Date: Sunday, November 5, 2017
Session Title: Sjögren's Syndrome I: Clinical Assessment and Trial Outcomes
Session Type: ACR Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
The common classification criteria sets of primary Sjogren syndrome, did not considered the ultrasonography (US) of the major salivary glands as a useful item. However, it is well known that US can increase the performance of these two sets.
UTOPIA study (ultrasonography to diagnose and classify pSS) was an international vignette survey undertaken to determine the accuracy of salivary gland ultrasonography (SGUS) and to add it as a new item in the AECG-2002 and new ACR/EULAR-2017 classification criteria.
Methods: Twenty four experts in primary Sjogren, from 20 countries participated in the study (22 Europeans from 13 countries, two North Americans and two Japanese). They evaluated on an internet-secure relational database, 512 realistics vignettes, randomly assigned, abstracted from 150 patients of an Italian cohort (CB). Each vignettes contained items of the classification criteria and sections on ‘history’ (duration of the symptoms, gender, age), clinical symptoms (dry mouth or eyes and systemic manifestations) and results of the SGUS evaluation. Each expert has to consider the diagnosis of pSS as absent, unlikely, likely or present for 64 vignettes. Each vignette was evaluated by 3 experts. The diagnosis of pSS (the gold standard) was obtained when 2/3 considered it as likely or present. Univariate and multivariate analysis were performed to evaluate the association of US to the diagnosis of pSS. Data were secondly verified on an independent French cohort (DiapSS cohort).
Results: The univariate and multivariate analysis confirmed that both classification criteria and SGUS were independently associated with the diagnosis of pSS (p<0.001). Disease duration, OSS and ocular dryness were not associated with the diagnosis of pSS. When adding US to the AECG-2002 criteria, the sensitivity (Se) and specificity (Sp) were respectively of 91 % and 83 % and of 98% and 80% if we add US. For the ACR/EULAR 2017 criteria, (with a global score of 4), the Se and Sp were respectively of 90 % and 84 % and of 95% and 82% if we add US. Results were quite similar in the independent French DiapSS. The SE and Sp of the ACR/EULAR 2017 were 87.5 and 84.5% and of 92.5 and 82 % with US. If we considered each items of the vignettes separately to build a new weighted score, only 6 variables were selected by logistic regression analysis: presence of anti-SSA (weight:4), focus score (weight:4), SGUS (weight:2), Schirmer’s test (weight:1), dry eye (weight:1) and salivary fow rate (weight:1). According to ROC curve analysis, a score of ≥5 had 96% Se and 84% Sp, compared with 90% Se and 84% Sp for the ACR/EULAR 2017 Criteria. The corrected C statistic (AUC) for the new weighted score was 0.98.
Adding US item to both AECG and ACR/EULAR 2017 classification criteria increased Se but did not change Sp. The modified scores are easy to use especially the ACR/EULAR 2017.
To cite this abstract in AMA style:Jousse-Joulin S, Gatineau F, Baldini C, Baer AN, Barone F, Bootsma H, Bowman S, Brito Zeron P, Cornec D, Doerner T, De Vita S, Fisher B, Hammenfors DS, Jonsson MV, Mariette X, Milic V, Nakamura H, Ng WF, Nowak E, Ralos-Casals M, Rasmussen A, Seror R, Shiboski C, Nakamura T, Vissink A, Saraux A, Devauchelle-Pensec V. Modification of the Classification Criteria for Primary Sjögren Syndrome: An International Vignette Survey [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/modification-of-the-classification-criteria-for-primary-sjogren-syndrome-an-international-vignette-survey/. Accessed February 27, 2020.
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