Box plot showing median cytokine levels and IQRs for (A) IP-10, (B) TNF-α, (C) LT-α and (D) IFN-γ in controls and pSS fatigue groups. Box plot showing.

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Box plot showing median cytokine levels and IQRs for (A) IP-10, (B) TNF-α, (C) LT-α and (D) IFN-γ in controls and pSS fatigue groups. Box plot showing median cytokine levels and IQRs for (A) IP-10, (B) TNF-α, (C) LT-α and (D) IFN-γ in controls and pSS fatigue groups. In all four cases, the levels of anti-inflammatory cytokines are significantly higher in patients with pSS. In addition, all four show an inverse relationship between fatigue severity and cytokine levels. Fatigue levels fall with increasing levels of the four cytokines. IFN-γ, interferon-γ; IP-10, interferon-γ-induced protein-10; LT-α, lymphotoxin-α; pSS, primary Sjögren's syndrome; TNF-α, tumour necrosis factor-α. Nadia Howard Tripp et al. RMD Open 2016;2:e000282 Copyright © BMJ Publishing Group & EULAR. All rights reserved.