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Hussein A, Gareeballah A, Hamd ZY, Elzaki M, Abouraida RA, Eltahir MA, Khogaly M, Alsharif W, Hamad AA. Secondary Sjögren's syndrome in a rheumatoid arthritis patient: A case report and review of literature. Radiol Case Rep 2024; 19:5513-5518. [PMID: 39285982 PMCID: PMC11403904 DOI: 10.1016/j.radcr.2024.07.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 09/19/2024] Open
Abstract
Secondary Sjogren's syndrome (sSS) is a medical condition that occurs in individuals with autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis. It predominantly affects females rather than males. We present a case of a 32-year-old female with a 3-year history of rheumatoid arthritis (RA) who presented to the internal medicine and rheumatology clinic with several complaints, including swelling and tenderness in her left jaw, dry mouth (xerostomia), irritated eyes (xerophthalmia), severe joint pain, and a decreased in saliva production. The blood tests demonstrate the presence of anti-SSA and anti-SSB autoantibodies and elevation of total leukocyte count (TLC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels, indicating inflammation. A high-frequency ultrasound confirmed the diagnosis of Secondary Sjogren's syndrome grade II, specifically affecting the left parotid gland (PG).
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Affiliation(s)
- Abdulaziz Hussein
- University of Medical Science and Technology, Graduate College, Khartoum, Sudan
| | - Awadia Gareeballah
- Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia
- Faculty of Radiological Science and Medical Imaging, Alzaiem Alazhari University, Khartoum, Sudan
| | - Zuhal Y Hamd
- Department of Radiological Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O.Box 84428, Riyadh 11671, Saudi Arabia
| | - Maisa Elzaki
- Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia
- Faculty of Radiological Science and Medical Imaging, Alzaiem Alazhari University, Khartoum, Sudan
| | - Raga Ahmed Abouraida
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Asir, Saudi Arabia
| | - Mohamed Abdalla Eltahir
- Department of Medical Radiologic Technologies, Faculty of Allied Medical Sciences, Zarqa University, Zarqa, Jordan
| | - Mariam Khogaly
- Department of Radiological Science, Al-Ghad International College of Applied Medical Science, Al-Madinah, Saudi Arabia
| | - Walaa Alsharif
- Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia
| | - Ali A Hamad
- Department of Biochemistry, Faculty of Medicine, Nile University, East Nile, Khartoum North, Khartoum, Sudan
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Lackner A, Dreo B, Hermann J, Zenz S, Fessler J, Thiel J, Stradner MH. Patients' recollection about the onset of Sjögren's disease - a mixed methods study on the patients' perspective. Arthritis Res Ther 2024; 26:169. [PMID: 39342382 PMCID: PMC11438132 DOI: 10.1186/s13075-024-03404-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 09/18/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Little is known about the symptoms at the onset of Sjögren's Disease (SjD) and it is unclear whether SjD starts with characteristic symptoms that could be differentiated from dryness of other origin (sicca syndrome). The aim of this study was to investigate patients' recollection of initial events and first symptoms of SjD. The second aim was to verify and quantify these aspects in a representative cohort. METHODS All SjD patients fulfilled the EULAR/ACR 2016 classification criteria. In the first part of the study, consecutive SjD patients were recruited for individual, semi-structured interviews. All interviews were audio-recorded and transcribed verbatim, and an inductive thematic data analysis was performed. In the second part, the identified aspects of the qualitative analysis were grouped into a checklist with ten items. RESULTS One-hundred and thirty-four patients participated in the study. 31 SjD patients completed the qualitative part. Major aspects emerged of how patients experienced the beginning and first symptoms of SjD: (1) "classic" SjD symptoms (fatigue, pain, dryness) (2), sicca symptoms started after initial swelling of parotid and/or lymph nodes (3), after hormonal transition or infections before the onset of SjD symptoms. In the second part of the study, the previous identified major aspects were verified in an independent cohort of 103 SjD patients. The main symptom before diagnosis was dryness (n = 77, 74.8%) with migratory joint pain (n = 51, 49.5%) and fatigue (n = 47, 45.6%). In 38.8% (n = 40), patients reported a swelling/inflammation of the parotid gland at the onset of disease. CONCLUSIONS We describe patients' recollection of the onset of SjD. Raising awareness of the symptoms identified among physicians and among the general public may allow earlier diagnosis of SjD.
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Affiliation(s)
- Angelika Lackner
- Department of Rheumatology & Immunology, Medical University Graz, Graz, Austria
| | - Barbara Dreo
- Department of Rheumatology & Immunology, Medical University Graz, Graz, Austria
| | - Josef Hermann
- Department of Rheumatology & Immunology, Medical University Graz, Graz, Austria
| | - Sabine Zenz
- Department of Rheumatology & Immunology, Medical University Graz, Graz, Austria
| | - Johannes Fessler
- Division of Immunology & Pathophysiology, Medical University Graz, Graz, Austria
| | - Jens Thiel
- Department of Rheumatology & Immunology, Medical University Graz, Graz, Austria
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Ohshima M, Suzuki T, Suzuki A. Case Series of Changes in Greyscale and Power Doppler Signals on Salivary Gland Ultrasonography after Treatment in Patients with Sjögren's Syndrome. Intern Med 2024; 63:2203-2208. [PMID: 38104991 PMCID: PMC11358743 DOI: 10.2169/internalmedicine.2812-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/26/2023] [Indexed: 12/19/2023] Open
Abstract
The usefulness of greyscale (GS) in salivary gland ultrasonography for Sjögren's syndrome (SS) has been established; however, limited information is currently available on power Doppler signals (PDs), and changes after treatment remain unknown. PDs are considered to represent glandular inflammation, which indicates the worsening of GS in later years. We examined the changes in PDs in three immunosuppressant-treated SS patients. PDs decreased, along with GS and markers of disease activity, after treatment. PDs have the potential to provide insights into glandular inflammation in real time; however, large-scale studies on their clinical usefulness are needed.
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Affiliation(s)
- Miho Ohshima
- Department of Rheumatology, Mitsui Memorial Hospital, Japan
| | - Takeshi Suzuki
- Department of Rheumatology, Mitsui Memorial Hospital, Japan
| | - Akitake Suzuki
- Department of Rheumatology, Mitsui Memorial Hospital, Japan
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Kida T, Kawahito Y, Suzuki Y, Tamaki S, Tanaka I. Improvement of active salivary gland ultrasonography findings in Sjögren's syndrome in response to short-term glucocorticoid treatment: A case report and review of the literature. Mod Rheumatol Case Rep 2024; 8:286-290. [PMID: 38226648 DOI: 10.1093/mrcr/rxae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/18/2023] [Accepted: 12/23/2023] [Indexed: 01/17/2024]
Abstract
Salivary gland ultrasonography is a non-invasive imaging technique that helps in the diagnosis and assessment of disease activity in Sjögren's syndrome. However, it remains unclear whether the salivary gland ultrasonography findings are reversible in response to treatment. We present a case of a woman in her 20s who presented with parotid swelling and pain lasting for 3 months. The patient was diagnosed with anti-SS-A antibody-positive Sjögren's syndrome with active sialadenitis, and short-term glucocorticoid treatment resulted in resolution of clinical symptoms and improvement of salivary gland ultrasonography findings by the Outcome Measures in Rheumatology Clinical Trials scoring system. Notably, the anechoic/hypoechoic foci and vascular signals in the parotid and submandibular glands were reduced after treatment. Furthermore, peak systolic blood flow velocity of the facial artery entering the submandibular gland was decreased. Our case highlights that the findings of 'inflammatory' structural changes and vascularisation on salivary gland ultrasonography, including the Outcome Measures in Rheumatology Clinical Trials scoring system, reflect the disease active of Sjögren's syndrome and are reversible with treatment. Salivary gland ultrasonography has the potential to be a useful tool for monitoring treatment response and stratifying patients by disease activity in Sjögren's syndrome; therefore, further research is needed on the relationship of salivary gland ultrasonography findings with the pathophysiological mechanisms of sialadenitis and long-term clinical outcomes.
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Affiliation(s)
- Takashi Kida
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Nagoya Rheumatology Clinic, Nagoya, Japan
| | - Yutaka Kawahito
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Zeng W, Thatayatikom A, Winn N, Lovelace TC, Bhattacharyya I, Schrepfer T, Shah A, Gonik R, Benos PV, Cha S. The Florida Scoring System for stratifying children with suspected Sjögren's disease: a cross-sectional machine learning study. THE LANCET. RHEUMATOLOGY 2024; 6:e279-e290. [PMID: 38658114 PMCID: PMC11261574 DOI: 10.1016/s2665-9913(24)00059-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/19/2024] [Accepted: 02/28/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Childhood Sjögren's disease is a rare, underdiagnosed, and poorly-understood condition. By integrating machine learning models on a paediatric cohort in the USA, we aimed to develop a novel system (the Florida Scoring System) for stratifying symptomatic paediatric patients with suspected Sjögren's disease. METHODS This cross-sectional study was done in symptomatic patients who visited the Department of Pediatric Rheumatology at the University of Florida, FL, USA. Eligible patients were younger than 18 years or had symptom onset before 18 years of age. Patients with confirmed diagnosis of another autoimmune condition or infection with a clear aetiological microorganism were excluded. Eligible patients underwent comprehensive examinations to rule out or diagnose childhood Sjögren's disease. We used latent class analysis with clinical and laboratory variables to detect heterogeneous patient classes. Machine learning models, including random forest, gradient-boosted decision tree, partial least square discriminatory analysis, least absolute shrinkage and selection operator-penalised ordinal regression, artificial neural network, and super learner were used to predict patient classes and rank the importance of variables. Causal graph learning selected key features to build the final Florida Scoring System. The predictors for all models were the clinical and laboratory variables and the outcome was the definition of patient classes. FINDINGS Between Jan 16, 2018, and April 28, 2022, we screened 448 patients for inclusion. After excluding 205 patients due to symptom onset later than 18 years of age, we recruited 243 patients into our cohort. 26 patients were excluded because of confirmed diagnosis of a disorder other than Sjögren's disease, and 217 patients were included in the final analysis. Median age at diagnosis was 15 years (IQR 11-17). 155 (72%) of 216 patients were female and 61 (28%) were male, 167 (79%) of 212 were White, and 20 (9%) of 213 were Hispanic, Latino, or Spanish. The latent class analysis identified three distinct patient classes: class I (dryness dominant with positive tests, n=27), class II (high symptoms with negative tests, n=98), and class III (low symptoms with negative tests, n=92). Machine learning models accurately predicted patient class and ranked variable importance consistently. The causal graphical model discovered key features for constructing the Florida Scoring System. INTERPRETATION The Florida Scoring System is a paediatrician-friendly tool that can be used to assist classification and long-term monitoring of suspected childhood Sjögren's disease. The resulting stratification has important implications for clinical management, trial design, and pathobiological research. We found a highly symptomatic patient group with negative serology and diagnostic profiles, which warrants clinical attention. We further revealed that salivary gland ultrasonography can be a non-invasive alternative to minor salivary gland biopsy in children. The Florida Scoring System requires validation in larger prospective paediatric cohorts. FUNDING National Institute of Dental and Craniofacial Research, National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Heart, Lung, and Blood Institute, and Sjögren's Foundation.
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Affiliation(s)
- Wenjie Zeng
- Epidemiology, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, FL, USA
| | - Akaluck Thatayatikom
- Pediatric Rheumatology, AdventHealth for Children, AdventHealth Medical Group, Orlando, FL, USA
| | - Nicole Winn
- Center for Orphaned Autoimmune Disorders, University of Florida College of Dentistry, Gainesville, FL, USA; Oral Medicine, Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Tyler C Lovelace
- Computational & Systems Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Indraneel Bhattacharyya
- Center for Orphaned Autoimmune Disorders, University of Florida College of Dentistry, Gainesville, FL, USA; Oral Pathology, Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Thomas Schrepfer
- Pediatric Otolaryngology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Ankit Shah
- Ophthalmology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Renato Gonik
- Pediatric Neurology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Panayiotis V Benos
- Epidemiology, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, FL, USA
| | - Seunghee Cha
- Center for Orphaned Autoimmune Disorders, University of Florida College of Dentistry, Gainesville, FL, USA; Oral Medicine, Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA.
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Bettacchioli E, Saraux A, Tison A, Cornec D, Dueymes M, Foulquier N, Hillion S, Roguedas-Contios AM, Benyoussef AA, Alarcon-Riquelme ME, Pers JO, Devauchelle-Pensec V. Association of Combined Anti-Ro52/TRIM21 and Anti-Ro60/SSA Antibodies With Increased Sjögren Disease Severity Through Interferon Pathway Activation. Arthritis Rheumatol 2024; 76:751-762. [PMID: 38130019 DOI: 10.1002/art.42789] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The biologic diagnosis of primary Sjögren disease (SjD) mainly relies on anti-Ro60/SSA antibodies, whereas the significance of anti-Ro52/TRIM21 antibodies currently remains unclear. The aim of this study was to characterize the clinical, serological, biologic, transcriptomic, and interferon profiles of patients with SjD according to their anti-Ro52/TRIM21 antibody status. METHODS Patients with SjD from the European PRECISESADS (n = 376) and the Brittany Diagnostic Suspicion of primitive Sjögren's Syndrome (DIApSS); (n = 146) cohorts were divided into four groups: double negative (Ro52-/Ro60-), isolated anti-Ro52/TRIM21 positive (Ro52+), isolated anti-Ro60/SSA positive (Ro60+), and double-positive (Ro52+/Ro60+) patients. Clinical information; EULAR Sjögren Syndrome Disease Activity Index, a score representing systemic activity; and biologic markers associated with disease severity were evaluated. Transcriptome data obtained from whole blood by RNA sequencing and type I and II interferon signatures were analyzed for PRECISESADS patients. RESULTS In the DIApSS cohort, Ro52+/Ro60+ patients showed significantly more parotidomegaly (33.3% vs 0%-11%) along with higher β2-microglobulin (P = 0.0002), total immunoglobulin (P < 0.0001), and erythrocyte sedimentation rate levels (P = 0.002) as well as rheumatoid factor (RF) positivity (66.2% vs 20.8%-25%) compared to other groups. The PRECISESADS cohort corroborated these observations, with increased arthritis (P = 0.046), inflammation (P = 0.005), hypergammaglobulinemia (P < 0.0001), positive RF (P < 0.0001), leukopenia (P = 0.004), and lymphopenia (P = 0.009) in Ro52+/Ro60+ patients. Cumulative EULAR Sjögren Syndrome Disease Activity Index results further confirmed these disparities (P = 0.002). Transcriptome analysis linked anti-Ro52/TRIM21 antibody positivity to interferon pathway activation as an underlying cause for these clinical correlations. CONCLUSION These results suggest that the combination of anti-Ro52/TRIM21 and anti-Ro60/SSA antibodies is associated with a clinical, biologic, and transcriptional profile linked to greater disease severity in SjD through the potentiation of the interferon pathway activation by anti-Ro52/TRIM21 antibodies.
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Affiliation(s)
- Eléonore Bettacchioli
- LBAI, UMR1227, INSERM, University of Western Brittany, Brest, France, and Centre Hospitalier Universitaire de Brest, Brest, France
| | - Alain Saraux
- LBAI, UMR1227, INSERM, University of Western Brittany, Brest, France, and Centre Hospitalier Universitaire de Brest, Brest, France
| | - Alice Tison
- LBAI, UMR1227, INSERM, University of Western Brittany, Brest, France, and Centre Hospitalier Universitaire de Brest, Brest, France
| | - Divi Cornec
- LBAI, UMR1227, INSERM, University of Western Brittany, Brest, France, and Centre Hospitalier Universitaire de Brest, Brest, France
| | - Maryvonne Dueymes
- LBAI, UMR1227, INSERM, University of Western Brittany, Brest, France, and Centre Hospitalier Universitaire de Brest, Brest, France
| | - Nathan Foulquier
- LBAI, UMR1227, INSERM, University of Western Brittany, Brest, France, and Centre Hospitalier Universitaire de Brest, Brest, France
| | - Sophie Hillion
- LBAI, UMR1227, INSERM, University of Western Brittany, Brest, France, and Centre Hospitalier Universitaire de Brest, Brest, France
| | | | | | | | | | - Valérie Devauchelle-Pensec
- LBAI, UMR1227, INSERM, University of Western Brittany, Brest, France, and Centre Hospitalier Universitaire de Brest, Brest, France
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Quéré B, Saraux A, Carvajal-Alegria G, Guellec D, Mouterde G, Lamotte C, Hammenfors D, Jonsson M, Choi SE, Hong-Ki M, Stel A, Fisher BA, Maybury M, Hofauer B, Ferro F, Milic V, Direnzo D, Devauchelle-Pensec V, Jousse-Joulin S. Reliability Exercise of Ultrasound Salivary Glands in Sjögren's Disease: An International Web Training Initiative. Rheumatol Ther 2024; 11:411-423. [PMID: 38372857 PMCID: PMC10920533 DOI: 10.1007/s40744-024-00645-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/29/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION Major salivary gland ultrasonography (SGUS) demonstrated its good metric properties as an outcome measure for diagnosing primary Sjögren's disease (SD). The objective was to assess SGUS reliability among sonographers with different levels of experience, using web training. METHODS Sonographers from expert centers participated in the reliability exercise. Before exercises, training was done by videoconferencing. Reliability of the two most experienced sonographers (MES) was assessed and then compared to other sonographers. Intra-reader and inter-reader reliability of SGUS items were assessed by computing Cohen's κ coefficients. RESULTS All sets were read twice by all 14 sonographers within a 4-month interval. Intra-reader reliability of MES was almost perfect for homogeneity, substantial for Outcome Measures in Rheumatology (OMERACT) scoring system (OMERACTss). Among LES (less experienced sonographers), reliability was moderate to almost perfect for homogeneity, fair to moderate for OMERACTss, and fair to almost perfect for binary OMERACTss. Inter-reader reliability between MES was almost perfect for homogeneity, substantial for diagnosis, moderate for OMERACTss, and substantial for binary OMERACTss. Compared to MES, reliabilities of LES were moderate to almost perfect for both homogeneity and diagnosis, only fair to moderate for OMERACTss, but increased in binary OMERACTss. CONCLUSIONS Videoconferencing training sessions in an international reliability exercise could be an excellent tool to train experienced and less-experienced sonographers. SGUS homogeneity items is useful to distinguish normal from abnormal salivary glands parenchyma independently of diagnosis. Structural damage evaluations by OMERACT scoring system is a new comprehensive score to diagnose patients with SD and could be easily used by sonographers in a binary method.
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Affiliation(s)
- Baptiste Quéré
- Rheumatology Department, CHU Hospital La Cavale-Blanche, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), Brest, France
- LBAI, UMR1227, Univ Brest, Inserm, Brest, France
| | - Alain Saraux
- Rheumatology Department, CHU Hospital La Cavale-Blanche, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), Brest, France.
- LBAI, UMR1227, Univ Brest, Inserm, Brest, France.
- Service de Rhumatologie, CHRU Cavale Blanche, Boulevard Tanguy Prigent, 29200, Brest, France.
| | | | - Dewi Guellec
- Rheumatology Department, CHU Hospital La Cavale-Blanche, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), Brest, France
- CIC INSERM 1412, Brest, France
| | - Gaël Mouterde
- Rheumatology Department and IDESP, CHU Montpellier, Montpellier University, Montpellier, France
| | | | - Daniel Hammenfors
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
- Broegelmann Research Laboratory, University of Bergen, Bergen, Norway
| | - Malin Jonsson
- Department of Clinical Dentistry-Section for Oral and Maxillofacial Radiology, University of Bergen, Bergen, Norway
| | - Sung-Eun Choi
- Chonnam National University Bitgoeul Hospital, Gwangju, South Korea
| | - Min Hong-Ki
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | | | - Benjamin A Fisher
- National Institute of Health Biomedical Research Centre and Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Mark Maybury
- National Institute of Health Biomedical Research Centre and Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Benedikt Hofauer
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Vera Milic
- Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Beograd, Serbia
| | - Dana Direnzo
- Division of Rheumatology, Johns Hopkins University, 5200 Eastern Ave., MFL Bldg. Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Valérie Devauchelle-Pensec
- Rheumatology Department, CHU Hospital La Cavale-Blanche, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), Brest, France
- LBAI, UMR1227, Univ Brest, Inserm, Brest, France
| | - Sandrine Jousse-Joulin
- Rheumatology Department, CHU Hospital La Cavale-Blanche, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), Brest, France
- LBAI, UMR1227, Univ Brest, Inserm, Brest, France
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Zehrfeld N, Witte T, Ernst D. [Update on Sjögren's syndrome : Diagnostics, treatment, and challenges]. Z Rheumatol 2024; 83:217-228. [PMID: 38498147 DOI: 10.1007/s00393-024-01493-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/20/2024]
Abstract
Sjögren's syndrome (SjS) is the most common connective tissue disease with a prevalence of 1:200. Predominantly affecting women, SjS is associated with destruction of the exocrine glands, leading to xerophthalmia and xerostomia. In over 50% of patients, there are also extraglandular manifestations, leading to multiple organ manifestations including polyneuropathies and interstitial lung disease as well as symptoms such as fatigue and arthralgia. Diagnostic procedures include biomarkers, in particular anti-SS-A/Ro antibodies, histology of salivary glands, and salivary gland sonography. There are currently no licensed immunosuppressive drugs for SjS, so current treatment is often based on off-label use of drugs. The European League Against Rheumatism (EULAR) has recently published treatment recommendations based on the prevailing organ manifestations. Several promising controlled trials with novel compounds and concepts are currently in progress.
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Affiliation(s)
| | | | - Diana Ernst
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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Martins FB, Oliveira MB, Oliveira LM, Lourenço AG, Paranhos LR, Motta ACF. Diagnostic accuracy of ultrasonography in relation to salivary gland biopsy in Sjögren's syndrome: a systematic review with meta-analysis. Dentomaxillofac Radiol 2024; 53:91-102. [PMID: 38177085 DOI: 10.1093/dmfr/twad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/17/2023] [Accepted: 11/16/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVES To evaluate the accuracy of major salivary gland ultrasonography (SGUS) in relation to minor salivary gland biopsy (mSGB) in the diagnosis of Sjögren's syndrome (SS). METHODS A systematic review and meta-analysis were performed. Ten databases were searched to identify studies that compared the accuracy of SGUS and mSGB. The risk of bias was assessed, data were extracted, and univariate and bivariate random-effects meta-analyses were done. RESULTS A total of 5000 records were identified; 13 studies were included in the qualitative synthesis and 10 in the quantitative synthesis. The first meta-analysis found a sensitivity of 0.86 (95% CI: 0.74-0.92) and specificity of 0.87 (95% CI: 0.81-0.92) for the predictive value of SGUS scoring in relation to the result of mSGB. In the second meta-analysis, mSGB showed higher sensitivity and specificity than SGUS. Sensitivity was 0.80 (95% CI: 0.74-0.85) for mSGB and 0.71 (95% CI: 0.58-0.81) for SGUS, and specificity was 0.94 (95% CI: 0.87-0.97) for mSGB and 0.89 (95% CI: 0.82-0.94) for SGUS. CONCLUSIONS The diagnostic accuracy of SGUS was similar to that of mSGB. SGUS is an effective diagnostic test that shows good sensitivity and high specificity, in addition to being a good tool for prognosis and for avoiding unnecessary biopsies. More studies using similar methodologies are needed to assess the accuracy of SGUS in predicting the result of mSGB. Our results will contribute to decision-making for the implementation of SGUS as a diagnostic tool for SS, considering the advantages of this method.
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Affiliation(s)
- Fernanda B Martins
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, 05508-000, Brazil
| | - Millena B Oliveira
- Postgraduate Program in Dentistry, Dental School, Federal University of Uberlândia, Uberlândia, 38405-320, Brazil
| | - Leandro M Oliveira
- Department of Stomatology, School of Dentistry, Federal University of Santa Maria, Santa Maria, 97105-900, Brazil
| | - Alan Grupioni Lourenço
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, 14040-904, Brazil
| | - Luiz Renato Paranhos
- Department of Preventive and Social Dentistry, Dental School, Federal University of Uberlandia, Uberlandia, 38405-320, Brazil
| | - Ana Carolina F Motta
- Department of Stomatology, Public Health and Forensic Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, 14040-904, Brazil
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Hoffman HT, Koch M, Witt RL, Ryan WR, Zenk J, Katz P, Rahmati R, Rassekh C, Donato F, McCulloch TM, Joshi AS, Chang JL, Gillespie MB, Pichardo PFA, Orloff LA, Marcelino A, Wenzel P, Cohen D, Fundakowski CE, Cognetti DM, Walvekar RR, Bertelli A, Quon H, Anderson C, Policeni B, Siegel G. Proposal for standardized ultrasound analysis of the salivary glands: Part 1 submandibular gland. Laryngoscope Investig Otolaryngol 2024; 9:e1224. [PMID: 38362174 PMCID: PMC10866606 DOI: 10.1002/lio2.1224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/05/2024] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
Objectives The Salivary Gland Committee of the American Academy of Otolaryngology-Head and Neck Surgery seeks to standardize terminology and technique for ultrasonograpy used in the evaluation and treatment of salivary gland disorders. Methods Development of expert opinion obtained through interaction with international practitioners representing multiple specialties. This committee work includes a comprehensive literature review with presentation of case examples to propose a standardized protocol for the language used in ultrasound salivary gland assessment. Results A multiple segment proposal is initiated with this focus on the submandibular gland. We provide a concise rationale for recommended descriptive language highlighted by a more extensive supplement that includes an extensive literature review with additional case examples. Conclusion Recommendations are provided to improve consistency both in performing and reporting submandibular gland ultrasound.
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Affiliation(s)
| | | | - Robert Lee Witt
- Christiana Care/Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - William R. Ryan
- University of California San FranciscoSan FranciscoCaliforniaUSA
| | | | - Philippe Katz
- Institut d'Explorations Fonctionnelles des Glandes SalivairesParisFrance
| | | | - Christopher Rassekh
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | | | | | - Arjun S. Joshi
- The George Washington UniversityWashingtonDistrict of ColumbiaUSA
| | | | - M. Boyd Gillespie
- University of Tennessee Health Science Center College of MedicineMemphisTennesseeUSA
| | | | | | | | - Piper Wenzel
- University of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - David Cohen
- Kaiser Permanente Los Angeles Medical CenterLos AngelesCaliforniaUSA
| | | | | | | | - Antonio Bertelli
- Faculdade de Ciencias Medicas da Santa Casa de Sao Paulo BrazilSao PauloBrazil
| | - Harry Quon
- Johns Hopkins Medical Institutions CampusBaltimoreMarylandUSA
| | | | - Bruno Policeni
- University of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Gordy Siegel
- Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
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11
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Baldini C, Berardicurti O, Giacomelli R, Bombardieri M. Is minor salivary gland biopsy still mandatory in Sjogren's syndrome? Does seronegative Sjogren's syndrome exist? Autoimmun Rev 2024; 23:103425. [PMID: 37634677 DOI: 10.1016/j.autrev.2023.103425] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
Sjӧgren's disease (SjD) is a systemic autoimmune disorder characterized by the chronic inflammation and dysfunction of exocrine glands, mainly salivary glands, causing dryness of the eyes and of the mouth. The disease may affect different organs and tissues with complex and heterogeneous clinical presentation, usually with sicca symptoms, profound fatigue, chronic pain, major organ involvement, and lymphomas. SjD diagnosis is based on the combination of clinical, serological, and functional tests with histological biomarkers. Minor salivary gland biopsy (mSGB) represents the cornerstone for the diagnosis of SjD, allowing the study of the characteristic focal infiltration of B- and T lymphocytes. Besides, mSGB might also have a prognostic role, being the infiltrates more complex in patients with severe SjD. But biopsy, so far, is not mandatory for SjD and mSG ultrasound and peripheral biomarkers might replace its role in the future. Another important aspect of SjD is the presence of autoantibodies, although 20 to 30% of patients are "seronegative" for specific autoantibodies (ANA, antiRo/SSA, antiLa/SSB). The characteristics of this subset of patients are currently under evaluation and "new" autoantibodies and biomarkers might be necessary for better patient's stratification and follow-up.
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Affiliation(s)
- Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy
| | - Onorina Berardicurti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Immuno-Rheumatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Roberto Giacomelli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Immuno-Rheumatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy.
| | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, Queen Mary University of London, London, UK
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12
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Dankiewicz-Fares I, Jeka D, Barczyńska T. Ocular involvement in rheumatic diseases. Reumatologia 2023; 61:389-394. [PMID: 37970118 PMCID: PMC10634405 DOI: 10.5114/reum/172767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/01/2023] [Indexed: 11/17/2023] Open
Abstract
Rheumatic diseases are associated with a significant decline in quality of life, which is not only related to the progression of the underlying disease but also to the development of coexisting conditions. One of the possible complications in this group of diseases is ocular involvement. Impaired vision is strongly associated with a significant decline in quality of life and can also exacerbate problems related to physical functioning. Consequently, it can lead to serious complications in the treatment of the underlying disease. Additionally, from a clinical point of view, it is also important to note that ocular diseases may precede the occurrence of inflammatory joint and spinal diseases, as well as organ involvement in systemic connective tissue disorders. Therefore, paying attention to ocular symptoms can help in early diagnosis and thus improve patient prognosis. For the aforementioned reasons, ocular diseases should be carefully considered in routine rheumatologic practice.
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Affiliation(s)
- Iwona Dankiewicz-Fares
- Department and Clinic of Rheumatology and Connective Tissue Diseases, Jan Biziel University Hospital No. 2, Bydgoszcz, Poland
| | - Daniel Jeka
- Kliniczne Terapie Innowacyjne, Torun, Poland
| | - Tacjana Barczyńska
- Department and Clinic of Rheumatology and Connective Tissue Diseases, Jan Biziel University Hospital No. 2, Bydgoszcz, Poland
- Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
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13
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Chen L, Nong L, Liu J, Chen L, Shao Y, Sun X. Value of High-Frequency Ultrasonography in the Qualitative and Semi-Quantitative Assessment of Immunoglobulin G4-Related Submandibular Sialadenitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2235-2246. [PMID: 37162711 DOI: 10.1002/jum.16240] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 04/06/2023] [Accepted: 04/09/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To assess the value of high-frequency ultrasonography in the evaluation of immunoglobulin G4-related submandibular sialadenitis (IgG4-SS). METHODS Thirty-four submandibular glands in 17 patients with IgG4-SS were retrospectively enrolled, as well as 34 submandibular glands in 17 healthy control subjects. Qualitative ultrasonic features including submandibular gland size, border, echogenicity, and vascularity were reviewed. Two different scoring systems (0-16 and 0-48, respectively) were used for semi-quantitative analysis of imaging features. Comparison of both qualitative and semi-quantitative ultrasonic analysis were made between patients with IgG4-SS and healthy controls. Spearman correlation was used to explore relationships between variables. RESULTS The submandibular glands with IgG4-SS presented with enlarged size, rough border, increased vascularity, and abnormal echogenicity (All P < .05). The most common echogenicity pattern for IgG-SS was diffuse hypoechoic foci pattern (44.1%), followed by superficial hypoechoic pattern (20.6%), tumor-like pattern (14.7%), and diffuse hypoechogenicity pattern (11.8%). Most IgG4-SS glands presented linear hyperechogenicity in parenchyma (91.2%). Based on both scoring system, scores of IgG4-SS were significantly higher than those of the controls (All P < .05). Association analysis of both scoring systems showed positive correlation of scores with vascularity in the gland parenchyma (All P < .05). CONCLUSION The ultrasonic features of IgG4-SS comprise enlarged gland, rough border, increased vascularity, and abnormal echogenicity, which correlate with its pathological characteristics. The most common echogenicity pattern for IgG4-SS was diffuse hypoechoic foci pattern. Semi-quantitative analysis systems could be useful in the assessment of IgG4-SS. Ultrasound is a potential, valuable, and non-invasive tool for the diagnosis and evaluation of IgG4-SS.
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Affiliation(s)
- Lei Chen
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Lin Nong
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Jumei Liu
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Luzeng Chen
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Yuhong Shao
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Xiuming Sun
- Department of Ultrasound, Peking University First Hospital, Beijing, China
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14
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AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:E55-E62. [PMID: 37172222 DOI: 10.1002/jum.16251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/14/2023]
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15
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Barrio-Nogal L, Novella-Navarro M, Heras CB, Sala-Icardo L, Calvo-Aranda E, Gómez AP. Ultrasonography in the diagnosis of suspected primary Sjögren's syndrome and concordance with salivary gland biopsy: a Spanish single-center study. Clin Rheumatol 2023; 42:2409-2417. [PMID: 37225928 DOI: 10.1007/s10067-023-06618-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The study aims to evaluate the utility of major salivary gland ultrasonography for diagnosis of primary Sjögren's syndrome (pSS) and to assess its concordance with minor salivary gland biopsy (MSGB). METHODS A cross-sectional study of 72 patients with suspected pSS was performed. Demographic, clinical, and serological data were collected. MSGB was performed, as was ultrasonography. The ultrasound technician was blind to clinical, serological, and histological data. The validity of ultrasonography compared with MSGB, the American-European Consensus Group (AECG), and American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) criteria was assessed by calculating the percentage of agreement, sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC). RESULTS Based on MSGB as the gold standard, the percentage of agreement between both tests was 78% (AUC 0.75). Based on the ACR/EULAR criteria, the percentage of agreement was 83% (AUC 0.78) for ultrasonography and 81% (AUC 0.83) for biopsy. Sensitivity and specificity were 90% and 67%, respectively, for ultrasonography and 76% and 90% for biopsy. The results were similar with the AECG criteria. The intra- and inter-observer variability was good (κ > 0.7). Significant differences were observed for positive anti-Ro52 values and hypergammaglobulinemia in pathological ultrasound scans. CONCLUSION Diagnostic ultrasonography is as useful as MSGB in pSS. Therefore, it could be included in the classification criteria. In this cohort, it proved more sensitive than MSGB and could be used as an initial test for patients suspected of having pSS. MSGB could be used in cases where clinical and serological results are inconclusive. Key Points • Major salivary gland ultrasonography adds diagnostic value similar to that of MSGB, thus potentially enabling this invasive procedure to be avoided. • Ultrasonography could be included in the classification criteria for primary Sjögren's syndrome. • Given that ultrasonography is more sensitive and less specific than MSGB, it could be used as an initial diagnostic test in patients with suspected Sjögren's syndrome. • Biopsy should be performed in those cases where ultrasonography, clinical, and serological data are inconclusive.
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Affiliation(s)
- Laura Barrio-Nogal
- Rheumatology Department, Hospital Universitario de Torrejón, Madrid, Spain.
| | | | | | - Luis Sala-Icardo
- Rheumatology Department, Hospital Universitario de Torrejón, Madrid, Spain
| | | | - Ana Pérez Gómez
- Rheumatology Department, Hospital Universitario Príncipe de Asturias, Madrid, Spain
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16
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Park Y, Oh M, Lee YS, Kim WU. Salivary ultrasonography and histopathologic evaluation of secondary Sjögren's syndrome in rheumatoid arthritis patients. Sci Rep 2023; 13:11339. [PMID: 37443200 PMCID: PMC10344871 DOI: 10.1038/s41598-023-38469-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/08/2023] [Indexed: 07/15/2023] Open
Abstract
Novel modalities, such as salivary ultrasonography (SGUS) and shear wave elastography (SWE), have previously been introduced to evaluate Sjögren's syndrome (SS). However, in secondary SS (sSS), the diagnostic performance of SGUS and its relationship with clinicopathological characteristics have not yet been clearly defined. In this study, we aimed to investigate sSS in RA patients using SGUS and SWE and sought to determine its pathological correlations. Thirty-one RA patients who presented with sicca symptoms were included to be evaluated on SS, and were compared with 18 primary SS (pSS) patients. All subjects were assessed through SGUS, SWE, and conventional diagnostic approaches for SS, including minor salivary gland biopsy (MSGB). In SGUS evaluation, two separate scoring systems, suggested by Hocevar and OMERACT, were used. Among 31 RA patients with sicca symptoms, 19 (61.2%) were diagnosed as sSS. Similar to pSS, SGUS showed good diagnostic performance (sensitivity 68.4% and 78.9%, and specificity 91.7% and 75.0% for Hocever and OMERACT, respectively) in differentiating sSS from RA patients with simple sicca symptoms. The sSS and pSS patients exhibited significantly higher lymphoid infiltration areas in MSGB than RA patients without SS. Focus score and lymphoid infiltration areas correlated well with sonographic severity. Severity of fibrosis in MSGB showed better positive correlation with SWE than with SGUS. Similar to pSS, SGUS shows good diagnostic performance for sSS in RA patients. SWE reflects histopathologic chronicity of MSGB well in both pSS and sSS.
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Affiliation(s)
- Youngjae Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Minae Oh
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn Soo Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Wan-Uk Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- Center for Integrative Rheumatoid Transcriptomics and Dynamics, The Catholic University of Korea, Seoul, Korea.
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17
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Carpio Astudillo K, Montero Reyes F, Janta I, Molina Collada J, Anzola AM, Caballero Motta LR, Serrano-Benavente B, Martínez-Barrio J, Ariza Lapuente A, Rivera Redondo J, González-Fernández C, Monteagudo I, Álvaro-Gracia JM, Nieto-González JC. Salivary gland ultrasound in clinical practice: What is its real usefulness? REUMATOLOGIA CLINICA 2023; 19:260-265. [PMID: 37147062 DOI: 10.1016/j.reumae.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/13/2022] [Indexed: 05/07/2023]
Abstract
BACKGROUND Salivary gland ultrasound (SGU) provides information about structural gland abnormalities that can be graded and used for primary Sjögren's syndrome (pSS) diagnosis. Its potential role as a prognostic marker for detecting patients at high risk of lymphoma and extra-glandular manifestations is still under evaluation. We aim to assess the usefulness of SGU for SS diagnosis in routine clinical practice and its relationship with extra-glandular involvement and lymphoma risk in pSS patients. METHODS We designed a retrospective observational single-center study. Data was collected using the electronic health records of patients referred to an ultrasound outpatient clinic for evaluation over a 4-year period. Data extraction included demographics, comorbidities, clinical data, laboratory tests, SGU results, salivary gland (SG) biopsy, and scintigraphy results. Comparisons were made between patients with and without pathological SGU. The external criterion for comparison was the fulfillment of the 2016 ACR/EULAR pSS criteria. RESULTS A total of 179 SGU assessments were included from this 4-year period. Twenty-four cases (13.4%) were pathological. The most frequently diagnosed conditions prior to SGU-detected pathologies were pSS (9.7%), rheumatoid arthritis (RA) (13.1%), and systemic lupus (4.6%). One hundred and two patients (57%) had no previous diagnosis (sicca syndrome work-up); of these, 47 patients (46.1%) were ANA positive and 25 (24.5%) anti-SSA positive. In this study, the sensitivity and specificity of SGU for SS diagnosis were 48% and 98% respectively, with a positive predictive value of 95%. There were statistically significant relationships between a pathological SGU and the presence of recurrent parotitis (p=.0083), positive anti-SSB antibodies (p=.0083), and a positive sialography (p=.0351). CONCLUSIONS SGU shows high global specificity but low sensitivity for pSS diagnosis in routine care. Pathological SGU findings are associated with positive autoantibodies (ANA and anti-SSB) and recurrent parotitis.
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Affiliation(s)
- Karen Carpio Astudillo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Fernando Montero Reyes
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Iustina Janta
- Department of Rheumatology, Hospital Clínico de Valladolid, Valladolid, Spain
| | - Juan Molina Collada
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana M Anzola
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Liz R Caballero Motta
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Julia Martínez-Barrio
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alfonso Ariza Lapuente
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Rivera Redondo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Indalecio Monteagudo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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18
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Fana V, Terslev L. Lacrimal and salivary gland ultrasound - how and when to use in patients with primary Sjögren's syndrome. Best Pract Res Clin Rheumatol 2023; 37:101837. [PMID: 37258318 DOI: 10.1016/j.berh.2023.101837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 06/02/2023]
Abstract
This paper addresses how to perform an ultrasound assessment of the salivary and lacrimal glands, how to identify pathological changes, and how to score disease activity, focusing on the use for primary Sjögren's syndrome (pSS). It addresses the role of salivary gland ultrasound for diagnosing and management of patients with pSS and touches upon the use for differential diagnosis, including how and when to perform ultrasound-guided biopsies and injections.
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Affiliation(s)
- Viktoria Fana
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research, Rigshospitalet, Copenhagen, Denmark.
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Copenhagen Center for Arthritis Research, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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19
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Mohammadi T, Yavari T, Ghorbani S, Mohammadi B. Associations of diagnostic findings with disease activity in primary Sjӧgren's syndrome: a cluster analysis. Rev Clin Esp 2023; 223:209-215. [PMID: 36841475 DOI: 10.1016/j.rceng.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
OBJECTIVE The diagnosis of primary Sjӧgren's syndrome still relies upon a constellation of clinical, laboratory, imaging, and pathological findings. We aimed to evaluate the relation of the disease activity with the results of diagnostic tests for primary Sjӧgren's syndrome. METHODS A principal component with cluster analysis was performed to classify 69 patients with primary Sjӧgren's syndrome based on the results of diagnostic evaluations. RESULTS Anti-SSA autoantibody was the most represented feature on the principal components. The anti-SSA and ultrasound score were positively correlated (p=0.001). We identified two distinct clusters of low or high disease activity (p<0.001). Except for disease duration and serum beta2-microglobulin, the clusters were significantly different in salivary flow (p= 0.004), ultrasound findings (p<0.001), IgG (p= 0.001), and salivary beta2-microglobulin (p= 0.048). Also, positive findings were significantly different between the clusters in rheumatoid factor, antinuclear antibody, anti-SSA, and anti-SSB (all p≤0.013). CONCLUSION Patients with higher syndrome activity were best recognized with serological and ultrasound assessments. However, patients with lower syndrome activity had a longer disease duration, higher stimulated salivary flow rate, and a positive biopsy of minor salivary glands (56%).
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Affiliation(s)
- T Mohammadi
- University of Tehran, College of Science, School of Mathematics, Statistics, and Computer Science, Tehran, Iran
| | - T Yavari
- Tehran University of Medical Sciences, Faculty of Medicine, Shariati Hospital, Tehran, Iran
| | - S Ghorbani
- Kerman University of Medical Sciences, Shafa Hospital, Department of Otorhinolaryngology, Kerman, Iran
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20
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Zimmermann F, Robin F, Caillault L, Cazalets C, Llamas-Gutierrez F, Garlantézec R, Jousse-Joulin S, Diot E, Mensi SE, Belhomme N, Jégo P, Coiffier G, Lescoat A. Sicca syndrome in systemic sclerosis: a narrative review on a neglected issue. Rheumatology (Oxford) 2023; 62:SI1-SI11. [PMID: 35866609 DOI: 10.1093/rheumatology/keac412] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 02/07/2023] Open
Abstract
SSc is an auto-immune disease characterized by life-threatening manifestations such as lung fibrosis or pulmonary arterial hypertension. Symptoms with a detrimental impact on quality of life are also reported and sicca syndrome (xerostomia, xeropthalmia) is present in up to 80% of patients with SSc. Sicca syndrome can occur in the absence of overlap with Sjögren's disease and recent studies highlight that fibrosis of minor and major salivary glands, directly linked to the pathogenesis of SSc, could be a major contributor of xerostomia in SSc. This narrative review provides an overview of the clinical presentation, diagnostic strategies, management and future perspectives on sicca syndrome in patients with SSc.
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Affiliation(s)
| | - François Robin
- Department of Rheumatology, CHU Rennes, University of Rennes 1.,Department of Rheumatology, Rennes University Hospital, University Rennes; Inserm UMR 1241, Inra, Institut NUMECAN (Nutrition Metabolisms and Cancer), University Rennes
| | | | | | | | - Ronan Garlantézec
- Département de Santé Publique, CHU de Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes
| | | | | | | | | | - Patrick Jégo
- Department of Internal Medicine.,Département de Santé Publique, CHU de Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes
| | - Guillaume Coiffier
- Department of Internal Medicine.,Department of Rheumatology, CH Dinan, Dinan, France
| | - Alain Lescoat
- Department of Internal Medicine.,Département de Santé Publique, CHU de Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes
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21
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Carvajal Alegria G, Depinoy T, Devauchelle-Pensec V, Jousse-Joulin S, Marhadour T, Guellec D, Marcorelles P, Pers JO, Saraux A, Cornec D. Diagnostic utility of a second minor salivary gland biopsy in patients with suspected Sjögren's syndrome: A retrospective cohort study. Joint Bone Spine 2023; 90:105459. [PMID: 36108904 DOI: 10.1016/j.jbspin.2022.105459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/29/2022] [Accepted: 09/07/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine whether repeated minor salivary gland biopsy (MSGB) has a clinical diagnostic utility in patients with suspicion of Sjögren's syndrome (SS). METHODS Clinical, biological, pathological data and physician's diagnosis after each MSGB from patients with suspected primary or secondary SS who had benefited from 2 MSGB at Brest University Hospital between January 1st, 1990 and January 14th, 2015, were retrospectively collected. We compared the characteristics of patients with and without first positive MSGB, concordance between the MSGB, and analyzed the modifications of diagnosis after the second MSGB. RESULTS Ninety-three patients were included, first MSGB was positive for 23 and negative for 70. Patients with first positive MSGB had more often renal involvement (P<0.05) and hypergammaglobulinemia (P=0.01), anti-SSA antibodies (P<0.05) and positive second biopsy with focus score ≥ 1 or Chisholm>2 (P<0.01). The mean time between the 2 MSGB was 5.7±4.3 years. The concordance between the results of the 2 biopsies was low (κ = 0.34). MSGB influenced diagnostic's change in 10 cases where the second MSGB was always guided by new specific clinical manifestations. CONCLUSION We observed a low concordance between 2 MSGB in patients with suspected pSS in our study. Despite this variability, performing a second MSGB changed the initial diagnosis in only a minority of the patients and was particularly useful when clinical manifestations had deeply evolved.
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Affiliation(s)
- Guillermo Carvajal Alegria
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Thibaud Depinoy
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France
| | - Valérie Devauchelle-Pensec
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Sandrine Jousse-Joulin
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Thierry Marhadour
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France
| | - Dewi Guellec
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; CIC Inserm 1412, CHRU de Brest, Brest, France
| | | | - Jacques-Olivier Pers
- Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Alain Saraux
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Divi Cornec
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France.
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22
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Schmidt NS, Voss A, Nilsson AC, Terslev L, Just SA, Lindegaard HM. Salivary gland ultrasound is associated with the presence of autoantibodies in patients with Sjögren's syndrome: A Danish single-centre study. PLoS One 2022; 17:e0265057. [PMID: 36508457 PMCID: PMC9744271 DOI: 10.1371/journal.pone.0265057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 02/22/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To investigate whether ultrasound findings of major salivary glands are correlated with serological markers, autoantibodies, patient- or doctor-reported disease activity in a Danish cohort of patients with primary Sjögren's Syndrome (pSS). METHODS In all, 49 patients at Odense University Hospital with pSS diagnosed according to the 2002 American-European Consensus Group (AECG) classification criteria were included. Patients were characterized using the EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI, score of systemic complications) and EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), serologic markers, Schirmer's test and salivary test. Salivary gland ultrasound (SGUS) was performed of the submandibular and parotid glands and scored according to the Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) semi-quantitative scoring system. RESULTS More patients with abnormal SGUS had antinuclear antibodies (ANA) (p = 0.002), anti-Ro52 (p = 0.001), anti-Ro60 (p<0.001), anti-La (p<0.001) and IgM-RF (p<0.001). Titers for ANA (p = 0.02) and anti-Ro52 (p = 0.03) were higher in patients with abnormal SGUS. Twenty-three of the pSS patients had no pathological findings on SGUS. There was no correlation between SGUS severity and ESSDAI- or ESSPRI-scores. CONCLUSIONS Abnormal SGUS findings are associated with autoantibodies of high specificity for pSS but not with ESSDAI, ESSPRI or inflammatory markers.
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Affiliation(s)
- Nanna Surlemont Schmidt
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark, Odense, Denmark
| | - Anne Voss
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anna Christine Nilsson
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Søren Andreas Just
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
- Section of Rheumatology, Department of Medicine, Svendborg Hospital–Odense University Hospital, Svendborg, Denmark
| | - Hanne M. Lindegaard
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- * E-mail:
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23
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Robin F, Albert JD, Lescoat A, Martel A, Perdriger A, DeBandt M, Maillot F, Coiffier G. Diagnostic Performances of Ultrasound Evaluation of Major Salivary Glands According to the 2019 Outcome Measures in Rheumatology Ultrasound Scoring System. Arthritis Care Res (Hoboken) 2022; 74:1924-1932. [PMID: 33973395 DOI: 10.1002/acr.24631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 03/19/2021] [Accepted: 04/20/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the diagnostic performance of ultrasound examination of the salivary glands (US-SG) according to the 2019 Outcome Measures in Rheumatology (OMERACT) US scoring system for Sjögren's syndrome (SS). METHODS The present work was a retrospective study based on a multicentric cohort with SS/sicca syndrome. The American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) 2016 classification criteria for SS (a score of ≥4 without ocular staining score), the American-European Consensus Group (AECG) 2002 classification criteria, and clinician experts were considered as reference standards for diagnosis of SS. An OMERACT score of ≥2 according to 2 independent readers defined the diagnosis of SS based on US-SG assessment. Diagnostic performances and interobserver reproducibility of US-SG were assessed. RESULTS Forty-two patients fulfilling the ACR/EULAR 2016 criteria for SS were compared to 30 control subjects with sicca syndrome. Twenty-five patients were diagnosed as having SS according to US-SG evaluation, and they were more frequently observed in the SS group (52.5%) than in the control group (10.0%) (P < 0.001). US-SG showed an area under the curve (AUC) of 0.751 (95% confidence interval [95% CI] 0.621, 0.882) for the diagnosis of SS (ACR/EULAR 2016 classification). The inclusion of US-SG in the ACR/EULAR 2016 classification improved sensitivity (91.5% versus 89.4%) with limited decrease of specificity (96.0% versus 100%) and with an AUC of 0.975 (95% CI 0.945, 1.00). Similar results were observed when US-SG was included in the AECG 2002 classification criteria. Interobserver reproducibility of a score of ≥2 according to the 2019 OMERACT US scoring system for SS diagnosis was good (κ = 0.73 [95% CI 0.64, 0.81]). Histologic lymphocyte infiltration of the minor salivary glands was associated with the OMERACT grading of US-SG. CONCLUSION The present study confirms the good specificity of the 2019 OMERACT US classification measures of US-SG for the diagnosis of SS and its feasibility in daily practice.
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Affiliation(s)
| | | | - Alain Lescoat
- University Hospital Center of Rennes and University of Rennes, CHU Rennes, INSERM, EHESP, IRSET, UMR_S 1085, F-35000 Rennes, France
| | | | | | - Michel DeBandt
- University Hospital Center of Fort-de-France, Martinique, France
| | | | - Guillaume Coiffier
- University Hospital Center of Rennes, Rennes, France, and Hospital Center of Dinan, Dinan, France
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24
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Lorenzon M, Spina E, Tulipano Di Franco F, Giovannini I, De Vita S, Zabotti A. Salivary Gland Ultrasound in Primary Sjögren’s Syndrome: Current and Future Perspectives. Open Access Rheumatol 2022; 14:147-160. [PMID: 36072437 PMCID: PMC9444027 DOI: 10.2147/oarrr.s284763] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/24/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Michele Lorenzon
- Institute of Radiology, Department of Medicine, University of Udine, Udine, Italy
- Correspondence: Michele Lorenzon, Institute of Radiology, Department of Medicine, University of Udine, Udine, Italy, Tel +39 0432 559232, Email
| | - Erica Spina
- Institute of Radiology, Department of Medicine, University of Udine, Udine, Italy
| | | | - Ivan Giovannini
- Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Udine, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medical and Biological Sciences, Azienda Sanitaria Universitaria Friuli Centrale c/o University of Udine, Udine, Italy
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25
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Zandonella Callegher S, Giovannini I, Zenz S, Manfrè V, Stradner MH, Hocevar A, Gutierrez M, Quartuccio L, De Vita S, Zabotti A. Sjögren syndrome: looking forward to the future. Ther Adv Musculoskelet Dis 2022; 14:1759720X221100295. [PMID: 35634352 PMCID: PMC9131387 DOI: 10.1177/1759720x221100295] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/26/2022] [Indexed: 12/25/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is a heterogeneous disease characterised by a wide spectrum of manifestations that vary according to the different stages of the disease and among different subsets of patients. The aim of this qualitative literature review is to summarise the recent advances that have been reported in pSS, ranging from the early phases to the established disease and its complications. We analysed the diagnostic, prognostic, and management aspects of pSS, with a look into future clinical and research developments. The early phases of pSS, usually antedating diagnosis, allow us to investigate the pathophysiology and risk factors of the overt disease, thus allowing better and timely patient stratification. Salivary gland ultrasound (SGUS) is emerging as a valid complementary, or even alternative, tool for histopathology in the diagnosis of pSS, due to a standardised scoring system with good agreement and performance. Other promising innovations include the application of artificial intelligence to SGUS, ultrasound-guided core needle biopsy, and a wide array of novel diagnostic and prognostic biomarkers. Stratifying pSS patients through the integration of clinical, laboratory, imaging, and histopathological data; differentiating between activity-related and damage-related manifestations; and identifying patients at higher risk of lymphoma development are essential steps for an optimal management and individualised treatment approach. As new treatment options are emerging for both glandular and systemic manifestations, there is a need for a more reliable treatment response evaluation. pSS is a complex and heterogeneous disease, and many distinct aspects should be considered in the different stages of the disease and subsets of patients. In recent years, efforts have been made to improve our understanding of the disease, and certainly in the coming years, some of these novelties will become part of our routine clinical practice, thus improving the management of pSS patients.
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Affiliation(s)
| | - Ivan Giovannini
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Sabine Zenz
- Division of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Valeria Manfrè
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Martin H. Stradner
- Division of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
- Rheumatology Center of Excellence, Mexico City, Mexico
| | - Luca Quartuccio
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
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26
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Research on primary Sjögren's syndrome in 2004-2021: a Web of Science-based cross-sectional bibliometric analysis. Rheumatol Int 2022; 42:2221-2229. [PMID: 35536378 DOI: 10.1007/s00296-022-05138-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
The extent, range, and nature of available research in the field of primary Sjögren's syndrome (pSS) have not been understood fully. This study aimed to map the literature available on pSS, and identify global hotspots and trends in the research. Papers on pSS published between 2004 and 2021 were searched from Web of Science Core Collection. The quantity and citations of publications, and the research hotspots and trends in the field of pSS were analyzed and presented visually by Microsoft Excel and Citespace software. A total of 3606 papers mainly from 526 institutions in 83 countries/regions were included for analysis. The number of publications presented an overall upward trend in the field of pSS from 2004 to 2021. The USA ranked first in the number of publications (n = 661), followed by China (n = 491), Italy (n = 405), France (n = 351), and Japan (n = 292). Moreover, seven of the top ten countries by the number of publications on pSS were from Europe. The University of Groningen (n = 661), Xavier Mariette (n = 95), and Clinical and Experimental Rheumatology (n = 184) were the most prolific affiliation, author, and journal, respectively. Vitali C (n = 2009) and Arthritis and Rheumatism (n = 3918) held the record for the most cited papers by an author and journal, respectively. At present, the hot keywords in the field of pSS include disease activity, ultrasonography, management, consensus, and data-driven. Lymphoid organization, clinical phenotypes outcome, salivary gland ultrasonography, and Toll-like receptor are the emerging research trends in pSS. Research on pSS is flourishing. Current research of pSS mainly focuses on disease activity, ultrasonography, and management. While, the emerging research trends in pSS are lymphoid organization, clinical phenotypes outcome, salivary gland ultrasonography, and Toll-like receptor.
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27
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Hammam N, Elzohri MH, Elsonbaty A, Eldaly ZH, Hammam O, Tarik D, Ibrahim HM, Gheita TA. Diagnostic value of salivary gland ultrasonography for secondary Sjögren syndrome in patients with systemic lupus erythematosus. Lupus 2022; 31:1045-1053. [PMID: 35514317 DOI: 10.1177/09612033221100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Salivary gland ultrasound (SGUS) is a reliable technique for assessing the salivary glands in patients with primary Sjögren's syndrome (SS); however, the role of SGUS for diagnosis of secondary SS (sSS) in patients with systemic lupus erythematosus (SLE) was not examined. OBJECTIVE To assess the diagnostic value of SGUS for sSS in patients with SLE, and to investigate the relationship between SGUS findings with clinical and laboratory characteristics of patients with SLE. PATIENTS AND METHODS This cross-sectional study included 49 patients with SLE. The diagnosis of sSS was confirmed according to the 2016 ACR/EULAR criteria. Salivary gland US was performed for all patients and graded using a validated Hočevar scoring system. A complete clinical and laboratory workup for SLE was assessed. Schirmer's test and the ocular staining were performed. RESULTS Of the 49 patients with a mean age of 30.2 ± 9.6 years, 98% were female. 19 (38.8%) had sSS. SGUS changes consistent with sSS (≥17) were found in 29 (59.2%) of the patients. Patients with higher SGUS score had more sicca findings as well as positive anti-Ro, anti-La antibodies, and poorer psychological stress (p < 0.05). The SGUS (≥17) showed a sensitivity of 84.2% and a specificity of 56.7% for sSS diagnosis, with an area under the curve of 0.77 (95% CI: 0.63, 0.91). CONCLUSION We propose salivary gland ultrasound as a non-invasive method in the diagnostic workup for sSS in patients with SLE. Further studies to confirm the diagnostic value of SGUS in a larger sample of patients with sSS will be necessary.
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Affiliation(s)
- Nevin Hammam
- Rheumatology Department, 68797Assiut University Hospitals, Assiut, Egypt
| | - Mona H Elzohri
- Faculty of Medicine, Department of Internal Medicine, Rheumatology and Clinical Immunology unit, 68797Assiut University, Assiut, Egypt
| | - Amira Elsonbaty
- Rheumatology Department, 68797Assiut University Hospitals, Assiut, Egypt
| | - Zeiad H Eldaly
- Department of Ophthalmology, 68797Assiut University, Assiut, Egypt
| | - Osman Hammam
- Assiut University Hospitals, 68797Assiut University, Assiut Egypt
| | - Dalia Tarik
- Clinical Pathology Department, 68797Assiut University Hospitals, Assiut, Egypt
| | - Hamdy M Ibrahim
- Department of Diagnostic Radiology, Faculty of Medicine, 68797Assiut University, Assiut, Egypt
| | - Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, 63527Cairo University, Cairo, Egypt
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28
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Izzetti R, Fulvio G, Nisi M, Gennai S, Graziani F. Reliability of OMERACT Scoring System in Ultra-High Frequency Ultrasonography of Minor Salivary Glands: Inter-Rater Agreement Study. J Imaging 2022; 8:jimaging8040111. [PMID: 35448238 PMCID: PMC9026431 DOI: 10.3390/jimaging8040111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/03/2022] [Accepted: 04/12/2022] [Indexed: 12/10/2022] Open
Abstract
Minor salivary gland ultra-high frequency ultrasonography (UHFUS) has recently been introduced for the evaluation of patients with suspected primary Sjögren’s Syndrome (pSS). At present, ultrasonographic assessment of major salivary glands is performed using the Outcome Measures in Rheumatology (OMERACT) scoring system. Previous reports have explored the possibility of applying the OMERACT scoring system to minor salivary glands UHFUS, with promising results. The aim of this study was to test the inter-reader concordance in the assignment of the OMERACT score to minor salivary gland UHFUS. The study was conducted on 170 minor salivary glands UHFUS scans of patients with suspected pSS. Three independent readers performed UHFUS image evaluation. Intraclass correlation coefficient (ICC) was employed to assess inter-reader reliability. Bland and Altman analysis was employed to test the agreement with a gold standard examiner. ICC values > 0.9 were found for scores 0 and 1, while score 2 and score 3 presented ICCs of 0.873 and 0.785, respectively. The measurements performed by the three examiners were in agreement with the gold standard examiner. According to these results, UHFUS interpretation showed good inter-observer reliability, suggesting that OMERACT score can be effectively used for the evaluation of glandular alterations, even for minor salivary glands.
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Affiliation(s)
- Rossana Izzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (M.N.); (S.G.); (F.G.)
- Unit of Dentistry and Oral Surgery, University Hospital of Pisa, 56126 Pisa, Italy
- Correspondence:
| | - Giovanni Fulvio
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
- Unit of Rheumatology, University Hospital of Pisa, 56126 Pisa, Italy
| | - Marco Nisi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (M.N.); (S.G.); (F.G.)
- Unit of Dentistry and Oral Surgery, University Hospital of Pisa, 56126 Pisa, Italy
| | - Stefano Gennai
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (M.N.); (S.G.); (F.G.)
- Unit of Dentistry and Oral Surgery, University Hospital of Pisa, 56126 Pisa, Italy
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (M.N.); (S.G.); (F.G.)
- Unit of Dentistry and Oral Surgery, University Hospital of Pisa, 56126 Pisa, Italy
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29
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Xu S, Luo J, Zhu C, Jiang J, Cheng H, Wang P, Hong J, Fang J, Pan J, Brown MA, Zhu X, Wang X. Performance Evaluation of Multiple Ultrasonographical Methods for the Detection of Primary Sjögren's Syndrome. Front Immunol 2021; 12:777322. [PMID: 34880870 PMCID: PMC8646092 DOI: 10.3389/fimmu.2021.777322] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Major salivary gland ultrasonography (SGUS) is increasingly being recognized as having critical roles in differentiating primary Sjögren’s syndrome (pSS) from other connective tissue disorders. Contrast-enhanced ultrasonography (CEUS) has been reported to evaluate microvascularity of lesions in different tissues with objective angiographic index, eliminating the observer-dependent defect of ultrasonography. However, there are few relevant studies concentrating on the application of CEUS in the diagnosis and assessment for pSS, and their clinical utility prospect remains uncertain. In this study, a total of 227 eligible patients were enrolled, including 161 pSS and 66 non-pSS patients with comprehensive ultrasonographic evaluation of the parotid and submandibular glands, including grayscale ultrasonography, color Doppler sonography (CDS), and CEUS. Compared with non-pSS, pSS patients had significantly higher grayscale ultrasound (US) scores and CDS blood grades in the parotid gland and significantly higher grayscale US and CEUS scores in the submandibular glands. Diagnostic model combining ultrasonographic signatures, anti-SSA/Ro60, and keratoconjunctivitis sicca (KCS) tests showed a remarkable discrimination [mean area under the curve (AUC)0.963 in submandibular glands and 0.934 in parotid glands] for pSS, and the nomogram provided excellent prediction accuracy and good calibration in individualized prediction of pSS. A combination of multiple ultrasonographical examinations of the major salivary glands (SGs) is a promising technique that may be used as a practical alternative to minor SG biopsy in the detection of pSS.
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Affiliation(s)
- Shihao Xu
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jing Luo
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Chengwei Zhu
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiachun Jiang
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hui Cheng
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ping Wang
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jingwei Hong
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinxia Fang
- Department of Rheumatology, Taizhou Hospital of Zhejiang University, Linhai, China
| | - Jingjing Pan
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Matthew A Brown
- Department of Medicine, Guy's and St Thomas' Hospital NHS Trust and King's College London NIHR Biomedical Research Centre, London, United Kingdom
| | - Xiaochun Zhu
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaobing Wang
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, China
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30
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Lesturgie-Talarek M, Goossens J, Berkani S, Forien M, Juge PA, Ebstein E, Palazzo E, Borie R, Crestani B, Dieudé P, Ottaviani S. Salivary gland ultrasonography in patients with connective tissue diseases: a multi-center observational study. Rheumatology (Oxford) 2021; 61:3362-3369. [PMID: 34888637 DOI: 10.1093/rheumatology/keab907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/26/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Ultrasonography (US) of salivary glands (SGUS) is a non-invasive tool that allows for diagnosing primary Sjögren's syndrome (pSS) or secondary SS (sSS). However, little is known about the prevalence of US findings of SS in other connective tissue diseases (CTDs). The aim of this multicentre observational study was to evaluate, in CTD patients with or without SS, the prevalence of abnormal SGUS findings and the possible association of the findings with clinical or biological phenotypes. METHODS B-Mode SGUS was performed by one operator blinded to clinical data. Each SG was semi-quantitatively rated on a scale from 0-4 according to the Jousse-Joulin score; a score ≥ 2 was considered pathological. RESULTS Data for 194 patients were analyzed (pSS, n = 30; sSS, n = 39; other CTDs, n = 77; controls, n = 48). SGUS findings were abnormal in 80%, 67%, 25% and 2% of patients, respectively. Independent of the underlying disease, age and sex, abnormal SGUS findings were significantly associated with presence of anti-SSA antibodies (p< 0.001), pSS (p< 0.001) and sSS (p< 0.01). Among SS patients, abnormal SGUS findings were associated with the presence of hypergammaglobulinemia, anti-SSA antibodies, objective eye dryness and increased anti-nuclear antibody level, with no difference in EULAR Sjögren's Syndrome Disease Activity Index. CONCLUSION Abnormal SGUS findings were associated with anti-SSA antibody positivity independent of the underlying disease. In SS patients, abnormal findings were associated with immunologic features and mouth involvement. Among CTD patients, SGUS changes may be associated with a particular immune profile.
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Affiliation(s)
| | - Julia Goossens
- Service de Médecine Interne, Centre hospitalier Ouest Réunion, Saint-Paul, France
| | - Sabryne Berkani
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, Paris, France
| | - Marine Forien
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, Paris, France
| | - Pierre-Antoine Juge
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, Paris, France
| | - Esther Ebstein
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, Paris, France
| | - Elisabeth Palazzo
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, Paris, France
| | - Raphael Borie
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Pneumologie, Paris, France
| | - Bruno Crestani
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Pneumologie, Paris, France
| | - Philippe Dieudé
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, Paris, France
| | - Sébastien Ottaviani
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, Paris, France
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31
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Min HK, Kim SH, Park Y, Lee KA, Kwok SK, Lee SH, Kim HR. Ultrasonographic characteristics of major salivary glands in anti-centromere antibody-positive primary Sjögren's syndrome. PLoS One 2021; 16:e0259519. [PMID: 34731207 PMCID: PMC8565722 DOI: 10.1371/journal.pone.0259519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/20/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate salivary gland ultrasonography (SGUS) findings in primary Sjögren’s syndrome (pSS) patients positive for the anti-centromere antibody (ACA) and compare these with those in ACA-negative pSS patients. Methods We analyzed demographic, clinical, laboratory, and SGUS data of pSS patients who fulfilled the 2002 American-European Consensus Group classification criteria for pSS. SGUS findings of four major salivary glands (bilateral parotid and submandibular glands) were scored in five categories and compared between ACA-positive and ACA-negative pSS patients. Linear regression analysis was performed to elucidate the factors associated with SGUS score. Results In total, 121 pSS patients were enrolled (19, ACA-positive). The ACA-positive patients were older (67.0 vs 58.0 years, P = 0.028), whereas anti-Ro/SSA and anti-La/SSB positivity was more prevalent in the ACA-negative group (89.2% vs 21.1%, P < 0.001, and 47.1% vs 10.5%, P = 0.007, respectively). The total SGUS and hypoechoic area scores were lower in ACA-positive patients (16.0 vs 23.0, P = 0.027, and 4.0 vs 7.0, P = 0.004, respectively). In univariate regression analysis, being positive for unstimulated salivary flow rate (USFR < 1.5 ml/15 min), anti-Ro/SSA, and rheumatoid factor were positively associated whereas ACA positivity was negatively associated with the SGUS score. In multivariate regression analysis, being positive for USFR, anti-Ro/SSA, and rheumatoid factor showed significant association with the SGUS score. Conclusions ACA-positive pSS patients showed a lower SGUS score than ACA-negative patients, which was especially prominent in the hypoechoic area component.
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Affiliation(s)
- Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Se-Hee Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Youngjae Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Ann Lee
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Seoul hospital, Seoul, Republic of Korea
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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Fana V, Dohn UM, Krabbe S, Terslev L. Application of the OMERACT Grey-scale Ultrasound Scoring System for salivary glands in a single-centre cohort of patients with suspected Sjögren's syndrome. RMD Open 2021; 7:rmdopen-2020-001516. [PMID: 33879581 PMCID: PMC8061801 DOI: 10.1136/rmdopen-2020-001516] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/05/2021] [Accepted: 04/02/2021] [Indexed: 01/17/2023] Open
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.
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Affiliation(s)
- Viktoria Fana
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Uffe M Dohn
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Simon Krabbe
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
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Takagi Y, Sasaki M, Eida S, Katayama I, Hashimoto K, Nakamura H, Shimizu T, Morimoto S, Kawakami A, Sumi M. Comparison of salivary gland MRI and ultrasonography findings among patients with Sjögren's syndrome over a wide age range. Rheumatology (Oxford) 2021; 61:1986-1996. [PMID: 34398226 PMCID: PMC9071520 DOI: 10.1093/rheumatology/keab560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives This retrospective study compared MRI and US findings among patients with SS over a wide age range. Methods Ninety patients with SS aged 8–84 years who had undergone both MRI and US examinations were divided into four groups according to age, as follows: <18 years (juvenile SS, JSS), 9 patients; 18–39 years, 12 patients; 40–69 years, 53 patients; >69 years, 16 patients. Imaging findings of parotid glands (PGs) and submandibular glands (SMGs) were compared among the four groups. Furthermore, the relationships within and between imaging findings and various clinical findings were examined. Results On MRI, patients with JSS commonly exhibited multiple high-intensity spots in the PGs on MR sialography and fat-suppressed T2-weighted imaging. With increasing SS group age, the frequencies and numbers of the high-intensity spots were lower. Fat areas on MRI and hyperechoic bands on US were rarely observed in the PGs and SMGs of patients with JSS, whereas they were more common in patients with adult SS. In addition, the presence of hyperechoic bands on US, the presence of fat areas on MRI, and decreased salivary flow were associated with one another. Conclusion Salivary gland imaging findings in patients with JSS were characterized by punctate sialectasis, whereas those findings in patients with adult SS were characterized by fatty degeneration. Distinct findings in patients with JSS and adult SS are likely to reflect differences in glandular lesion stage. MRI and US are presumably useful for evaluation of glandular lesion severity during follow-up.
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Affiliation(s)
- Yukinori Takagi
- Department of Radiology and Biomedical Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Miho Sasaki
- Department of Radiology and Biomedical Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Sato Eida
- Department of Radiology and Biomedical Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ikuo Katayama
- Department of Radiology and Biomedical Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kunio Hashimoto
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideki Nakamura
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shimpei Morimoto
- Department of Innovation Platform & Office for Precision Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Misa Sumi
- Department of Radiology and Biomedical Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Ottaviani S, Khaleche S, Borie R, Debray MP, Dieudé P, Crestani B. Rheumatological evaluation of patients with interstitial lung disease. Scand J Rheumatol 2021; 51:34-41. [PMID: 34132624 DOI: 10.1080/03009742.2021.1907945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: Interstitial lung disease (ILD) is a common feature of connective tissue disease (CTD). The diagnosis of CTD-ILD can be challenging and is important for therapeutic decisions. In this study, we aimed to determine whether a systematic rheumatological assessment could help pulmonologists in the diagnosis and care of ILD patients.Method: We conducted an observational single-centre study of patients with ILD. All patients underwent standardized pulmonary and rheumatological evaluations, including clinical evaluation (pulmonary symptoms and musculoskeletal signs), immunological screening, chest high-resolution computed tomography, pulmonary function tests, and ultrasonography (US) of joints and major salivary glands.Results: We included 100 consecutive ILD patients (47% women, mean ± sd age 67 ± 14 years); 15 patients already had CTD. The main extrapulmonary symptoms were joint pain (n = 52), joint swelling (n = 26), and sicca syndrome (n = 33). US of joints revealed synovitis, bone erosion, and tenosynovitis in 37, 17, and 13 patients, respectively. US of major salivary glands detected features associated with Sjögren's syndrome in 13 patients. After rheumatological evaluation, CTD-ILD was confidently diagnosed in 39 patients; diseases were mainly rheumatoid arthritis (n = 20), primary Sjögren's syndrome (n = 17), and inflammatory myopathies (n = 7). The diagnosis of CTD-ILD was associated with the presence of musculoskeletal symptoms and immunological and US abnormalities. The CTD diagnosis led to a therapeutic change in 21 patients.Conclusion: Our findings suggest that musculoskeletal symptoms are frequent in ILD patients, which supports multidisciplinary management, involving the rheumatologist, for evaluating patients with ILD.
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Affiliation(s)
- S Ottaviani
- Rheumatology Department, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - S Khaleche
- Rheumatology Department, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - R Borie
- Pulmonology Department, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - M-P Debray
- Radiology Department, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - P Dieudé
- Rheumatology Department, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - B Crestani
- Pulmonology Department, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
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Bukhari AF, Farag A, Papas A, Ganguly R, Campos H, Ramesh A. Salivary glands ultrasonography as a diagnostic aid in Sjögren syndrome: A prospective pilot investigation. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:172-181. [PMID: 33992583 DOI: 10.1016/j.oooo.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/22/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aims of this pilot investigation were to calculate the levels of sensitivity and specificity of salivary glands ultrasonography (SGUS) in diagnosing Sjögren syndrome (SS) and to assess the ultrasonographic findings of parotid and submandibular glands. STUDY DESIGN Patients diagnosed with SS or dry mouth and healthy controls were enrolled. Bilateral parotid and submandibular glands were assessed for (1) parenchymal inhomogeneity (PIH), (2) median size of the glands, (3) visibility of glandular posterior borders, and (4) size of sialolith, if present. RESULTS This study included 34 female patients, of whom 12 had SS (35.3%), 12 had dry mouth (35.3%), and 10 were healthy controls (29.4%). Patients with SS showed higher PIH scores in all glands with the median differences being statistically higher in the right and left parotids and left submandibular glands (P < .001, P = .012, and P < .001, respectively). SGUS, with a PIH cutoff ≥2, showed a sensitivity of 100% and a specificity of 81.6% for detecting SS. The majority of SS had invisible glandular posterior borders (P < .001). Median size of the glands and size of the sialolith did not show any statistically significant differences between groups. CONCLUSIONS SGUS is a noninvasive imaging modality with good sensitivity and specificity that might be valuable as a diagnostic aid for SS.
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Affiliation(s)
- Alaa F Bukhari
- Assistant Professor, Department of Oral Diagnostic Sciences, Division of Oral Medicine, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia.
| | - Arwa Farag
- Assistant Professor, Department of Oral Diagnostic Sciences, Division of Oral Medicine, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia and Department of Diagnostic Sciences, Division of Oral Medicine, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Athena Papas
- Distinguished Professor, Department of Diagnostic Sciences, Division of Oral Medicine, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Rumpa Ganguly
- Assistant Professor, Department of Diagnostic Sciences, Oral & Maxillofacial Radiology, University of California San Francisco, School of Dentistry, San Francisco, CA, USA
| | - Hugo Campos
- Assistant Professor, Department of Diagnostic Sciences, Oral & Maxillofacial Radiology, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Aruna Ramesh
- Professor, Department of Diagnostic Sciences, Oral & Maxillofacial Radiology, Tufts University School of Dental Medicine, Boston, MA, USA
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Mo YQ, Hao SY, Li QH, Liang JJ, Luo Y, Lan YQ, Zhong JL, Wang JW, Zhang XP, Huang WK, Dai L. Ultrasonography predicts the results of labial salivary gland biopsy in patients with suspected Sjögren's syndrome: a matrix risk model. Ther Adv Musculoskelet Dis 2021; 13:1759720X211010592. [PMID: 33995602 PMCID: PMC8071977 DOI: 10.1177/1759720x211010592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: Although a positive result of labial salivary gland biopsy (LSGB) is critical for the diagnosis of Sjögren’s syndrome, rheumatologists prefer assessing the non-invasive objective items and hope to learn the predicted probability of positive LSGB before referring patients with suspected Sjögren’s syndrome to receive biopsy. This study aimed to explore the predictive value of combined B-mode ultrasonography (US) and shear-wave elastography (SWE) examination on LSGB results. Methods: A derivation cohort and later a validation cohort of patients with suspected Sjögren’s syndrome were recruited. All participants received clinical assessments, B-mode US and SWE examination on bilateral parotid and submandibular glands before LSGB. Positive LSGB was defined by a focus score ⩾1 per 4 mm2 of glandular tissue. Results: In the derivation cohort of 91 participants, either the total US scores or the total SWE values of four glands significantly distinguished patients with positive LSGB from those with negative results (area under the curve (AUC) = 0.956, 0.825, both p < 0.001). The positive predictive value (PPV) was 100% in patients with total US scores ⩾9 or with total SWE values ⩾33 kPa. The negative predictive value (NPV) was 100% in patients with total US scores <5, but 68% in patients with total SWE values <27 kPa. A matrix risk model was derived based on the combination of total US scores and total SWE values. Patients can be stratified into high, moderate, and low risk of positive LSGB. In the validation cohort of 52 participants, the PPV was 94% in the high-risk subpopulation and the NPV was 93% in the low-risk subpopulation. Conclusion: A novel matrix risk model based on the combined B-mode US and SWE examination can help rheumatologists to make a shared decision with suspected Sjögren’s syndrome patients on whether the invasive procedure of LSGB should be performed.
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Affiliation(s)
- Ying-Qian Mo
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Shao-Yun Hao
- Department of Ultrasonography, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Qian-Hua Li
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Jin-Jian Liang
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Yi Luo
- Department of Ultrasonography, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Yu-Qing Lan
- Department of Ophthalmology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Jiang-Long Zhong
- Department of Oral & Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Jun-Wei Wang
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Xue-Pei Zhang
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Wen-Ke Huang
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Lie Dai
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, P.R. China
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Park J, Lee JS, Oh D, Ryoo HG, Han JH, Lee WW. Quantitative salivary gland SPECT/CT using deep convolutional neural networks. Sci Rep 2021; 11:7842. [PMID: 33837284 PMCID: PMC8035179 DOI: 10.1038/s41598-021-87497-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 03/30/2021] [Indexed: 11/08/2022] Open
Abstract
Quantitative single-photon emission computed tomography/computed tomography (SPECT/CT) using Tc-99m pertechnetate aids in evaluating salivary gland function. However, gland segmentation and quantitation of gland uptake is challenging. We develop a salivary gland SPECT/CT with automated segmentation using a deep convolutional neural network (CNN). The protocol comprises SPECT/CT at 20 min, sialagogue stimulation, and SPECT at 40 min post-injection of Tc-99m pertechnetate (555 MBq). The 40-min SPECT was reconstructed using the 20-min CT after misregistration correction. Manual salivary gland segmentation for %injected dose (%ID) by human experts proved highly reproducible, but took 15 min per scan. An automatic salivary segmentation method was developed using a modified 3D U-Net for end-to-end learning from the human experts (n = 333). The automatic segmentation performed comparably with human experts in voxel-wise comparison (mean Dice similarity coefficient of 0.81 for parotid and 0.79 for submandibular, respectively) and gland %ID correlation (R2 = 0.93 parotid, R2 = 0.95 submandibular) with an operating time less than 1 min. The algorithm generated results that were comparable to the reference data. In conclusion, with the aid of a CNN, we developed a quantitative salivary gland SPECT/CT protocol feasible for clinical applications. The method saves analysis time and manual effort while reducing patients' radiation exposure.
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Affiliation(s)
- Junyoung Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jae Sung Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Dongkyu Oh
- Department of Nuclear Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Korea
| | - Hyun Gee Ryoo
- Department of Nuclear Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Korea
| | - Jeong Hee Han
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Korea
| | - Won Woo Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, 13620, Gyeonggi-do, Korea.
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea.
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Roszkowska AM, Oliverio GW, Aragona E, Inferrera L, Severo AA, Alessandrello F, Spinella R, Postorino EI, Aragona P. Ophthalmologic Manifestations of Primary Sjögren's Syndrome. Genes (Basel) 2021; 12:genes12030365. [PMID: 33806489 PMCID: PMC7998625 DOI: 10.3390/genes12030365] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023] Open
Abstract
Sjögren’s syndrome (SS) is a chronic, progressive, inflammatory, autoimmune disease, characterized by the lymphocyte infiltration of exocrine glands, especially the lacrimal and salivary, with their consequent destruction. The onset of primary SS (pSS) may remain misunderstood for several years. It usually presents with different types of severity, e.g., dry eye and dry mouth symptoms, due to early involvement of the lacrimal and salivary glands, which may be associated with parotid enlargement and dry eye; keratoconjunctivitis sicca (KCS) is its most common ocular manifestation. It is still doubtful if the extent ocular surface manifestations are secondary to lacrimal or meibomian gland involvement or to the targeting of corneal and conjunctival autoantigens. SS is the most representative cause of aqueous deficient dry eye, and the primary role of the inflammatory process was evidenced. Recent scientific progress in understanding the numerous factors involved in the pathogenesis of pSS was registered, but the exact mechanisms involved still need to be clarified. The unquestionable role of both the innate and adaptive immune system, participating actively in the induction and evolution of the disease, was recognized. The ocular surface inflammation is a central mechanism in pSS leading to the decrease of lacrimal secretion and keratoconjunctival alterations. However, there are controversies about whether the ocular surface involvement is a direct autoimmune target or secondary to the inflammatory process in the lacrimal gland. In this review, we aimed to present actual knowledge relative to the pathogenesis of the pSS, considering the role of innate immunity, adaptive immunity, and genetics.
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Affiliation(s)
- Anna Maria Roszkowska
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
- Correspondence:
| | - Giovanni William Oliverio
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Emanuela Aragona
- IRCCS San Raffaele Scientific Institute, Ophthalmology Clinic, Vita Salute San Raffaele University, 20132 Milan, Italy;
| | - Leandro Inferrera
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Alice Antonella Severo
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Federica Alessandrello
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Rosaria Spinella
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Elisa Imelde Postorino
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Pasquale Aragona
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
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Salivary Glands and Periodontal Changes in a Population of Sjögren's and Sicca Syndrome Treated by Pilocarpine: A Pilot Study. Rheumatol Ther 2020; 8:219-231. [PMID: 33336287 PMCID: PMC7990995 DOI: 10.1007/s40744-020-00263-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Oral administration of pilocarpine enhances salivary flow in sicca patients but its effect upstream on ultrasound (US) of salivary glands (SG) and downstream on periodontium remain unknown.
Methods Sicca patients were prospectively included. Echostructural and vascularization of SG were assessed using B mode and pulsed Doppler (USPD). Vascularization of SG was measured using resistive index (RI) before and after stimulation by lemon juice. Echostructure (measure of glandular length in cm2, evaluation of parotid and submandibular glands parenchymal abnormalities) was assessed at baseline (M0) and after 3 months (M3) of treatment with pilocarpine. A dental consultation was performed at M0 and M3 to evaluate changes in unstimulated salivary flow (USSF), stimulated salivary flow (SSF), and periodontal parameters such as modified gingival index (Lobene), plaque index (Silness), bleeding index, pocket depth, and pH.
Results Nineteen patients were included but only 11 received pilocarpine treatment for 3 months, as six stopped pilocarpine due to side effects and two were excluded for other causes. Among the 11 patients who completed the 3-month follow-up, five had primary Sjögren’s syndrome according to the American-European’s classification criteria. As expected, statistical differences were found concerning SSF (p = 0.018) and USSF (p = 0.027) between M0 and M3 while no statistical change in both SG echostructure and vascularization or periodontal evaluation was shown. Conclusions Pilocarpine improved SSF and USSF measurements in sicca syndrome but no ultrasonography of major salivary glands (SGUS) structural and vascular changes were detected as well as periodontal evaluation. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-020-00263-y.
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High prevalence of salivary gland ultrasound abnormalities in systemic sclerosis. Joint Bone Spine 2020; 88:105113. [PMID: 33278589 DOI: 10.1016/j.jbspin.2020.105113] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/04/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate salivary gland (SG) involvement in patients with systemic sclerosis (SSc) using SG ultrasound (SGUS). METHODS Patients with SSc (n=62), primary Sjögren's syndrome (pSS) (n=59), and idiopathic Sicca syndrome (n=43) were evaluated using the outcome measures in rheumatology clinical trial (OMERACT) definitions of the SGUS scoring system. The hyperechogenic bands using the 0-3 scoring system, intraglandular power Doppler signal (PDS), and SG volumes were also assessed. RESULTS The proportion of patients with OMERACT grades (≥2) among the four SGs was significantly higher in SSc (51.6%) and pSS (62.7%) groups than those in the idiopathic Sicca syndrome group (4.7%). Patients with SSc and pSS had significantly higher total fibrosis grades than controls. No difference in fibrosis grades was observed between SSc and pSS groups. The PDS scores of SGs were higher in the SSc group than in the idiopathic Sicca syndrome group. SG volumes did not differ between the groups. SSc patients with SGUS grades ≥2 had more anti-centromere antibodies (ACA) (65.6% vs. 30.0%) than individuals with grades 0-1. SSc patients with fibrosis grades ≥2 reported more Sicca symptoms than those with grades 0-1. Inhomogeneity and hyperechogenic bands within the SGs were not associated with organ involvement in SSc. CONCLUSIONS More than half of patients with SSc, specifically with ACA, showed SG involvement. SG fibrosis was more prominent in SSc than in idiopathic Sicca syndrome and was associated with subjective Sicca symptoms. However, hyperechoic bands within the SGs are not features that can differentiate between SSc and pSS.
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DEMİRAL U, KARAPINAR G, EKMEKCİOĞLU H, ÜNÜR M. Diagnostic Value of Minor Salivary Gland Biopsy: A Retrospective Study. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2020. [DOI: 10.33808/clinexphealthsci.573390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Law ST, Jafarzadeh SR, Govender P, Sun X, Sanchorawala V, Kissin EY. Comparison of Ultrasound Features of Major Salivary Glands in Sarcoidosis, Amyloidosis, and Sjögren's Syndrome. Arthritis Care Res (Hoboken) 2020; 72:1466-1473. [PMID: 31309727 DOI: 10.1002/acr.24029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/09/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE While salivary gland ultrasound (SGU) has gained prominence for evaluating Sjögren's syndrome, little information exists on SGU appearance of sarcoidosis and amyloidosis, potential mimics of Sjögren's syndrome. Our goal in this study was to estimate the diagnostic accuracy of major SGU features in differentiating Sjögren's syndrome from sarcoidosis, amyloidosis, and controls. METHODS We enrolled consecutive adult ambulatory patients with a clinical diagnosis of Sjögren's syndrome fulfilling the 2016 American College of Rheumatology (ACR) classification criteria; we also enrolled patients with a clinical diagnosis of sarcoidosis or systemic immunoglobulin light chain (AL) amyloidosis, with histologic confirmation from any tissue, and rheumatology outpatients without diagnoses affecting salivary glands. Subjects underwent major SGU using the Hočevar protocol, with resulting video clips reviewed blind to clinical diagnosis. RESULTS Sjögren's syndrome SGU scores were greater than in patients from the other groups, but there were no distinguishing salivary gland features from AL amyloidosis or sarcoidosis. None of the patients in the control group scored higher than 17, a cutoff previously suggested for Sjögren's syndrome, but 27% of patients with AL amyloidosis and 19% with sarcoidosis scored higher than 17. Adding Hočevar SGU scores of ≥17 to the 2016 ACR/European League Against Rheumatism criteria in a parallel scheme increased the sensitivity for Sjögren's syndrome from 87% to 98%, while combining the 2 criteria in series increased specificity from 81% to 98%. CONCLUSION Sjögren's syndrome, sarcoidosis, and AL amyloidosis share common SGU features that can help distinguish these conditions from patients without systemic rheumatologic disease. Clinicians should carefully consider these potential mimics when interpreting salivary gland US results.
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Affiliation(s)
| | | | | | - Xianbang Sun
- Boston University School of Medicine, Boston, Massachusetts
| | - Vaishali Sanchorawala
- Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
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Ramsubeik K, Motilal S, Sanchez-Ramos L, Ramrattan LA, Kaeley GS, Singh JA. Diagnostic accuracy of salivary gland ultrasound in Sjögren's syndrome: A systematic review and meta-analysis. Ther Adv Musculoskelet Dis 2020; 12:1759720X20973560. [PMID: 33281953 PMCID: PMC7682247 DOI: 10.1177/1759720x20973560] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/25/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To systematically review the diagnostic accuracy of salivary gland ultrasound in primary Sjögren's syndrome (pSS). METHODS PubMed, Embase, CINAHL, Cochrane Central and Scopus and ClinicalTrials.gov were searched to identify diagnostic or validation studies in patients with pSS meeting the diagnostic criteria. A diagnostic test meta-analysis was performed using a bivariate model to calculate the pooled sensitivity, specificity, positive/negative likelihood ratios, and the diagnostic odds ratio. Meta-regression analyses were done for several pSS covariates. RESULTS Sixty-five studies met our criteria for the qualitative review. Fifty-four studies with a total of 6087 patients were included in the meta-analysis. Pooled sensitivity for salivary gland ultrasound was 80% [95% confidence interval (CI): 77-83%; I 2 = 78%], and specificity was 90% (95% CI: 87-92%; I 2 = 76%). The pooled positive and negative likelihood ratios were 8 (95% CI: 6.4-10) and 0.22 (95% CI: 0.19-0.25), respectively. The corresponding pooled diagnostic odds ratio (DOR) was 37 (95% CI: 28-48). Separate meta-regression models resulted in similar diagnostic estimates: (a) adjusted for mean age: sensitivity 81% (95% CI:77-84%; I 2 = 99%) and specificity 90% (95% CI: 87-93%; I2 = 99%); (b) adjusted for mean disease duration, sensitivity 79% (95% CI:72-84%; I 2 = 99%), and specificity 90% (89-94%; I 2 = 99%). The diagnostic estimates were robust to sensitivity analyses by quality criteria, pSS diagnostic criteria and ultrasound scoring systems. CONCLUSION Salivary gland ultrasound is a valuable modality for the diagnosis of Sjögren's syndrome. It is plausible that salivary gland ultrasound can be used as an important criterion for the diagnosis of pSS.
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Affiliation(s)
- Karishma Ramsubeik
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Shastri Motilal
- Department of Para Clinical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - Luis Sanchez-Ramos
- Division of Maternal and Fetal Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Laurie Ann Ramrattan
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Gurjit S. Kaeley
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Jasvinder A. Singh
- Department of Medicine, Birmingham VA Medical Center, Faculty Office Tower 805B, 510, 20th Street South, Birmingham, AL 35233, USA
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Seror R, Bowman S. Outcome Measures in Primary Sjögren's Syndrome. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:134-149. [PMID: 33091252 DOI: 10.1002/acr.24331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/19/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Raphaèle Seror
- Hôpital Bicêtre Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, and Institut National de la Santé et de la Recherche Médicale U1012, Le Kremlin Bicêtre, France
| | - Simon Bowman
- Milton Keynes University Hospital, Milton Keynes, United Kingdom, and University Hospitals Birmingham and University of Birmingham, Birmingham, United Kingdom
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Bautista-Vargas M, Vivas AJ, Tobón GJ. Minor salivary gland biopsy: Its role in the classification and prognosis of Sjögren's syndrome. Autoimmun Rev 2020; 19:102690. [PMID: 33099041 DOI: 10.1016/j.autrev.2020.102690] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 12/16/2022]
Abstract
Sjögren's syndrome (SS) is an autoimmune disorder characterized by mononuclear cell infiltration in the exocrine glands, which leads to sicca syndrome (xerostomia and xerophthalmia). The etiology of SS is unknown, but multiple environmental factors (infectious, hormonal and stress-related), as well as genetic factors, may play a role in its pathogenesis. The diagnosis of SS is complex considering its clinical and paraclinical parameters may not be very specific. The minor salivary gland biopsy (MSGB) has undoubtedly become crucial for classifying and determining the prognosis of SS. The three main different classification systems for its interpretation have been described by Chisholm and Mason, Greenspan and Daniels, and Tarpley. However, this invasive procedure has variable sensitivity and specificity as well as low reproducibility. The use of additional methods, such as skin biopsy, imaging techniques, and serum/salivary biomarkers, may be combined with current methods to develop a bioscore that could increase diagnostic performance. In this review, we summarized the main pathological findings in SS and the prognosis of patients with SS according to the biopsy results.
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Affiliation(s)
- Mario Bautista-Vargas
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia
| | - Alvaro J Vivas
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia
| | - Gabriel J Tobón
- GIRAT: Grupo de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia.
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Abstract
Primary Sjögren's syndrome (pSS) is an autoimmune disease, which involves salivary glands (SG) and extra glandular organs. Today, Sjögren's patients' diagnosis is based on classification criteria taking into account five objective tests, including histology, immunology, two ophthalmological tests, and salivary flow evaluation. To date, the challenge is to find the right imaging tool for diagnosis, follow up, and prognosis of pSS. The objective of this review is to describe as to what are these imaging modalities and particularly the place and validity of salivary glands ultrasonography (SGUS) in the diagnosis and follow-up strategy of patients with suspected pSS. Moreover, new noninvasive tools are emerging, including elastography, a new ultrasonography technique that provides an estimate of tissue elasticity, MRI, MR sialography, and 18 fluorodeoxyglucose-positron emission tomography. Although new imaging opportunities are available, SGUS should be the first-line choice in pSS because of its accessibility, feasibility over time, and sensitivity to change.
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Ecografía y elastografía en el diagnóstico de síndrome de Sjögren. Med Clin (Barc) 2020; 155:254-255. [DOI: 10.1016/j.medcli.2020.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/15/2022]
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Salivary gland ultrasound: Update. Med Clin (Barc) 2020; 156:81-87. [PMID: 32739098 DOI: 10.1016/j.medcli.2020.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 11/20/2022]
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van Nimwegen JF, Mossel E, Delli K, van Ginkel MS, Stel AJ, Kroese FGM, Spijkervet FKL, Vissink A, Arends S, Bootsma H. Incorporation of Salivary Gland Ultrasonography Into the American College of Rheumatology/European League Against Rheumatism Criteria for Primary Sjögren's Syndrome. Arthritis Care Res (Hoboken) 2020; 72:583-590. [PMID: 31254454 PMCID: PMC7155092 DOI: 10.1002/acr.24017] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/25/2019] [Indexed: 12/13/2022]
Abstract
Objective To assess whether the addition of salivary gland ultrasonography (SGUS) or replacement of current criteria items by SGUS influences the performance of the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria for primary Sjögren's syndrome. Methods Included were consecutive patients with complete data on all ACR/EULAR items (n = 243) who underwent SGUS in our primary Sjögren's syndrome expertise center. Clinical diagnosis by the treating physician was used as the gold standard. Separate analyses were performed for patients who underwent labial or parotid gland biopsies. The average score for hypoechogenic areas in 1 parotid and 1 submandibular gland was determined (range 0–3). Next, performance of the ACR/EULAR criteria was evaluated after addition of SGUS or replacement of current items by SGUS. Results Receiver operating characteristic analysis showed an optimal cutoff value of ≥1.5 for SGUS. The optimal weight for SGUS positivity was 1. Cutoff for ACR/EULAR fulfilment remained ≥4. In patients who underwent a labial gland biopsy (n = 124), the original criteria showed an area under the curve (AUC) of 0.965, sensitivity of 95.9%, and specificity of 92.2%. After the addition of SGUS, the AUC was 0.966, with a sensitivity of 97.3% and specificity of 90.2%. In patients who underwent a parotid gland biopsy (n = 198), similar results were found. Sensitivity of the criteria decreased substantially when SGUS replaced salivary gland biopsy or anti‐SSA antibodies, while performance remained equal when SGUS replaced the ocular staining score, Schirmer's test, or unstimulated whole saliva flow. Conclusion Validity of the ACR/EULAR criteria remains high after incorporation of SGUS. With SGUS, clinicians are offered a larger array of tests to evaluate fulfillment of the ACR/EULAR criteria.
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Affiliation(s)
- Jolien F van Nimwegen
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Esther Mossel
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Konstantina Delli
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Martha S van Ginkel
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Alja J Stel
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Frans G M Kroese
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Fred K L Spijkervet
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Suzanne Arends
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Hendrika Bootsma
- University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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James-Goulbourne T, Murugesan V, Kissin EY. Sonographic Features of Salivary Glands in Sjögren's Syndrome and its Mimics. Curr Rheumatol Rep 2020; 22:36. [PMID: 32562049 DOI: 10.1007/s11926-020-00914-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW For 30 years, ultrasound has been investigated as a means to evaluate salivary gland abnormalities in patients with autoimmune disease. We aim to review the test characteristics of ultrasound for diagnosing Sjögren's syndrome, the scoring systems used for this purpose, and the ultrasound similarities and differences between Sjögren's syndrome and some of its potential salivary gland mimics. RECENT FINDINGS Hypo/anechoic glandular lesions are the major ultrasound characteristic found in Sjögren's syndrome. Most studies have reported such ultrasound abnormalities to have a sensitivity and specificity in the range of 65-85% and 85-95%, respectively, as well as a positive likelihood ratio between 4 and 12. However, similar findings can also be seen in sarcoidosis, amyloidosis, IgG4-related disease, HIV, and lymphoma. A "nodal" pattern of involvement or the ultrasound artifact of "through transmission" can help distinguish some of these mimics from Sjogren's syndrome. Ultrasound can substantially influence the diagnosis of Sjögren's syndrome.
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Affiliation(s)
| | | | - Eugene Y Kissin
- Section of Rheumatology, 72 East Concord Str, Evans 501, Boston, MA, 02118, USA.
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