{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T09:44:55Z","timestamp":1793353495921,"version":"4.5.0"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T00:00:00Z","timestamp":1624579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Sj\u00f6gren\u2019s syndrome (SS) is an autoimmune disease affecting the salivary and lacrimal glands. Symptoms range from dryness to severe extra-glandular disease involving manifestations in the skin, lungs, nervous system, and kidney. Fatigue occurs in 70% of patients, characterizing primary SS (pSS) and significantly impacting the patient\u2019s quality of life. There are some generic and specific instruments used to measure fatigue in SS. The mechanisms involved with fatigue in SS are still poorly understood, but it appears fatigue signaling pathways are more associated with cell protection and defense than with pro-inflammatory pathways. There are no established pharmacological treatment options for fatigue in pSS. So far, exercise and neuromodulation techniques have shown positive effects on fatigue in pSS. This study briefly reviews fatigue in pSS, with special attention to outcome measures, biomarkers, and possible treatment options.<\/jats:p>","DOI":"10.3389\/fimmu.2021.703079","type":"journal-article","created":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T06:58:21Z","timestamp":1624604301000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":43,"title":["Understanding Fatigue in Sj\u00f6gren\u2019s Syndrome: Outcome Measures, Biomarkers and Possible Interventions"],"prefix":"10.3389","volume":"12","author":[{"given":"Elisabeth","family":"M\u00e6land","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samira T.","family":"Miyamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Hammenfors","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Valim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malin V.","family":"Jonsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,6,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-205375","article-title":"Epidemiology of Primary Sj\u00f6gren\u2019s Syndrome: A Systematic Review and Meta-Analysis","volume":"74","author":"Qin","year":"2015","journal-title":"Ann Rheum Dis"},{"key":"B2","article-title":"Sj\u00f6gren\u2019s Syndrome","volume-title":"Arthritis and Allied Conditions - A Textbook of Rheumatology","author":"Jonsson","year":"2001"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22263","article-title":"Primary Sj\u00f6gren\u2019s Syndrome: Fatigue is an Ever-Present, Fluctuating, and Uncontrollable Lack of Energy","volume":"66","author":"Mengshoel","year":"2014","journal-title":"Arthritis Care Res"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1177\/0961203319857132","article-title":"Prognostic Markers of Lymphoma Development in Primary Sj\u00f6gren Syndrome","volume":"28","author":"Retamozo","year":"2019","journal-title":"Lupus"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keq009","article-title":"Primary Sj\u00f6gren\u2019s Syndrome: Too Dry and Too Tired","volume":"49","author":"Ng","year":"2010","journal-title":"Rheumatol (Oxford)"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1002\/art.11384","article-title":"Physical Capacity in Women With Primary Sj\u00f6gren\u2019s Syndrome: A Controlled Study","volume":"49","author":"Str\u00f6mbeck","year":"2003","journal-title":"Arthritis Rheum"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22974","article-title":"Severe Health-Related Quality of Life Impairment in Active Primary Sj\u00f6gren\u2019s Syndrome and Patient-Reported Outcomes: Data From a Large Therapeutic Trial","volume":"69","author":"Cornec","year":"2017","journal-title":"Arthritis Care Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"R167","DOI":"10.1186\/ar3487","article-title":"A Five-Year Prospective Study of Fatigue in Primary Sj\u00f6gren\u2019s Syndrome","volume":"13","author":"Haldorsen","year":"2011","journal-title":"Arthritis Res Ther"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21738","article-title":"Impaired Functional Status in Primary Sj\u00f6gren\u2019s Syndrome","volume":"64","author":"Hackett","year":"2012","journal-title":"Arthritis Care Res"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S163417","article-title":"The Impact of Disease Activity and Psychological Status on Quality of Life for Chinese Patients With Primary Sj\u00f6gren\u2019s Syndrome","volume":"12","author":"Cui","year":"2018","journal-title":"Patient Prefer Adherence"},{"key":"B11","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s42358-021-00181-9","article-title":"Pain and Fatigue are Predictors of Quality of Life in Primary Sj\u00f6gren\u2019s Syndrome","volume":"61","author":"Dias","year":"2021","journal-title":"Adv Rheumatol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/s40744-020-00220-9","article-title":"An Innovative Online Qualitative Study to Explore the Symptom Experience of Patients With Primary Sj\u00f6gren\u2019s Syndrome","volume":"7","author":"Gairy","year":"2020","journal-title":"Rheumatol Ther"},{"key":"B13","doi-asserted-by":"publisher","first-page":"kez027","DOI":"10.1093\/rheumatology\/kez027","article-title":"Pain and Fatigue in Primary Sj\u00f6gren\u2019s Syndrome","author":"Omdal","year":"2019","journal-title":"Rheumatol (Oxford)"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keq023","article-title":"Sleepiness or Fatigue? 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