sep 27;274(12):961–967. [PubMed]
  • Rowe PC, Bou-Holaigah I, Kan JS, Calkins H. Is neurally mediated hypotension an unrecognised cause of chronic fatigue? Lancet. 1995 Mar 11;345(8950):623–624. [PubMed]
  • Toussirot E, Serratrice G, Valentin P. Autonomic nervous system involvement in rheumatoid arthritis. 50 cases. J Rheumatol. 1993 Sep;20(9):1508–1514. [PubMed]
  • Lioté F, Osterland CK. Autonomic neuropathy in systemic lupus erythematosus: cardiovascular autonomic function assessment. Ann Rheum Dis. 1994 Oct;53(10):671–674. [PMC free article] [PubMed]
  • Dessein PH, Joffe BI, Metz RM, Millar DL, Lawson M, Stanwix AE. Autonomic dysfunction in systemic sclerosis: sympathetic overactivity and instability. Am J Med. 1992 Aug;93(2):143–150. [PubMed]
  • Andonopoulos AP, Ballas C. Autonomic cardiovascular neuropathy in primary Sjögren's syndrome. Rheumatol Int. 1995;15(3):127–129. [PubMed]
  • Vitali C, Bombardieri S, Moutsopoulos HM, Balestrieri G, Bencivelli W, Bernstein RM, Bjerrum KB, Braga S, Coll J, de Vita S, et al. Preliminary criteria for the classification of Sjögren's syndrome. Results of a prospective concerted action supported by the European Community. Arthritis Rheum. 1993 Mar;36(3):340–347. [PubMed]
  • Chisholm DM, Mason DK. Labial salivary gland biopsy in Sjögren's disease. J Clin Pathol. 1968 Sep;21(5):656–660. [PMC free article] [PubMed]
  • Markusse HM, van Putten WI, Breedveld FC, Oudkerk M. Digital subtraction sialography of the parotid glands in primary Sjögren's syndrome. J Rheumatol. 1993 Feb;20(2):279–283. [PubMed]
  • Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. [PubMed]
  • Smets EM, Garssen B, Bonke B, De Haes JC. The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 1995 Apr;39(3):315–325. [PubMed]
  • van der Heijde DM, van 't Hof MA, van Riel PL, Theunisse LA, Lubberts EW, van Leeuwen MA, van Rijswijk MH, van de Putte LB. Judging disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score. Ann Rheum Dis. 1990 Nov;49(11):916–920. [PMC free article] [PubMed]
  • Krupp LB, LaRocca NG, Muir J, Steinberg AD. A study of fatigue in systemic lupus erythematosus. J Rheumatol. 1990 Nov;17(11):1450–1452. [PubMed]
  • Wysenbeek AJ, Leibovici L, Weinberger A, Guedj D. Fatigue in systemic lupus erythematosus. Prevalence and relation to disease expression. Br J Rheumatol. 1993 Jul;32(7):633–635. [PubMed]
  • Haraldsson A, Tiddens HA, Fiselier T, Bakkeren JA, Weemaes CM. Altered immunoglobulin concentrations and light chain ratios in juvenile onset mixed connective tissue disease. Clin Rheumatol. 1995 Jan;14(1):51–54. [PubMed]
  • Fox RI. Vth International Symposium on Sjögren's syndrome. Clinical aspects and therapy. Clin Rheumatol. 1995 Jul;14 (Suppl 1):17–19. [PubMed]

Figures and Tables

Figure 1
Example of the Multidimensional Fatigue Inventory.

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group