Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
A Step Toward New Diagnostic Criteria in Sjgren's Syndrome: Contribution of Major Salivary Gland Ultrasonography and Blood B-Cell Subset Profiling.
Cornec1, Divi, Saraux1, Alain, Jousse-Joulin2, Sandrine, Marhadour3, Thierry, Pers1, Jacques-Olivier, Cochener1, Beatrice, Youinou1, Pierre
Brest Occidentale University, Brest, France
Brest university medical school, EA 2216, UBO and CHU de la Cavale Blanche,, Brest, France
CHU La Cavale Blanche, Brest, France
Brest Occidentale university, Brest, France
The clinical diagnosis of primary Sjögren's Syndrome (pSS) is mainly based on the AECG classification criteria, published in 2002. They do not include salivary gland ultrasonography (SGUS) and B-cell subset profiling, which have recently shown promising performance for the diagnosis of pSS. The aim of this prospective study was to determine their diagnostic value, and to suggest modifications of the classification criteria.
This study was conducted in a prospective monocentric cohort of patients with suspected pSS (sicca symptoms, parotidomegaly or extraglandular manifestations suggestive of pSS), included between 2006 and 2011. Clinical examination, basic biology, immunological tests and minor labial salivary gland biopsy (SGB) were performed systematically. SGUS was standardized and performed on bilateral parotid and submandibular glands, and their echostructure was quoted on a scale between 0 and 4, as previously published. The maximal score of one of the glands was considered for analysis. For blood B-cell subset profiling, the ratio (Bm2+Bm2')/(eBm5+Bm5) was determined using flow cytometry. A ratio >=5 has been shown suggestive of pSS. The gold standard for the analysis was a clinical diagnosis of pSS performed by a group of experts blinded to the results ultrasonograophy and Blood B cells.
185 patients have been included in the study (mean age 56.5±12.9 years, symptoms duration 6.4±6.7 years, 91.4% females). 78 patients had pSS, of whom 62 (79.5%) fulfilled AECG criteria. Other diagnoses were idiopathic sicca (n=54), secondary SS (n=27), drug-induced sicca (n=22) and diabetes (n=4). No differences were found between the 2 groups concerning age, disease duration, and sex ratio. All items of AECG criteria were significantly associated with the diagnosis of pSS. SGUS was performed in 147 patients. ROC analysis determined an ideal cut-off of >=2 on the 04 scale, for a 63.0% sensitivity (Se) and a 97.3% specificity (Sp). 37/72 pSS and 17/98 non-pSS patients had a (Bm2+Bm2')/(eBm5+Bm5) ratio >=5. The sensibility of this test was 51.4% for a 82.7% specificity. Higher cut-off led to an increased Sp but a lower Se (>=6.5: Se 40.3%, Sp 92.9%; >=9: Se 26.4%, Sp 98.0%). Logistic regression analysis selected only 5 items independently predictive of pSS diagnosis: xerostomy, Schirmer test, SGB, SSA/SSB positivity and SGUS. A weighted score was constructed using these variables: (Xerostomy × 2) + Schirmer + (SGB × 2) + (SSA/SSAB × 2) + SGUS. After ROC analysis, we found that a score >=5/8 had a 84.9% Se and a 97.2% Sp, compared to 79.5% and 98.6% for AECG criteria. The area under the ROC curve of our criteria was higher than of AECG criteria (0.966 vs 0.891).
In this study, B-cell subset profiling was suggestive of pSS, but was not independent from other items. SGUS has an important diagnostic value for pSS, and modifications of AECG criteria including this item notably improve their diagnostic performance. The diagnostic value of such criteria have to be confirmed in other studies.
To cite this abstract, please use the following information:
Cornec, Divi, Saraux, Alain, Jousse-Joulin, Sandrine, Marhadour, Thierry, Pers, Jacques-Olivier, Cochener, Beatrice, et al; A Step Toward New Diagnostic Criteria in Sjgren's Syndrome: Contribution of Major Salivary Gland Ultrasonography and Blood B-Cell Subset Profiling. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :476