Increased severity of lower urinary tract symptoms and daytime somnolence in primary Sjogren's syndrome

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J Rheumatol. 2003 Nov;30(11):2406-12.

Increased severity of lower urinary tract symptoms and daytime

somnolence in primary Sjogren's syndrome.

J, Gordon T, Lester S, Downie-Doyle S, McEvoy D, Pile K, Waterman

S, Rischmueller M.

Department of Immunology, Allergy and Arthritis, Flinders Medical

Centre, Adelaide, Australia.

OBJECTIVE: Functional antimuscarinic receptor autoantibodies have

recently been described in both primary and secondary Sjogren's syndrome

(SS) in a mouse bladder contraction assay. Most patients with these

antibodies complained of severe lower urinary tract disturbances, which

are not a recognized feature of SS. We compared the severity of

self-reported urological symptoms, daytime somnolence, and fatigue

between a cohort of patients with primary SS and controls with

osteoarthritis (OA). METHODS: Female patients were recruited from

rheumatology outpatient clinics at 2 hospitals. The American Urological

Symptom Index (AUA-7), Epworth Sleepiness Scale, and FACIT-F fatigue

self-administered instruments were employed. Results were obtained for

76 patients with primary SS and 43 controls (response rates 85% and 67%,

respectively). The patient groups were matched for parity, hormone

replacement and diuretic therapy, and number of bladder operations and

urinary tract infections, although OA patients were slightly older.

RESULTS: AUA-7 urological symptoms were more severe in patients with

primary SS compared to OA controls (p = 0.039). Severe urological

symptoms were reported by 61% of primary SS patients compared with 40%

of OA controls. This difference was predominantly attributable to

bladder irritability associated with urgency (p = 0.015) and not

nocturia (p = 0.85). Epworth Sleepiness Scale scores were also more

severe in primary SS patients compared to OA controls (p = 0.02),

independent of nocturia. The FACIT-F fatigue severity scores were not

significantly different between patient groups (p = 0.14).

CONCLUSION: Urological symptoms and daytime somnolence may be previously

unrecognized symptoms of primary SS. These symptoms are consistent with

functional disturbances of muscarinic receptors, possibly mediated by

muscarinic receptor autoantibodies.

PMID: 14677185