Salivary gland ultrasonography improves the diagnostic performance of the 2012 American College of Rheumatology classification criteria for Sjögren's syndrome.
OBJECTIVE
The aim of this study was to evaluate whether salivary gland ultrasonography (SGUS) improves the diagnostic performance of the 2012 ACR classification criteria for SS.


METHODS
We studied a cohort of 101 patients with suspected SS seen at a single centre in Brittany, France. An SGUS echostructure score ≥2 was considered abnormal. The reference standard was a clinical diagnosis of SS made by a group of experts blinded to SGUS findings.


RESULTS
SS was diagnosed in 45 patients. Similar proportions of patients with and without SS had an ocular staining score ≥3. Adding RF positivity and ANA titre ≥1:320 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 was 60.0% sensitive and 87.5% specific for SS. Adding the SGUS score to the ACR criteria increased sensitivity from 64.4% to 84.4% and only slightly decreased specificity, from 91.1% to 89.3%.


CONCLUSIONS
The diagnostic performance of the ACR classification criteria for SS is notably improved by adding the SGUS score. SGUS should be included in future classification criteria for SS.
Department of Rheumatology, EA 2216 Immunology and Pathology, SFR ScinBios, Labex Immunotherapy, Graft, Oncology, Brest University, Department of Odontology and Laboratory of Immunology and Immunotherapy, Brest Teaching Hospital, Brest, France. Department of Rheumatology, EA 2216 Immunology and Pathology, SFR ScinBios, Labex Immunotherapy, Graft, Oncology, Brest University, Department of Odontology and Laboratory of Immunology and Immunotherapy, Brest Teaching Hospital, Brest, France.
Divi
D
Cornec
Department of Rheumatology, EA 2216 Immunology and Pathology, SFR ScinBios, Labex Immunotherapy, Graft, Oncology, Brest University, Department of Odontology and Laboratory of Immunology and Immunotherapy, Brest Teaching Hospital, Brest, France. Department of Rheumatology, EA 2216 Immunology and Pathology, SFR ScinBios, Labex Immunotherapy, Graft, Oncology, Brest University, Department of Odontology and Laboratory of Immunology and Immunotherapy, Brest Teaching Hospital, Brest, France.
Sandrine
S
Jousse-Joulin
Department of Rheumatology, EA 2216 Immunology and Pathology, SFR ScinBios, Labex Immunotherapy, Graft, Oncology, Brest University, Department of Odontology and Laboratory of Immunology and Immunotherapy, Brest Teaching Hospital, Brest, France.
Thierry
T
Marhadour
Department of Rheumatology, EA 2216 Immunology and Pathology, SFR ScinBios, Labex Immunotherapy, Graft, Oncology, Brest University, Department of Odontology and Laboratory of Immunology and Immunotherapy, Brest Teaching Hospital, Brest, France. Department of Rheumatology, EA 2216 Immunology and Pathology, SFR ScinBios, Labex Immunotherapy, Graft, Oncology, Brest University, Department of Odontology and Laboratory of Immunology and Immunotherapy, Brest Teaching Hospital, Brest, France.
Jacques-Olivier
JO
Pers
Department of Rheumatology, EA 2216 Immunology and Pathology, SFR ScinBios, Labex Immunotherapy, Graft, Oncology, Brest University, Department of Odontology and Laboratory of Immunology and Immunotherapy, Brest Teaching Hospital, Brest, France.
Sylvie
S
Boisramé-Gastrin
Department of Rheumatology, EA 2216 Immunology and Pathology, SFR ScinBios, Labex Immunotherapy, Graft, Oncology, Brest University, Department of Odontology and Laboratory of Immunology and Immunotherapy, Brest Teaching Hospital, Brest, France. Department of Rheumatology, EA 2216 Immunology and Pathology, SFR ScinBios, Labex Immunotherapy, Graft, Oncology, Brest University, Department of Odontology and Laboratory of Immunology and Immunotherapy, Brest Teaching Hospital, Brest, France.
Yves
Y
Renaudineau
Department of Rheumatology, EA 2216 Immunology and Pathology, SFR ScinBios, Labex Immunotherapy, Graft, Oncology, Brest University, Department of Odontology and Laboratory of Immunology and Immunotherapy, Brest Teaching Hospital, Brest, France. Department of Rheumatology, EA 2216 Immunology and Pathology, SFR ScinBios, Labex Immunotherapy, Graft, Oncology, Brest University, Department of Odontology and Laboratory of Immunology and Immunotherapy, Brest Teaching Hospital, Brest, France.
Alain
A
Saraux
Department of Rheumatology, EA 2216 Immunology and Pathology, SFR ScinBios, Labex Immunotherapy, Graft, Oncology, Brest University, Department of Odontology and Laboratory of Immunology and Immunotherapy, Brest Teaching Hospital, Brest, France. Department of Rheumatology, EA 2216 Immunology and Pathology, SFR ScinBios, Labex Immunotherapy, Graft, Oncology, Brest University, Department of Odontology and Laboratory of Immunology and Immunotherapy, Brest Teaching Hospital, Brest, France. valerie.devauchelle-pensec@chu-brest.fr.
Valérie
V
Devauchelle-Pensec
D000328:Adult; D000368:Aged; D000974:Antibodies, Antinuclear / Q000097:blood; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012217:Rheumatoid Factor / Q000097:blood; D012469:Salivary Glands / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D012859:Sjogren's Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging*; D014463:Ultrasonography
D000974:Antibodies, Antinuclear; D015415:Biomarkers; D012217:Rheumatoid Factor
Sjögren’s syndrome; classification criteria; diagnosis; sensitivity; specificity; ultrasonography