The validated patient-reported outcome for primary Sjogren's disease. Three questions covering dryness (average of ocular and oral), fatigue, and pain - each rated 0 to 10. The final ESSPRI score is the simple average of these three domains. Acceptable symptom state is defined as ESSPRI below 5. Minimal clinically important improvement is 1 point or 15%.
The dryness domain is the average of ocular and oral dryness scores. Rate each 0 (not severe) to 10 (maximally severe). These questions refer to the past week.
| ESSPRI | Status | Clinical Meaning |
|---|---|---|
| < 5 | Acceptable Symptom State | Patient-acceptable symptom state (PASS). Well-tolerated symptom burden. |
| 5 to 6.9 | Moderate Burden | Significant symptom burden. May warrant targeted symptomatic therapy review. |
| 7+ | High Symptom Burden | High patient-reported symptom severity. Prioritize symptom management alongside systemic therapy. |
MCII (minimal clinically important improvement): decrease of at least 1 point or 15% from baseline. PASS: score below 5. These were defined in a cohort of 790 patients (Seror et al., Ann Rheum Dis 2016; online first 2014).
Important: ESSPRI and ESSDAI assess different dimensions of Sjogren's disease. Correlations between them are typically weak (r = 0.07 to 0.29). A patient may have well-controlled ESSDAI (systemic activity) but high ESSPRI (symptom burden), or vice versa. Both should be assessed at every visit.
ESSPRI was developed by the EULAR Sjogren's Task Force and published by Seror and colleagues in Annals of the Rheumatic Diseases in 2011. The instrument was derived using consensus methods with a worldwide panel of primary Sjogren's experts. Validation in 790 patients across two prospective cohorts derived the PASS threshold of less than 5 and the MCII of 1 point or 15% (Seror et al., Ann Rheum Dis 2016). ESSPRI is now the standard patient-reported endpoint in Sjogren's clinical trials, alongside ESSDAI.
Patient-reported symptom burden in primary Sjogren's disease across three domains: dryness (the average of eye and mouth scores), fatigue, and pain, each rated 0 to 10. The ESSPRI is the average of the three domain scores.
A decrease of at least 1 point or 15% from baseline is the minimal clinically important improvement reported in the derivation study (Seror et al., Ann Rheum Dis 2016; online first 2014).
A score below 5 is the patient-acceptable symptom state (PASS) in the validation cohort.
The ESSPRI is what the patient reports. The ESSDAI is the physician's assessment of systemic disease activity. They capture different things, so a patient can have a high symptom burden with low systemic activity, and the reverse.
Sources
Seror R, Ravaud P, Mariette X, et al. EULAR Sjogren's syndrome patient reported index (ESSPRI): development of a consensus patient index for primary Sjogren's syndrome. Ann Rheum Dis. 2011.
Seror R, Bootsma H, Saraux A, et al. Defining disease activity states and clinically meaningful improvement in primary Sjogren's syndrome with EULAR primary Sjogren's syndrome disease activity index (ESSDAI) and patient-reported index (ESSPRI). Ann Rheum Dis. 2014.