Psychiatric dysfunction in connective tissue diseases: association with Sjögren's syndrome

Abstract

We studied 217 patients with connective tissue disease (CTD), comprising 55 patients with primary Sjögren's syndrome (SS), 34 with secondary SS, and 128 without SS. Psychiatric manifestations were investigated using three questionnaires: the Arthritis Impact Measurement Scale 2 (AIMS2), the Cornell Medical Index (CMI), and the Beck Depression Inventory (BDI). Stratified analysis revealed that the frequency of a neurotic state (levels III + IV in CMI) in both primary SS patients (53%; 29% + 24%) and secondary SS patients (67%; 41% + 26%) was significantly greater than in CTD patients without SS (34%; 20% + 14%) (P < 0.05 and P < 0.001, respectively). The median and Q1–Q3 BDI scores in secondary SS patients (7.5 and 4.0–20.0) were significantly higher than those in CTD patients without SS (5.0 and 1.0–10.0) (P < 0.05). Neither the frequency of a neurotic state nor the BDI score differed significantly between patients with primary SS and those with secondary SS. Regression analysis showed significant correlations between the AIMS2 level-of-tension scale and CMI classifications (rs = 0.676, P < 0.001), and between the AIMS2 mood scale and BDI score (rs = 0.679, P < 0.001). SS should always be borne in mind when patients with sicca syndrome and multifarious psychiatric complaints are examined.