Cortisol during the day in patients with systemic lupus erythematosus or primary Sjogren's syndrome.

OBJECTIVE: To compare the level and change of cortisol during the day of patients with systemic lupus erythematosus (SLE) and primary Sjögren's syndrome (pSS) with low and high erythrocyte sedimentation rate (ESR). METHODS: Saliva was collected in the real-life environment of 21 women with SLE, 16 women with pSS, and 30 age-matched healthy women at 9 fixed timepoints during 2 consecutive days. Repeated measures ANOVA was performed to examine whether cortisol levels during the day were different for the patients with low ESR (≤ 20 mm/h) versus those with high ESR (> 20 mm/h). RESULTS: The groups with low and high ESR showed the characteristic change of cortisol during the day (time-of-day effect, F = 124.9, p < 0.001). The cortisol awakening level was lower for patients with high ESR than for patients with low ESR (group*time effect, F = 3.1, p = 0.02). CONCLUSION: The cortisol awakening level differs for patients with low and high ESR, which indicates the usefulness of further studies of hypothalamic-pituitary-adrenal axis dynamics in patients with SLE and pSS.

Psychological and somatic predictors of perceived and measured ocular dryness of patients with primary Sjögren's syndrome.

OBJECTIVE: To test if age, disease activity, pain, fatigue, and depression are associated with subjective and objective ocular dryness of patients with primary Sjögren's syndrome (pSS). METHODS: Sixty female patients with pSS and 60 age matched healthy controls filled out visual analog scale (VAS) scores of ocular dryness and pain, and questionnaires regarding fatigue (Multidimensional Fatigue Inventory) and depression (Zung). Lacrimal tear production was measured by Schirmer I test. As surrogate indicators of disease activity the erythrocyte sedimentation rate, hemoglobin concentration, and total serum immunoglobulin G were determined. RESULTS: Perceived ocular sicca symptoms were not related to Schirmer I test scores. The rate of tear production was related to age (r = -0.47, p < 0.001), disease activity (r = -0.27, p < 0.05), and pain (r = 0.42, p < 0.001). Age and pain together explained 42% of the variance of the Schirmer I test results. CONCLUSION: Not unexpectedly, age and disease activity were associated with ocular dryness, but contrary to expectation, pain was associated with more instead of less tear production. We did not find evidence that pain, fatigue, or depression are associated with reduced tear production or perceived ocular dryness.

Moderation of physiological stress responses by personality traits and daily hassles: less flexibility of immune system responses.

Previously we demonstrated that stressors varying on the dimension of mental effort and controllability have distinctive effects on cardiovascular, endocrine and immune system responses. The purpose of the present study was to relate individual differences in physiological stress responsivity to task appraisal and stress-induced mood changes (issue 1), trait characteristics (issue 2) and daily hassles (issue 3). Appraisal and mood changes did not mediate the differential effects of the stressors. The trait characteristics, aggression and external locus of control and daily hassles moderated the effect of the stressor on physiological parameters, especially immune parameters. Moreover, the moderation effect was different in the high versus the low effort stress task. High aggression, high external locus of control and more daily hassles were associated with increased reactivity in the low effort condition and decreased reactivity in the high effort condition, which is suggested to reflect less differentiated responding to changing task demands and hence, less flexibility in the immune system.