Background PSS is characterized by pain, fatigue, lack of a cure, uncertainty and chronicity. Psychological factors are known to modulate health status in persons with chronic illness, but little data is available in PSS. Illness perceptions (especially perceived consequence and perceived control) are important factors influencing medical, psychological and behavioral outcomes in patients with rheumatic disorders.
Objectives The aim of this study was to use a validated instrument: the Illness Perceptions Questionnaire (IPQ-R) to investigate potential links between illness perceptions and functional outcomes in patients with primary Sjogren’s syndrome (PSS) and to compare illness representations in patients with different disease characteristics. We compared seropositive and seronegative PSS patients to assess the effects of serologic status and illness perceptions on key outcomes including fatigue, pain and health status.
Methods Demographics, clinical characteristics (sicca symptoms and objective sicca measures), health outcomes: fatigue (FSS), pain(BPI), sleep quality(PSQI), mood (HADS), generic health status (SF-12) and illness perceptions (IPQ-R) were evaluated by survey. Relationships between illness perceptions, clinical characteristics and SF-12 domains were assessed by spearman rank correlation. Psychological and clinical characteristics were compared in the two groups by t test and Pearson’s Chi-Squared Test.
Results PSS patients (N=123) by AECG criteria were compared based on serologic status (SSA/and or SSB positive vs. SSA/SSB negative) Seronegative (N=45) and seropositive subjects (N=78) were similar in gender (95% F), education (77% college), ethnicity (95% Caucasian), whereas seronegative patients were slightly older (63 yrs. vs. 58 yrs., p=.004). The seronegative group reported greater pain severity (p=.003) and had more negative physical domain SF-12 scores (p=.021) despite a trend toward less severe sicca and similar illness perceptions in all domains of the IPQ-R. Pessimistic beliefs about the consequences of illness were associated with fatigue, with pain severity and with reduced physical function in both patient groups. Mental domain SF-12 scores were negatively associated with fatigue and depression in the seropositive and with fatigue and anxiety in the seronegative group.
Conclusions In other chronic illnesses in which fatigue and pain are prominent, coping styles, self-efficacy and catastrophizing are predictive of health outcome. We found that psychological factors, particularly pessimistic beliefs about the consequences of illness, contribute to fatigue and pain as well as to health status in PSS. Assessment of illness perceptions and appropriately designed cognitive behavioral interventions could be helpful to reduce fatigue, pain and psychological distress.
Disclosure of Interest None Declared
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