Department of Rheumatology, Princess Margaret Hospital, Okus Road, Swindon SN1 4JU and
1 Kennedy Institute of Rheumatology Division, Imperial College, 1 Aspenlea Road, London W6 8LH, UK
It is interesting that Mariette and colleagues have recognized a similar group of patients to that which we described, and have designated them as sicca, asthenia and polyalgia syndrome (SAPS) [1] rather than dry eyes and mouth syndrome (DEMS) [2]. The term SAPS is possibly more evocative than DEMS, though we suggest that DEMS is simpler and more descriptive of typical presenting symptoms to a Sjögren's clinic. We totally support the importance of separating these patients from true primary Sjögren's syndrome because many of the DEMS/SAPS population do indeed receive treatment comprising steroids and immunosuppressive drugs.
It is a different question as to whether these patients require separate diagnostic criteria. We would argue against this for two reasons. First, a negative diagnosis of Sjögren's is sufficient to avoid inappropriate treatment. This is simply achieved by the application of the revised Vitali criteria [3] for Sjögren's syndrome. Second, a diagnosis of fibromyalgia (FM) or chronic fatigue syndrome (CFS) (reviewed in [4]) would help in management, as treatment for these two conditions has been extensively evaluated [4]. This provides at least some evidence base for a positive therapeutic approach. We therefore suggest that diagnosis of CFS or FM is more useful than creating yet another group of patients with their own classification criteria.
What is common and important to both ours [2] and Mariette et al. 's [1] studies is that there is a large group of patients with symptoms of Sjögren's syndrome who do not have the disease and who require a completely different approach to management. We are also in agreement that further investigation of the physiology and psychopathology of these patients is required. We particularly emphasize that the relationship of DEMS/SAPS to the spectrum of CFS/FM needs further research.
Conflicts of interest
The authors have declared no conflicts of interest.
Notes
Correspondence to: P. J. W. Venables. E-mail: p.venables{at}ic.ac.uk
References