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Observational Study
. 2020 Feb 24;22(1):38.
doi: 10.1186/s13075-020-2132-3.

Unstimulated whole saliva flow for diagnosis of primary Sjögren's syndrome: time to revisit the threshold?

Valentin Lacombe  1 , Carole Lacout  1 , Pierre Lozac'h  1 , Alaa Ghali  1 , Aline Gury  1 , Christian Lavigne  1 , Geoffrey Urbanski  2
Affiliations
Observational Study

Unstimulated whole saliva flow for diagnosis of primary Sjögren's syndrome: time to revisit the threshold?

Valentin Lacombe et al. Arthritis Res Ther. .

Abstract

Background: Unstimulated whole saliva (UWS) flow rate is one of the ACR/EULAR 2016 criteria for primary Sjögren's syndrome (pSS). With a single threshold of ≤ 0.1 mL/min, UWS flow does not take into account the age- and sex-related physiological variations. Furthermore, it has a low sensitivity for the diagnosis of pSS (about 50%), contrary to the screening test for xerophthalmia, Schirmer's test (sensitivity of about 70%). We aimed to identify UWS thresholds allowing better performances for a screening test for pSS comparable to Schirmer's test, and considering age- and sex-related variations.

Methods: A prospective cohort of 185 patients with oral and/or ocular dryness was classified into 3 groups: men, women < 50 (< 50 years old), and women ≥ 50 (≥ 50 years old). The diagnostic performances of UWS flow rate in these groups were compared in terms of sensitivity, specificity, positive and negative predictive values, and ROC curves. The identification of thresholds that optimize diagnostic performances was carried out using Youden's index.

Results: The diagnostic performances of UWS flow rate varied according to age and sex. UWS had poor diagnostic performances whatever the threshold in the women ≥ 50 group. The threshold of 0.2 mL/min had a sensitivity of ≥ 70% and a specificity of ≥ 50% in both men and women < 50 groups. In the whole population and compared to the current cutoff, a threshold of 0.2 mL/min increased sensitivity (+ 19.8%) and positive (+ 2.3%) and negative (+ 7.0%) predictive values, with a better specificity (65.2%) than Schirmer's test.

Conclusion: For objective assessment of xerostomia, raising the threshold of the UWS flow rate to 0.2 mL/min would optimize its screening performances for pSS.

Keywords: Age groups; Classification; Saliva; Sex; Sjögren’s syndrome; Xerostomia.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Evolution of unstimulated whole saliva (UWS) flow rate with age, in women (a, b) and in men (c, d)
Fig. 2
Fig. 2
ROC curves representing the diagnostic value of UWS flow in primary Sjögren’s syndrome in the whole population and in each group
Fig. 3
Fig. 3
Youden’s index according to the saliva flow rate in each group. UWS, unstimulated whole saliva
See this image and copyright information in PMC

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