Ultrasound Improves Sjogren's Syndrome Classification

By David Douglas

May 03, 2014

NEW YORK (Reuters Health) - Salivary gland ultrasonography (SGUS) enhances American College of Rheumatology (ACR) classification of patients with Sjögren's syndrome (SS) and in the future should be included in evaluations, according to French investigators.

"In this study, we confirm that salivary gland ultrasonography has a large clinical impact for the diagnosis of primary Sjögren's syndrome," Dr. Divi Cornec told Reuters Health by email. "This non-invasive, easily accessible tool should be included in the diagnostic work-up for suspected Sjögren's syndrome. An international study group has been recently created to definitely validate the procedure."

In an April 4th online paper in Rheumatology, Dr. Cornec of Hopital de la Cavale Blanche, Brest and colleagues note that in 2012, the ACR issued new classification criteria for SS. These were selected based on expert opinion but none reflects salivary gland function and morphology, which are altered in SS.

To examine the utility of SGUS in augmenting the diagnostic performance of the ACR approach, the researchers examined 101 patients with suspected SS. Among inclusion criteria were subjective ocular or oral dryness, recurrent or bilateral parotidomegaly or laboratory abnormalities suggesting SS. An SGUS echostructure score of 2 or more was considered abnormal.

All cases were reviewed by a panel of three experts blinded to the SGUS findings and SS was diagnosed in 45 patients. Similar proportions of patients with and without SS had an ocular staining score at or beyond 3.

As covered in the ACR classification criteria, adding rheumatoid factor positivity and an antinuclear antibody titer of 1.320 or more as an alternative to anti-SSA/SSB positivity increased the sensitivity of the serological item without modifying specificity compared with using anti-SSA/SSB alone.

SGUS alone gave a sensitivity of 60.0% and a specificity of 87.5%. Adding the SGUS score to the ACR criteria increased the sensitivity from 64.4% to 84.4% and only "slightly" decreased specificity, from 91.1% to 89.3%.

SGUS, say the researchers, "is simple, non-invasive, widely available, non-irradiating and less expensive than other imaging techniques." Adding it "substantially improved the diagnostic performance of the 2012 ACR criteria set."

Thus they conclude that SGUS "should be included in future consensual classification criteria for SS."

SOURCE: https://bit.ly/R825Kg

Rheumatology 2014.


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