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. 2021 Apr;7(2):e001516.
doi: 10.1136/rmdopen-2020-001516.

Application of the OMERACT Grey-scale Ultrasound Scoring System for salivary glands in a single-centre cohort of patients with suspected Sjögren's syndrome

Viktoria Fana  1 , Uffe M Dohn  1 , Simon Krabbe  1 , Lene Terslev  1
Affiliations

Application of the OMERACT Grey-scale Ultrasound Scoring System for salivary glands in a single-centre cohort of patients with suspected Sjögren's syndrome

Viktoria Fana et al. RMD Open. 2021 Apr.

Abstract

Aim: To describe salivary gland involvement in patients suspected of Sjögren's syndrome (SS) using the OMERACT Ultrasound Scoring System for SS. Next, using different ultrasound cut-offs, to assess the performance of the scoring system for diagnosis and fulfilment of 2016 ACR/EULAR SS classification criteria.

Methods: All patients referred to our department with a suspicion of SS in a 12-month period were included. All underwent grey-scale ultrasound of the parotid and submandibular glands prior to clinical examination, Schirmer's test, unstimulated salivary flow, blood samples including autoantibody analysis. Labial biopsy was performed according to clinicians' judgement. Images of the four glands were scored 0-3 according to the scoring system and a consensus score was obtained using a developed ultrasound atlas.

Results: Of the 134 patients included in the analysis, 43 were diagnosed with primary SS (pSS) and all fulfilled the 2016 American College of Rheumatology (ACR)/EULAR classification criteria. More patients with pSS compared with non-pSS had score ≥2 in at least one gland (72% vs 13%; p<0.001). In patients with score ≥2 in any gland, significantly more had positive autoantibodies, sialometry, Schirmer's test and positive labial biopsy compared with those with scores ≤1. The best ultrasound cut-off value for diagnosing pSS was ≥1 gland with a score ≥2 (sensitivity=0.72, specificity=0.91).

Conclusion: The OMERACT Ultrasound Scoring System showed good sensitivity (0.72) and excellent specificity (0.91) for fulfilling 2016 ACR/EULAR criteria using cut-off score >2 in at least one gland. Our data supports the use of ultrasound for diagnosing pSS and supports incorporation of ultrasound in the classification criteria.

Keywords: Sjogren's syndrome; autoimmune diseases; ultrasonography.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
OMERACT Ultrasound Scoring System for Sjögren. Representative examples of images reflecting the written definitions of the OMERACT scoring system grade 0–3 for (left) the parotid gland and (right) the submandibular gland. The examples can also be seen in the atlas—online supplemental file 1.
Figure 2
Figure 2
Patient disposition. Patients with pSS: 2016 ACR/EULAR criteria for pSS were fulfilled (at least four points), all had a clinical diagnosis of pSS. Non-pSS patients: 2016 ACR/EULAR criteria for pSS not fulfilled (below 4 points, 27 patients had 1–3 points according to the 2016 ACR/EULAR criteria but did not have labial salivary gland biopsy, none of these had a clinical diagnosis of pSS). ACR, American College of Rheumatology; MALT, mucosa-associated lymphoid tissue; non-pSS, patients without pSS; pSS, primary Sjögren’s syndrome; SLE, systemic lupus erythematosus; SS, Sjögrens syndrome.
See this image and copyright information in PMC

References

    1. Mossel E, Delli K, van Nimwegen JF, et al. . Ultrasonography of major salivary glands compared with parotid and labial gland biopsy and classification criteria in patients with clinically suspected primary Sjögren's syndrome. Ann Rheum Dis 2017;76:1883–9. 10.1136/annrheumdis-2017-211250 - DOI - PubMed
    1. Shiboski CH, Shiboski SC, Seror R. 2016 American College of Rheumatology/European League against rheumatism classification criteria for primary Sjögren's syndrome: a consensus and data-driven methodology involving three international patient cohorts. Arthritis Rheumatol 2016;2017:35–45. 10.1002/art.39859 - DOI - PMC - PubMed
    1. Salaffi F, Argalia G, Carotti M, et al. . Salivary gland ultrasonography in the evaluation of primary Sjögren's syndrome. Comparison with minor salivary gland biopsy. J Rheumatol 2000;27:1229–36. - PubMed
    1. Mossel E, Arends S, van Nimwegen JF, et al. . Scoring hypoechogenic areas in one parotid and one submandibular gland increases feasibility of ultrasound in primary Sjögren's syndrome. Ann Rheum Dis 2018;77:556–62. 10.1136/annrheumdis-2017-211992 - DOI - PubMed
    1. Le Goff M, Cornec D, Jousse-Joulin S, et al. . 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. Arthritis Res Ther 2017;19:269. 10.1186/s13075-017-1475-x - DOI - PMC - PubMed

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