Vatinee Y Bunya1, Satasuk Joy Bhosai2, Ana Maria Heidenreich3, Kazuko Kitagawa4, Genevieve B Larkin5, Thomas M Lietman2, Bruce D Gaynor2, Esen K Akpek6, Mina Massaro-Giordano7, M Srinivasan8, Travis C Porco2, John P Whitcher2, Stephen C Shiboski9, Lindsey A Criswell10, Caroline H Shiboski11. 1. Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: vatinee.bunya@uphs.upenn.edu. 2. Department of Ophthalmology and F. I. Proctor Foundation, University of California San Francisco, San Francisco, California. 3. Department of Ophthalmology, German Hospital and University of Buenos Aires, Argentina. 4. Department of Ophthalmology, Kanazawa Medical University, Ishikawa, Japan. 5. Department of Ophthalmology, King's College Hospital, London, London, United Kingdom. 6. Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland. 7. Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania. 8. Aravind Eye Hospital, Madurai, Tamil Nadu, India. 9. Division of Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California. 10. Rosalind Russell/Ephraim P. Engleman Rheumatology Research Center, Departments of Medicine and Orofacial Sciences, University of California San Francisco, San Francisco, California. 11. Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, California.
Abstract
PURPOSE: To identify a screening strategy for dry eye patients with a high likelihood of having Sjogren syndrome (SS) through the evaluation of the association of ocular surface tests with the extraocular signs used for the diagnosis of SS. DESIGN: Multicenter cross-sectional study. METHODS: The Sjogren's International Clinical Collaborative Alliance (SICCA) registry enrolled 3514 participants with SS or possible SS from 9 international academic sites. Ocular surface evaluation included Schirmer I testing, tear breakup time (TBUT), and staining of the cornea (0-6 points) and conjunctiva (0-6 points). Multivariate logistic regression analysis was performed to identify predictive factors for (1) histopathologic changes on labial salivary gland (LSG) biopsies (positive = focus score of ≥1 focus/4 mm2) and (2) positive anti-SSA/B serology. RESULTS: The adjusted odds of having a positive LSG biopsy were significantly higher among those with an abnormal Schirmer I test (adjusted OR = 1.26, 95% CI 1.05-1.51, P = .014) and positive conjunctival staining (for each additional unit of staining 1.46; 95% CI 1.39-1.53, P < .001) or corneal staining (for each additional unit of staining 1.14; 95% CI 1.08-1.21, P < .001). The odds of having a positive serology were significantly higher among those with an abnormal Schirmer I test (adjusted OR = 1.3; 95% CI 1.09-1.54, P = .004) and conjunctival staining (adjusted OR = 1.51; 95% CI 1.43-1.58, P < .001). CONCLUSIONS: In addition to corneal staining, which was associated with a higher likelihood of having a positive LSG biopsy, conjunctival staining and abnormal Schirmer I testing are of critical importance to include when screening dry eye patients for possible SS, as they were associated with a higher likelihood of having a positive LSG biopsy and serology.
PURPOSE: To identify a screening strategy for dry eyepatients with a high likelihood of having Sjogren syndrome (SS) through the evaluation of the association of ocular surface tests with the extraocular signs used for the diagnosis of SS. DESIGN: Multicenter cross-sectional study. METHODS: The Sjogren's International Clinical Collaborative Alliance (SICCA) registry enrolled 3514 participants with SS or possible SS from 9 international academic sites. Ocular surface evaluation included Schirmer I testing, tear breakup time (TBUT), and staining of the cornea (0-6 points) and conjunctiva (0-6 points). Multivariate logistic regression analysis was performed to identify predictive factors for (1) histopathologic changes on labial salivary gland (LSG) biopsies (positive = focus score of ≥1 focus/4 mm2) and (2) positive anti-SSA/B serology. RESULTS: The adjusted odds of having a positive LSG biopsy were significantly higher among those with an abnormal Schirmer I test (adjusted OR = 1.26, 95% CI 1.05-1.51, P = .014) and positive conjunctival staining (for each additional unit of staining 1.46; 95% CI 1.39-1.53, P < .001) or corneal staining (for each additional unit of staining 1.14; 95% CI 1.08-1.21, P < .001). The odds of having a positive serology were significantly higher among those with an abnormal Schirmer I test (adjusted OR = 1.3; 95% CI 1.09-1.54, P = .004) and conjunctival staining (adjusted OR = 1.51; 95% CI 1.43-1.58, P < .001). CONCLUSIONS: In addition to corneal staining, which was associated with a higher likelihood of having a positive LSG biopsy, conjunctival staining and abnormal Schirmer I testing are of critical importance to include when screening dry eyepatients for possible SS, as they were associated with a higher likelihood of having a positive LSG biopsy and serology.
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