S Jousse-Joulin1, F Gatineau2, C Baldini3, A Baer4, F Barone5, H Bootsma6, S Bowman7, P Brito-Zerón8, D Cornec1, T Dorner9, S de Vita10, B Fisher5, D Hammenfors11,12, M Jonsson13, X Mariette14,15, V Milic16, H Nakamura17, W-F Ng18, E Nowak2, M Ramos-Casals8, A Rasmussen19, R Seror14,15, C H Shiboski20, T Nakamura21, A Vissink22, A Saraux1, V Devauchelle-Pensec1. 1. From the, Rheumatology Department, INSERM UMR 1227, Cavale Blanche Hospital and Brest Occidentale University, Brest, France. 2. INSERM CIC 1412, Brest Medical University Hospital, Brest, France. 3. Rheumatology Unit, University of Pisa, Pisa, Italy. 4. Department of Medicine (Rheumatology), Johns Hopkins University School of Medicine, Baltimore, MD, USA. 5. Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK. 6. Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands. 7. Department of Rheumatology, University Hospitals, Birmingham NHS Trust, Birmingham, UK. 8. Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA- Sanitas, Barcelona, Spain. 9. Department of Medicine, Rheumatology and Clinical Immunology, Charite Universitätsmedizin Berlin and DRFZ Berlin, Berlin, Germany. 10. Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital "Santa Maria della Misericordia", Udine, Italy. 11. Department of Rheumatology, Haukeland University Hospital, Bergen, Norway. 12. Section for Rheumatology, Department of Clinical Science, University of Bergen, Bergen, Norway. 13. Section for Oral and Maxillofacial Radiology, Department of Clinical Dentistry, University of Bergen, Bergen, Norway. 14. Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique, Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France. 15. INSERM, Université Paris Sud, Paris, France. 16. Institute of Rheumatology, School of Medicine, University of Belgrade, Belgrade, Serbia. 17. Department of Immunology and Rheumatology, Unit of Advanced Medical Sciences, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. 18. Institute of Cellular Medicine, Newcastle University & NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK. 19. Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA. 20. Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, CA, USA. 21. Department of Radiology and Cancer Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. 22. Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
Abstract
OBJECTIVE: Major salivary gland ultrasonography (SGUS) is widely used for the diagnosis of primary Sjögren's syndrome (pSS). Our objective was to assess the contribution of SGUS compared to other items of the 2016 ACR/EULAR pSS classification criteria, based on expert opinion. METHODS: A secure web-based relational database was used by 24 experts from 14 countries to assess 512 realistic vignettes developed from data of patients with suspected pSS. Each vignette provided classification criteria items and information on history, clinical symptoms and SGUS findings. Each expert assessed 64 vignettes, and each vignette was assessed by 3 experts. A diagnosis of pSS was defined according to at least 2 of 3 experts. Validation was performed in the independent French DiapSS cohort of patients with suspected pSS. RESULTS: A criteria-based pSS diagnosis and SGUS findings were independently associated with an expert diagnosis of pSS (P < 0.001). The derived diagnostic weights of individual items in the 2016 ACR/EULAR criteria including SGUS were as follows: anti-SSA, 3; focus score ≥ 1, 3; SGUS score ≥ 2, 1; positive Schirmer's test, 1; dry mouth, 1; and salivary flow rate < 0.1 mL/min, 1. The corrected C statistic area under the curve for the new weighted score was 0.96. Adding SGUS improves the sensitivity from 90.2 % to 95.6% with a quite similar specificity 84.1% versus 82.6%. Results were similar in the DiapSS cohort: adding SGUS improves the sensitivity from 87% to 93%. CONCLUSION: SGUS had similar weight compared to minor items, and its addition improves the performance of the 2016 ACR/EULAR classification criteria.
OBJECTIVE: Major salivary gland ultrasonography (SGUS) is widely used for the diagnosis of primary Sjögren's syndrome (pSS). Our objective was to assess the contribution of SGUS compared to other items of the 2016 ACR/EULAR pSS classification criteria, based on expert opinion. METHODS: A secure web-based relational database was used by 24 experts from 14 countries to assess 512 realistic vignettes developed from data of patients with suspected pSS. Each vignette provided classification criteria items and information on history, clinical symptoms and SGUS findings. Each expert assessed 64 vignettes, and each vignette was assessed by 3 experts. A diagnosis of pSS was defined according to at least 2 of 3 experts. Validation was performed in the independent French DiapSS cohort of patients with suspected pSS. RESULTS: A criteria-based pSS diagnosis and SGUS findings were independently associated with an expert diagnosis of pSS (P < 0.001). The derived diagnostic weights of individual items in the 2016 ACR/EULAR criteria including SGUS were as follows: anti-SSA, 3; focus score ≥ 1, 3; SGUS score ≥ 2, 1; positive Schirmer's test, 1; dry mouth, 1; and salivary flow rate < 0.1 mL/min, 1. The corrected C statistic area under the curve for the new weighted score was 0.96. Adding SGUS improves the sensitivity from 90.2 % to 95.6% with a quite similar specificity 84.1% versus 82.6%. Results were similar in the DiapSS cohort: adding SGUS improves the sensitivity from 87% to 93%. CONCLUSION: SGUS had similar weight compared to minor items, and its addition improves the performance of the 2016 ACR/EULAR classification criteria.
Authors: Sara Zandonella Callegher; Alen Zabotti; Ivan Giovannini; Elena Treppo; Luca Quartuccio; Salvatore De Vita Journal: Front Med (Lausanne) Date: 2020-12-09
Authors: Alen Zabotti; Sara Zandonella Callegher; Annarita Tullio; Arso Vukicevic; Alojzija Hocevar; Vera Milic; Giacomo Cafaro; Marina Carotti; Konstantina Delli; Orazio De Lucia; Diana Ernst; Francesco Ferro; Angelica Gattamelata; Giuseppe Germanò; Ivan Giovannini; Daniel Hammenfors; Malin V Jonsson; Sandrine Jousse-Joulin; Pierluigi Macchioni; Simone Parisi; Carlo Perricone; Martin Helmut Stradner; Nenad Filipovic; Athanasios G Tzioufas; Francesca Valent; Salvatore De Vita Journal: Front Med (Lausanne) Date: 2020-11-23
Authors: Esther Mossel; Martha S van Ginkel; Erlin A Haacke; Suzanne Arends; Silvia C Liefers; Konstantina Delli; Jolien F van Nimwegen; Alja J Stel; Fred K L Spijkervet; Arjan Vissink; Bert van der Vegt; Frans G M Kroese; Hendrika Bootsma Journal: Rheumatology (Oxford) Date: 2022-05-30 Impact factor: 7.046