{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:47:27Z","timestamp":1790153247450,"version":"4.0.1"},"reference-count":31,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T00:00:00Z","timestamp":1659484800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000072","name":"National Institute of Dental and Craniofacial Research","doi-asserted-by":"publisher","award":["75N92019P00427"],"award-info":[{"award-number":["75N92019P00427"]}],"id":[{"id":"10.13039\/100000072","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000072","name":"National Institute of Dental and Craniofacial Research","doi-asserted-by":"publisher","award":["HHSN26S201300057C"],"award-info":[{"award-number":["HHSN26S201300057C"]}],"id":[{"id":"10.13039\/100000072","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["KL2TR002374"],"award-info":[{"award-number":["KL2TR002374"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR002373"],"award-info":[{"award-number":["UL1TR002373"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000053","name":"National Eye Institute","doi-asserted-by":"publisher","award":["EY026972"],"award-info":[{"award-number":["EY026972"]}],"id":[{"id":"10.13039\/100000053","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Although symptom relief is a critical aspect for successful drug development in Sj\u00f6gren's disease, patient experiences with Sj\u00f6gren's\u2010related symptoms are understudied. Our objective was to determine how pain, dryness, and fatigue, the cardinal symptoms of Sj\u00f6gren's disease, drive cluster phenotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used data from the Sj\u00f6gren's International Collaborative Clinical Alliance (SICCA) Registry and a Sj\u00f6gren's Foundation survey. We performed hierarchical clustering of symptoms by levels of dryness, fatigue, and pain. Using international and US cohorts, we performed multiple logistic regression analysis to compare the clusters, which included comparisons of differences in symptoms, quality of life (QoL), medication use, and systemic manifestations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four similar clusters were identified among 1,454 SICCA registrants and 2,920 Sj\u00f6gren's Foundation survey participants: 1) low symptom burden in all categories (LSB); 2) dry with low pain and low fatigue (DLP); 3) dry with high pain and low to moderate fatigue (DHP); and 4) high symptom burden in all categories (HSB). Distribution of SICCA registrants matching the symptom profile for each cluster was 10% in the LSB cluster, 30% in the DLP cluster, 23% in the DHP cluster, and 37% in the HSB cluster. Distribution of survey participants matching the symptom profile for each cluster was 23% in the LSB cluster, 14% in the DLP cluster, 21% in the DHP cluster, and 42% in the HSB cluster. Individuals in the HSB cluster had more total symptoms and lower QoL but lower disease severity than those in the other clusters. Despite having milder disease as measured by laboratory tests and organ involvement, individuals in the HSB cluster received immunomodulatory treatment most often.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We identified 4 symptom\u2010based Sj\u00f6gren's clusters and showed that symptom burden and immunomodulatory medication use do not correlate with Sj\u00f6gren's end\u2010organ or laboratory abnormalities. Findings highlight a discordance between objective measures and treatments and offer updates to proposed symptom\u2010based clustering approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/art.42238","type":"journal-article","created":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T15:30:07Z","timestamp":1653060607000},"page":"1569-1579","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":60,"title":["Symptom\u2010Based Cluster Analysis Categorizes Sj\u00f6gren's Disease Subtypes: An International Cohort Study Highlighting Disease Severity and Treatment Discordance"],"prefix":"10.1002","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5293-4185","authenticated-orcid":false,"given":"Sara S.","family":"McCoy","sequence":"first","affiliation":[{"name":"University of Wisconsin  Madison Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Woodham","sequence":"additional","affiliation":[{"name":"University of Wisconsin  Madison Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6523-0374","authenticated-orcid":false,"given":"Christie M.","family":"Bartels","sequence":"additional","affiliation":[{"name":"University of Wisconsin  Madison Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2062-3382","authenticated-orcid":false,"given":"Ian J.","family":"Saldanha","sequence":"additional","affiliation":[{"name":"Brown University  Providence Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vatinee Y.","family":"Bunya","sequence":"additional","affiliation":[{"name":"University of Pennsylvania  Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah","family":"Maerz","sequence":"additional","affiliation":[{"name":"University of Wisconsin  Madison Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esen K.","family":"Akpek","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew A.","family":"Makara","sequence":"additional","affiliation":[{"name":"Sj\u00f6gren's Foundation  Reston Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8344-013X","authenticated-orcid":false,"given":"Alan N.","family":"Baer","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,8,3]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/key370"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kep141"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rdc.2016.03.009"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.10512"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.23794"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kez142"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(19)30042-6"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.7682"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-212268"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.30381"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.24397"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21591"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.24014"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210571"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199603000-00003"},{"key":"e_1_2_7_17_1","article-title":"Characteristics 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