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Hernández-Molina G, Nuñez-Alvarez C, Avila-Casado C, Llorente L, Hernández-Hernández C, Calderillo ML, Marroquín V, Recillas-Gispert C, Romero-Díaz J, Sánchez-Guerrero J. Usefulness of IgA Anti-α-fodrin Antibodies in Combination with Rheumatoid Factor and/or Antinuclear Antibodies as Substitute Immunological Criterion in Sjögren Syndrome with Negative Anti-SSA/SSB Antibodies. J Rheumatol 2016; 43:1852-1857. [PMID: 27481899 DOI: 10.3899/jrheum.151315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We aimed to evaluate the usefulness of anti-α-fodrin antibodies (AFA) in combination with rheumatoid factor (RF) and/or antinuclear antibodies (ANA) as an alternative immunological criterion for Sjögren syndrome (SS) among patients with negative anti-Ro/La serology. METHODS The study included 350 patients (100 with rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis, and 50 with primary SS) randomly selected and assessed for SS. All patients were tested for ANA, RF, anti-SSA/SSB, and AFA antibodies. SS diagnosis was made on a clinical basis by 2 rheumatologists based on the 6-item screening questionnaire, Schirmer-I test, nonstimulated whole salivary flow rate, fluorescein staining test, autoantibodies, lip biopsy, and medical chart review. Non-SS was defined as lack of clinical diagnosis and not fulfilling the American-European Consensus Group classification criteria and the American College of Rheumatology (ACR) criteria. The ACR criteria were applied substituting the immunological criteria as follows: (1) RF plus ANA > 1:320, (2) RF plus AFA, (3) ANA > 1:320 plus AFA, (4) RF alone, and (5) 2 positive tests out of RF, ANA > 1:320, or AFA. We estimated the sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio positivity with 95% CI for each criterion. RESULTS There were 236 patients (67%) who tested negative for anti-SSA/SSB antibodies, of whom 65 (27.5%) were clinically diagnosed as SS, and 149 (63%) with non-SS. RF + AFA and ANA + AFA performed similarly to RF + ANA > 1:320. The model 2 out of 3 of RF, ANA, or AFA improved the sensitivity from 56.9% to 70.7%, although the specificity decreased. CONCLUSION The combination AFA + RF, AFA + ANA > 1:320, or at least 2 out of 3, performed well as a proxy immunological test for patients with SS and negative Ro/La serology.
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Affiliation(s)
- Gabriela Hernández-Molina
- From the Department of Immunology and Rheumatology, the Dental Service, and the Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Department of Pathology, University Health Network, Toronto General Hospital, and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.G. Hernández-Molina, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Nuñez-Alvarez, PhD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Avila-Casado, PhD, Department of Pathology, University Health Network, Toronto General Hospital, University of Toronto; L. Llorente, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Hernández-Hernández, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; M.L. Calderillo, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; V. Marroquín, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Recillas-Gispert, MD, Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Romero-Díaz, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MS, Mount Sinai Hospital and University Health Network, University of Toronto
| | - Carlos Nuñez-Alvarez
- From the Department of Immunology and Rheumatology, the Dental Service, and the Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Department of Pathology, University Health Network, Toronto General Hospital, and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.G. Hernández-Molina, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Nuñez-Alvarez, PhD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Avila-Casado, PhD, Department of Pathology, University Health Network, Toronto General Hospital, University of Toronto; L. Llorente, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Hernández-Hernández, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; M.L. Calderillo, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; V. Marroquín, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Recillas-Gispert, MD, Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Romero-Díaz, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MS, Mount Sinai Hospital and University Health Network, University of Toronto
| | - Carmen Avila-Casado
- From the Department of Immunology and Rheumatology, the Dental Service, and the Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Department of Pathology, University Health Network, Toronto General Hospital, and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.G. Hernández-Molina, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Nuñez-Alvarez, PhD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Avila-Casado, PhD, Department of Pathology, University Health Network, Toronto General Hospital, University of Toronto; L. Llorente, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Hernández-Hernández, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; M.L. Calderillo, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; V. Marroquín, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Recillas-Gispert, MD, Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Romero-Díaz, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MS, Mount Sinai Hospital and University Health Network, University of Toronto
| | - Luis Llorente
- From the Department of Immunology and Rheumatology, the Dental Service, and the Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Department of Pathology, University Health Network, Toronto General Hospital, and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.G. Hernández-Molina, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Nuñez-Alvarez, PhD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Avila-Casado, PhD, Department of Pathology, University Health Network, Toronto General Hospital, University of Toronto; L. Llorente, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Hernández-Hernández, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; M.L. Calderillo, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; V. Marroquín, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Recillas-Gispert, MD, Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Romero-Díaz, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MS, Mount Sinai Hospital and University Health Network, University of Toronto
| | - Carlos Hernández-Hernández
- From the Department of Immunology and Rheumatology, the Dental Service, and the Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Department of Pathology, University Health Network, Toronto General Hospital, and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.G. Hernández-Molina, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Nuñez-Alvarez, PhD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Avila-Casado, PhD, Department of Pathology, University Health Network, Toronto General Hospital, University of Toronto; L. Llorente, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Hernández-Hernández, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; M.L. Calderillo, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; V. Marroquín, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Recillas-Gispert, MD, Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Romero-Díaz, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MS, Mount Sinai Hospital and University Health Network, University of Toronto
| | - María Luisa Calderillo
- From the Department of Immunology and Rheumatology, the Dental Service, and the Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Department of Pathology, University Health Network, Toronto General Hospital, and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.G. Hernández-Molina, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Nuñez-Alvarez, PhD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Avila-Casado, PhD, Department of Pathology, University Health Network, Toronto General Hospital, University of Toronto; L. Llorente, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Hernández-Hernández, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; M.L. Calderillo, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; V. Marroquín, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Recillas-Gispert, MD, Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Romero-Díaz, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MS, Mount Sinai Hospital and University Health Network, University of Toronto
| | - Verónica Marroquín
- From the Department of Immunology and Rheumatology, the Dental Service, and the Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Department of Pathology, University Health Network, Toronto General Hospital, and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.G. Hernández-Molina, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Nuñez-Alvarez, PhD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Avila-Casado, PhD, Department of Pathology, University Health Network, Toronto General Hospital, University of Toronto; L. Llorente, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Hernández-Hernández, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; M.L. Calderillo, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; V. Marroquín, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Recillas-Gispert, MD, Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Romero-Díaz, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MS, Mount Sinai Hospital and University Health Network, University of Toronto
| | - Claudia Recillas-Gispert
- From the Department of Immunology and Rheumatology, the Dental Service, and the Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Department of Pathology, University Health Network, Toronto General Hospital, and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.G. Hernández-Molina, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Nuñez-Alvarez, PhD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Avila-Casado, PhD, Department of Pathology, University Health Network, Toronto General Hospital, University of Toronto; L. Llorente, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Hernández-Hernández, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; M.L. Calderillo, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; V. Marroquín, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Recillas-Gispert, MD, Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Romero-Díaz, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MS, Mount Sinai Hospital and University Health Network, University of Toronto
| | - Juanita Romero-Díaz
- From the Department of Immunology and Rheumatology, the Dental Service, and the Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Department of Pathology, University Health Network, Toronto General Hospital, and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.G. Hernández-Molina, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Nuñez-Alvarez, PhD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Avila-Casado, PhD, Department of Pathology, University Health Network, Toronto General Hospital, University of Toronto; L. Llorente, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Hernández-Hernández, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; M.L. Calderillo, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; V. Marroquín, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Recillas-Gispert, MD, Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Romero-Díaz, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MS, Mount Sinai Hospital and University Health Network, University of Toronto
| | - Jorge Sánchez-Guerrero
- From the Department of Immunology and Rheumatology, the Dental Service, and the Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Department of Pathology, University Health Network, Toronto General Hospital, and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.G. Hernández-Molina, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Nuñez-Alvarez, PhD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Avila-Casado, PhD, Department of Pathology, University Health Network, Toronto General Hospital, University of Toronto; L. Llorente, MD, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Hernández-Hernández, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; M.L. Calderillo, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; V. Marroquín, MD, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; C. Recillas-Gispert, MD, Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Romero-Díaz, MS, Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; J. Sánchez-Guerrero, MS, Mount Sinai Hospital and University Health Network, University of Toronto.
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Chen J, Zhao X, Liu H, Zhou S, Yang Y, Li S, Xianyu Z, Han Y, Shen G, Li J, Ye C, Sun W, Dong L. A Point-Scoring System for the Clinical Diagnosis of Sjögren's Syndrome Based on Quantified SPECT Imaging of Salivary Gland. PLoS One 2016; 11:e0155666. [PMID: 27195488 PMCID: PMC4873230 DOI: 10.1371/journal.pone.0155666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/01/2016] [Indexed: 11/18/2022] Open
Abstract
Objective To establish a point-scoring diagnostic system for Sjögren's syndrome (SS) based on quantified SPECT imaging of salivary gland, and evaluate its feasibility and performance compared with 2002 AECG criteria and 2012 ACR criteria. Methods 213 patients with suspected SS enrolled in this study. The related clinical data of all patients were collected. All patients were evaluated and grouped on a clinical basis and posttreatment follow-up by rheumatology specialists as the unified standard (SS group with 149 cases and nSS group with 64 cases). From SPECT imaging of salivary gland, Tmax, UImax, Ts and EFs were derived for bilateral parotid and submandibular glands, and compared between the groups. A point-scoring diagnostic system for SS was established based on the quantified SPECT imaging of salivary gland. We estimated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for the new diagnostic system, compared with 2002 AECG criteria and 2012 ACR criteria. Results When 7.0 was used as the cut-off point, the sensitivity, specificity, PPV, NPV and accuracy for the new point-scoring system in diagnosing SS were 89.93% (134/149), 93.75% (60/64), 97.10% (134/138), 80.00% (60/75) and 91.08% (194/213), respectively. The new point-scoring diagnostic system based on quantified SPECT imaging of salivary gland keeps the specificity comparatively to 2002 AECG criteria and 2012 ACR criteria, but improves the sensitivity significantly (P<0.01). Conclusion The new point-scoring diagnostic system for SS based on quantified SPECT imaging of salivary gland may be superior to 2002 AECG criteria and 2012 ACR criteria, with higher sensitivity and similar specificity in the diagnosis of SS. Additionally, it also has good feasibility in the clinical settings.
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Affiliation(s)
- Jing Chen
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Xia Zhao
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Haixia Liu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Sheng Zhou
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Yunqiang Yang
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Shouxin Li
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Zhiqun Xianyu
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Yunfeng Han
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Guifen Shen
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Jinming Li
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Cong Ye
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Wei Sun
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
- * E-mail: (LD); (WS)
| | - Lingli Dong
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
- * E-mail: (LD); (WS)
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