Monday, July 27, 2015

Non-Pharmaceutical Interventions for Sjogren's -- A Systematic Review

Take a look at this recent article that appeared in Reuters Health, and give me your unvarnished opinions:

NEW YORK (Reuters Health) - Currently, there's no evidence to support non-pharmacological interventions for primary Sjogren's syndrome, according to the first-ever systematic review on the topic. 
The review, published online in the June 30 in Rheumatology, found no evidence that an oral lubricating device, acupuncture, lacrimal punctum plugs, or psychodynamic therapy improve quality of life for patients with primary Sjogren's syndrome.  Continue reading on Nurses Medscape here. (Requires free registration to view)
After reading the headline and first paragraph of this story, I thought it deserved close attention. So I read the article completely, and then found the actual full-text review published online in the June 2015 issue of Rheumatology:

Katie L. Hacket et al. 
Objective. To evaluate the effects of non-pharmacological interventions for primary SS (pSS) on outcomes falling within the World Health Organization International Classification of Functioning Disability and Health domains. 
Methods. We searched the following databases from inception to September 2014: Cochrane Database of Systematic Reviews; Medline; Embase; PsychINFO; CINAHL; and clinical trials registers. We included randomized controlled trials of any non-pharmacological intervention. Two authors independently reviewed titles and abstracts against the inclusion/exclusion criteria and independently assessed trial quality and extracted data. 
Results. A total of 1463 studies were identified, from which 17 full text articles were screened and 5 studies were included in the review; a total of 130 participants were randomized. The included studies investigated the 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. Overall, the studies were of low quality and at high risk of bias. Although one study showed punctum plugs to improve dry eyes, the sample size was relatively small. 
Conclusion. Further high-quality studies to evaluate non-pharmacological interventions for PSS are needed. Continue reading here. [bolding mine]
After reading the Reuters article and the Rheumatology review, it was clear to me that the review which included 1463 studies and 17 full text articles was very thorough; and I can whole heartedly agree with one of its conclusions, which was "further high-quality studies to evaluate non-pharmacological interventions for PSS are needed." More high quality Sjogren's studies? Absolutely.

But I was a bit confused by the review conclusion which also states,
Overall, we identified no current evidence to support any non-pharmacological interventions to improve the quality of life for people with pSS. [italics mine]
The assumption being that the only non-drug Sjogren's Syndrome treatments available to patients are oral lubricating devices, acupuncture, lacrimal puncture plugs, and psychodynamic therapy.

Surely there's other non-pharmacological interventions for Sjogren's being studied? Such as:

  • anti inflammatory diets
  • autologous eye drops 
  • graded exercise therapy name just a few. Can you think of more? Add them in the comment section below.


Annette said...

Despite saying there was poor to no evidence for non pharmcologic interventions she is going ahead to work on a toolkit. The Medscape article was also contradictory.
I thought it was a confusing paper. You need to wonder about researchers sometimes.


Kate Stout said...

I was most upset by how few studies there were to assess. And those that did exist had a number of problems in their design.

To me, the right conclusion was not there was "no current evidence to support any non-pharmacological intervention", (though this is true based on the quality of the existing studies, but that "there is a need to do high quality research on non-pharmalogical interventions".

To your original question - other potential therapies - we always told to reduce stress, meditate. Warm eye compresses, humidifiers, moisture trapping glasses, TENS units for pain, massage.

One of the problems is there are so many symptoms to possibly treat.

Nancy C said...

The article said that the studies are small and very much subject to bias. So why does the Reuters article suggest that there was a conclusion? In my mind, the conclusion is that there is insufficient evidence in either direction. Further high-quality studies are most certainly needed!!

Nicole said...

I have not used any of those therapeutic measures mentioned.

What I have used that has been effective: nasal saline lavage (couldn't live without it), wrist splints and special exercises, ummm.... eye drops(!), humidifier, exercise, heat and ice packs.

I guess that none of these interventions have ever been studied... ? It's all just common sense.

I also use a lot of supplements but those could be considered pharmaceutical, I suppose.