ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2930

Precisely Quantified Fibrosis in Labial Salivary Glands Predicts Sjögren’s Syndrome Classification in a Multiple Regression Model

Kerry M. Leehan1,2, Michael Brown1, Courtney Montgomery1, Astrid Rasmussen1, David M. Lewis3, Lida Radfar4, Donald U. Stone5, Stephen Young3, R. Hal Scofield1,6, Kathy L. Sivils1,2 and A. Darise Farris2,7, 1Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 2Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 3College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 4College of Dentristry, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 5Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 6Department of Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 7Arthritis and Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: , ,

Session Information

Title: Sjogren's Syndrome I: Clinical Perspectives

Session Type: Abstract Submissions (ACR)

Background/Purpose: Primary Sjögren’s Syndrome (pSS) is a systemic, progressive autoimmune exocrinopathy that presents diagnostic challenges.  Focal lymphocytic infiltrates in labial salivary gland (SG) biopsies, serum autoantibodies, objective measures of dryness, and patient-reported symptoms are used to classify pSS. Because focus score (FS) may vary with course of disease, we asked whether precisely quantified SG fibrosis can distinguish pSS from non-SS sicca. 

Methods: Formalin-fixed biopsy sections (4-6 glandular cross-sections per subject) collected from symptomatically dry individuals attending the Oklahoma Sjögren’s Syndrome Center of Research Translation clinic were stained with hematoxylin/eosin, imaged and digitally reconstructed. American European Consensus Group (AECG) classification status (n=50 pSS; n=28 non-SS) was blinded in order to eliminate bias by the scorer.  AECG pSS exclusions were applied to all subjects.  Fibrosis was quantified using a digital grid overlay; sections were scored and reported as average percent area per individual.  Relationship of degree of fibrosis with age, focus score, whole unstimulated salivary flow, stimulated parotid flow, van Bijsterveld score and Schirmer’s score was evaluated using Spearman correlations.  Logistic regression was implemented using rank-transformed fibrosis scores to assess their predictive value for disease classification.

Results: Fibrosis was significantly increased (p=0.0004, Mann-Whitney U) in pSS salivary glands (median 25.39%, range 1.788%-70.45%) compared to non SS sicca subjects (median 15.52%, range 8.876%-31.38%). Among pSS subjects, fibrosis correlated with age (p=0.029, r=0.307), lip biopsy focus score (p=0.01, r=0.360) and van Bijsterveld Score (vBS, p=0.02, r=0.310). No significant correlation between fibrosis and salivary flow or Schirmer’s score was observed. In a predictive model including fibrosis and age, degree of labial salivary gland fibrosis predicted disease classification with 68% accuracy irrespective of age  (fibrosis, p=3.91×10-5; age, p=0.63).

Conclusion:  Although age is associated with salivary gland fibrosis, multiple regression analysis suggests that labial salivary gland fibrosis is a significant feature of primary Sjögren’s syndrome regardless of age.

Disclosure:

K. M. Leehan,
None;

M. Brown,
None;

C. Montgomery,
None;

A. Rasmussen,
None;

D. M. Lewis,
None;

L. Radfar,
None;

D. U. Stone,
None;

S. Young,
None;

R. H. Scofield,
None;

K. L. Sivils,
None;

A. D. Farris,
None.

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