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Incorporation of salivary gland ultrasonography into the ACR-EULAR criteria for primary Sjögren's syndrome

van Nimwegen, J. F., Mossel, E., Delli, K., van Ginkel, M. S., Stel, A. J., Kroese, F. G. M., Spijkervet, F. K. L., Vissink, A., Arends, S. & Bootsma, H., 29-Jun-2019, In : ARTHRITIS CARE & RESEARCH.

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  • Incorporation of salivary gland ultrasonography into the ACR‐EULAR criteria for primary Sjögren's syndrome

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OBJECTIVE: To assess whether addition of salivary gland ultrasonography (SGUS) or replacement of current criteria items by SGUS influences the performance of the ACR-EULAR criteria for primary Sjögren's syndrome (pSS).

METHODS: Included were consecutive patients with complete data on all ACR-EULAR items (n=243), who underwent SGUS in our pSS expertise center. Clinical diagnosis by the treating physician was used as gold standard. Separate analyses were performed for patients who underwent labial or parotid gland biopsies. The average score for hypoechogenic areas in one parotid and one submandibular gland was determined (range 0-3). Next, performance of the ACR-EULAR criteria was evaluated after addition of SGUS or replacement of current items by SGUS.

RESULTS: Receiver operating characteristic analysis showed an optimal cut-off value of ≥1.5 for SGUS. The optimal weight for SGUS positivity was 1. Cut-off for ACR-EULAR fulfilment remained ≥4. In patients who underwent a labial gland biopsy (n=124), the original criteria showed an AUC of 0.965, sensitivity of 95.9% and specificity of 92.2%. After addition of SGUS, AUC was 0.966, with a sensitivity of 97.3% and specificity of 90.2%. In patients who underwent a parotid gland biopsy (n=198), similar results were found. Sensitivity of the criteria decreased substantially when SGUS replaced salivary gland biopsy or anti-SSA antibodies, while performance remained equal when SGUS replaced OSS, Schirmer's test or UWS.

CONCLUSION: Validity of the ACR-EULAR criteria remains high after incorporation of SGUS. With SGUS, clinicians are offered a larger array of tests to evaluate fulfilment of the ACR-EULAR criteria. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalARTHRITIS CARE & RESEARCH
Publication statusE-pub ahead of print - 29-Jun-2019

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