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Comparative Study
. 2017 Dec 6;19(1):269.
doi: 10.1186/s13075-017-1475-x.

Comparison of 2002 AECG and 2016 ACR/EULAR classification criteria and added value of salivary gland ultrasonography in a patient cohort with suspected primary Sjögren's syndrome

Maëlle Le Goff  1 , Divi Cornec  2   3 , Sandrine Jousse-Joulin  1   4 , Dewi Guellec  1 , Sebastian Costa  4   5 , Thierry Marhadour  1 , Rozenn Le Berre  6 , Steeve Genestet  7 , Béatrice Cochener  8 , Sylvie Boisrame-Gastrin  9 , Yves Renaudineau  4   10 , Jacques-Olivier Pers  4   9 , Alain Saraux  1   4 , Valérie Devauchelle-Pensec  1   4
Affiliations
Comparative Study

Comparison of 2002 AECG and 2016 ACR/EULAR classification criteria and added value of salivary gland ultrasonography in a patient cohort with suspected primary Sjögren's syndrome

Maëlle Le Goff et al. Arthritis Res Ther. .

Abstract

Background: The objective was to evaluate concordance between 2002 American-European Consensus Group (AECG) and 2016 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for primary Sjögren's syndrome (pSS) and to assess how salivary gland ultrasonography (SGUS) might improve the classification of patients.

Methods: Patients with suspected pSS underwent a standardised evaluation, including SGUS, at inclusion into the single-centre Brittany DIApSS cohort. Agreement between the two criteria sets was assessed using Cohen's κ coefficient. Characteristics of discordantly categorised patients were detailed.

Results: We prospectively included 290 patients between 2006 and 2016, among whom 125 (43%) met ACR/EULAR criteria and 114 (39%) also met AECG criteria; thus, 11 (4%) patients fulfilled only ACR/EULAR, no patients AECG only, and 165 (57%) patients neither criteria set. Concordance was excellent (κ = 0.92). Compared to patients fulfilling both criteria sets, the 11 patients fulfilling only ACR/EULAR criteria had similar age and symptom duration but lower frequencies of xerophthalmia and xerostomia (p < 0.01 for each) and salivary gland dysfunction (p < 0.01); most had systemic involvement (91%), including three (27%) with no sicca symptoms; 91% had abnormal salivary gland biopsy and 46% anti-Sjögren's-syndrome-related antigen A (anti-SSA); 64% were diagnosed with pSS by the physician. SGUS was abnormal in 12% of the 165 patients fulfilling no criteria set. Including SGUS among the ACR/EULAR criteria increased sensitivity from 87.4% to 91.1% when physician diagnosis was the reference standard.

Conclusions: Agreement between AECG and ACR/EULAR criteria sets is excellent. ACR/EULAR criteria are slightly more sensitive and classified some patients without sicca symptoms as having pSS. Including SGUS in the ACR/EULAR criteria may further improve their sensitivity.

Keywords: Classification criteria; Diagnosis; Primary; Sjögren’s syndrome; Ultrasonography.

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Conflict of interest statement

Ethics approval and consent to participate

All participants gave written informed consent, and the study was approved by the Brest University Hospital institutional review board.

Consent for publication

No personal and identifiable data are included in the manuscript.

Competing interests

The authors have no conflicts of interest to declare concerning this work.

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