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Title: The effect of primary Sjögren's Syndrome on the senses of smell, taste and sexuality in female patients in the UK : impact on quality of life
Author: Al-Ezzi, Minan Y. Husein
ISNI:       0000 0004 7653 9774
Awarding Body: Queen Mary University of London
Current Institution: Queen Mary, University of London
Date of Award: 2018
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It is well established that mucosal dryness is the most common symptom in primary Sjögren's Syndrome (pSS) patients, affecting the nasal, oral and genital mucosa. A systematic review was conducted and a study with the following aims was established: 1) To assess the functions of the smell, taste and sexuality in patients with pSS. 2) To determine whether the mucosal dryness has an impact on the functions of the smell, taste and sexuality in pSS patients. 3) To investigate the impact of the impairment of the functions of smell, taste and sexuality on the quality of life (QoL) and mental health well-being in women with pSS. Methodology: Sixty-five pSS patients and 62 sex-matched healthy volunteers were recruited for this study. The smell function was assessed by the University of Pennsylvania Smell Identification Test (UPSIT). The taste function was comprehensively evaluated by assessing the gustatory function using the Taste Strips Test (TST), and the neurosensory threshold by an electrogustometer (EGM). The sexual function was assessed by the Female Sexual Function Index (FSFI). The oral dryness was assessed by means of stimulated and unstimulated salivary flow rate (SFR), clinical assessment of oral dryness scale (CODS) and Xerostomia Inventory (XI). The World Health Organisation Quality of Life-BRÉF (WHOQoL- BRÉF) and Oral Health Impact Profile-14 (OHIP-14) were used for the general and oral health related QoL respectively. The Hospital Anxiety and Depression Scale (HADS) was used to assess the mental health status. Results: Data analysis showed that the smell dysfunction was twice as prevalent in the patients group (41.5%, n=27/65) compared with healthy volunteers (24.1%, n=15/62). This difference was even more pronounced when assessing the gustatory function impairment, which was six times more prevalent in pSS patients (54%, n=34/63) than in healthy participants (8.3%, n=5/60). The neurosensory threshold of taste was three times higher in the patients' group (31.7%, n=20/64) compared with the healthy volunteers (9.8%, n=6/61), and was associated with gustatory deterioration in pSS group (β=-0.4, 95% CI=-0.2 - 0), indicating possible neurological impairment in this group. As expected, the salivary flow rate and the clinical oral dryness score were significantly lower in the patient group compared with healthy volunteers. No evidence was found to support that the oral dryness was associated with deterioration of smell, taste or sexual functions in pSS patients. The number of sexually active pSS patients (n=28) was half of that in the healthy volunteers group (n=42), and the FSFI showed that the sexual function was significantly impaired in pSS patients (p= < 0.05). The self-administered questionnaires showed that the life quality was significantly compromised in patients, who were more anxious (58.5%, n=38/65) and four times more depressed (32.3%, n=21/65) compared with healthy volunteers (Anxiety=21%, n=13/61; depression=8.2%, n=5/61). However, neither smell nor taste dysfunction were contributory factors to the reduced QoL, but the sexual dysfunction was the main factor contributed to the compromised general QoL in pSS patients. Conclusion: The smell, taste and sexual impairment are manifestations seen in pSS, but only the sexual dysfunction appear to have a diminishing effect on the QoL and mental health well-being of patients. The taste deterioration in pSS does not seem to be associated with mucosal dryness but maybe precipitated by a Sjögren's syndrome-associated neuropathy.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available