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SAT0592-HPR Non-Pharmacological Interventions for Primary SjÖGren's Syndrome: A Systematic Review of the Evidence
  1. K.L. Hackett1,
  2. K. Deane2,
  3. V. Deary3,
  4. T. Rapley4,
  5. J.L. Newton5,
  6. W.-F. Ng1
  1. 1Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne
  2. 2School of Nursing, University of East Anglia, Norwich
  3. 3Department of Psychology, Northumbria University
  4. 4Insititute of Health and Society
  5. 5Insititute of Ageing and Health, Newcastle University, Newcastle upon Tyne, United Kingdom


Background Symptoms of primary Sjögren's syndrome are varied and impact on quality of life. Non pharmacological interventions such as complimentary therapies, psychotherapy and medical devices aim to relieve symptoms and improve function. We pre-registered a protocol with PROSPERO (CRD42013004997), then conducted a systematic review.

Objectives To determine the efficacy of non pharmacological interventions on all outcomes in primary Sjogren's syndrome.

Methods A predefined list of databases were searched from inception to July 2013 with a list of search terms. Randomised controlled trials (RCTs) of any non-pharmacological interventions for adults with PSS were included. Any comparator was allowed. Titles and abstracts of studies were considered according to the inclusion/exclusion criteria. Full texts were reviewed for inclusion independently by two authors.

Two review authors separately extracted the data of included studies onto standardised forms. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Outcomes fell within the main domains addressed by the World Health Organisation International Classification of Functioning.

Results 996 studies were identified of which 17 full text articles were screened and 5 studies were included in this review with a total of 130 participants randomised. The included studies investigated effectiveness of an oral lubricating device for dry mouth, acupuncture for dry mouth, lacrimal punctum plugs for dry eyes and psychodynamic group therapy for coping with symptoms. One study[1] showed improvement in salivary flow and speed of speech with an oral lubricating device but was at high risk of bias. One study of punctum plugs[2] had no extractable data and another[4] comparing punctum plugs to artificial tears reported improvements on tear volume and film with punctum plugs, but this study was small (n=42). No benefits were reported on psychodynamic therapy in a small, poor quality study[5].

Conclusions We identified no evidence that any non-pharmacological interventions improved symptoms of PSS.


  1. Frost PM, Shirlaw PJ, et al. Impact of wearing an intra-oral lubricating device on oral health in dry mouth patients. Oral Dis 2006;12(1):57-62.

  2. List T, Lundeberg T, et al. The effect of acupuncture in the treatment of patients with primary Sjogren's syndrome. A controlled study. Acta Odontol Scand 1998;56(2):95-9.

  3. Mansour K, Leonhardt CJ, et al. Lacrimal punctum occlusion in the treatment of severe keratoconjunctivitis Sicca caused by Sjogren syndrome: a uniocular evaluation. Cornea 2007; 26(2).

  4. Qiu WQ, Liu ZY, et al. Punctal plugs versus artificial tears for treating primary Sjogren's syndrome with keratoconjunctivitis SICCA: a comparative observation of their effects on visual function. Rheumatol Int 2013;33(10):2543-48.

  5. Poulsen A. Psychodynamic, time-limited group therapy in rheumatic disease – a controlled study with special reference to alexithymia. Psychother Psychosom 1991;56(1-2):12-23.

Acknowledgements Arthritis Research UK and The Constance Owens Trust.

Disclosure of Interest None declared

DOI 10.1136/annrheumdis-2014-eular.3000

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