Elderly-onset primary Sjögren's syndrome focused on clinical and salivary gland ultrasonographic features

Lee, Kyung‐Ann; Choi, Won‐Ho; Kim, Jong-Sun; Lee, Sang‐Heon; Kim, Hae-Rim; Kim, Hyun‐Sook

doi:10.1016/j.jbspin.2021.105132

Cited by 16 publications

(24 citation statements)

References 33 publications

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“…However, the USFR threshold of 0.1 mL/min was chosen based on a small study that included 25 patients with pSS ( 23 ). Histopathological and SGUS studies reported age related-changes in the salivary glands, including fibrosis, atrophy, and duct dilatations ( 11 , 15 ). Conversely, young pSS patients had higher SGUS scores and more frequent enlargement of salivary glands, reflecting a severe phenotype of salivary glandular involvement.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were divided into three groups according to age at the time of diagnosis: elderly (≥65 years), middle-aged (40–64 years), and young (< 40 years) ( 15 ). The following data were collected during diagnosis: age, sex, duration of sicca symptoms, history of dry eyes/mouth, autoantibodies (antinuclear antibody, anti-SSA/Ro, and anti-SSB/La), Schirmer's test result (≤ 5 mm/5 min on at least one side is abnormal), and whole USFR, OSS, FS ( 17 ), and presence of comorbidities (including diabetes, hypertension).…”

Section: Methodsmentioning

confidence: 99%

“…Distinct clinical and serological features of early-and elderly-onset pSS have been previously reported. Although the subjective oral dryness and atrophic changes on SGUS were more frequent in elderly pSS patients, young pSS patients had higher SGUS scores and more frequent enlargement of salivary glands (14)(15)(16). Different patterns of salivary gland abnormalities according to age may affect the diagnostic performance of the classification criteria for pSS when incorporating SGUS.…”

Section: Introductionmentioning

confidence: 99%

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Impact of age on the diagnostic performance of unstimulated salivary flow rates and salivary gland ultrasound for primary Sjögren's syndrome

Lee

Kim²,

Kim³

et al. 2022

Front. Med.

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BackgroundAge-related changes and different patterns of salivary gland abnormalities according to age may affect the diagnostic performance of unstimulated salivary flow rate (USFR) and salivary gland ultrasound (SGUS) for primary Sjögren's syndrome (pSS). We aimed to evaluate the threshold and diagnostic performance of USFR and whether incorporating SGUS or replacing USFR with SGUS affects the performance of the ACR/EULAR criteria for pSS according to age.Materials and methodsThis medical chart review study included patients with suspected pSS who completed evaluations for pSS. Patients were classified based on age at pSS evaluation: elderly (≥65 years), middle-aged (40–64), and young (< 40). The USFR's optimal thresholds were evaluated using the ROC curve. The diagnostic performances of the USFR and modified ACR/EULAR criteria were compared.ResultsIn total, 239 pSS patients and 92 patients with idiopathic sicca syndrome were included. The cut-off of USFR ≤ 0.1 mL/min was irrelevant to age, demonstrating the best sensitivity (44.3–53.0%) and specificity (74.1–90.9%). SGUS had a significantly better AUC than USFR in the young (p < 0.01) and middle-aged groups (p < 0.01). The middle-aged group demonstrated better diagnostic performance of the ACR/EULAR criteria incorporating SGUS (AUC 0.957) (p < 0.01) and criteria replacing USFR with SGUS (AUC 0.957) (p < 0.001) compared to the original criteria (AUC 0.916). In the young and elderly groups, adding SGUS to the ACR/EULAR criteria or replacing USFR with SGUS did not significantly increase the AUC.ConclusionsThe thresholds of USFR ≤ 0.1 mL/min was optimal, irrespective of age. Using SGUS can improve diagnostic accuracy of ACR/EULAR criteria by supplementing the USFR, especially in middle-aged patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of age on the diagnostic performance of unstimulated salivary flow rates and salivary gland ultrasound for primary Sjögren's syndrome

Lee

Kim²,

Kim³

et al. 2022

Front. Med.

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“…SG enlargement, lymphadenopathy, purpura, renal involvement, hypergammaglobulinaemia, hypocomplementemia, presence of autoantibodies) and higher ESSDAI, 96 whereas late-onset pSS (age ⩾65 years) is characterised by less frequent autoantibody positivity, lower biological activity, higher prevalence of lung involvement and lower prevalence of arthritis. 97 Considering systemic activity, Black/African American patients exhibit the highest ESSDAI scores, followed by White, Asian and Hispanic pSS patients. 94 Importantly, the immunoserological profile influences the disease phenotype and represents the traditional basis for stratification of pSS patie nts.…”

Section: The Stratification Of Pss Patientsmentioning

confidence: 99%

Sjögren syndrome: looking forward to the future

Callegher

Giovannini

Zenz

et al. 2022

Therapeutic Advances in Musculoskeletal

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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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“…Recently, elastography has been used to detect tissue elasticity and glandular fibrosis ( 11 – 13 ); there is scarce information in elderly pSS patients in which MSG US is associated with glandular atrophy ( 14 ). There is no valid scoring system to interpret elastography in MSG, however, a four-grade score has been used, which gives an interpretation related to the main color in the area of interest.…”

Section: Introductionmentioning

confidence: 99%

A Novel Technique for the Evaluation and Interpretation of Elastography in Salivary Gland Involvement in Primary Sjögren Syndrome

et al. 2022

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Ultrasound (US) of major salivary glands (MSG) evaluates echogenicity, border features and vascularization, with elastography, it can detect tissue elasticity and glandular fibrosis, related to inflammation in Primary Sjögren’s syndrome (pSS). This study aimed to develop a novel technique by pixel analysis for evaluation and interpretation of elastography in MSG in pSS. A cross-sectional and observational multicenter study was conducted. The US of MSG performed in orthogonal planes in grayscale, Doppler, and shear-wave elastography. For elastography images of each gland were analyzed with the open-source program ImageJ to perform a pixel analysis. Statistical analysis was performed with the IBM-SPSS v25 program. Fifty-nine women with a mean age of 57.69 (23–83) years were recruited; pSS mean duration of 87 (5–275) months, and 12 healthy women without sicca symptoms as a control group with a mean age of 50.67 (42–60) years. Intragroup analysis showed p-values >0.05 between sicca symptoms, ocular/dryness tests, biopsy, US, and pixel analysis; correlation between Hocevar and pixel analysis was not found (rho < 0.1, p >0.5). MSG anatomical size was 41.7 ± 28.2 mm vs. 67.6 ± 8.8 mm (p ≤ 0.0001); unstimulated whole saliva flow rate was 0.80 ± 0.80 ml/5 min vs. 1.85 ± 1.27 ml/5 min (p = 0.016). The elastography values (absolute number of pixels) were 572.38 ± 99.21 vs. 539.69 ± 93.12 (p = 0.290). A cut-off point risk for pSS identified with less than 54% of red pixels in the global MSG mass [OR of 3.8 95% CI (1.01–15.00)]. Pixel analysis is a new tool that could lead to a better understanding of the MSG chronic inflammatory process in pSS.

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Elderly-onset primary Sjögren's syndrome focused on clinical and salivary gland ultrasonographic features

Cited by 16 publications

References 33 publications

Impact of age on the diagnostic performance of unstimulated salivary flow rates and salivary gland ultrasound for primary Sjögren's syndrome

Impact of age on the diagnostic performance of unstimulated salivary flow rates and salivary gland ultrasound for primary Sjögren's syndrome

Sjögren syndrome: looking forward to the future

A Novel Technique for the Evaluation and Interpretation of Elastography in Salivary Gland Involvement in Primary Sjögren Syndrome

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