Abstract
BackgroundThe objective was to evaluate concordance between 2002 American-European Consensus Group (AECG) and 2016 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for primary Sjögren’s syndrome (pSS) and to assess how salivary gland ultrasonography (SGUS) might improve the classification of patients.MethodsPatients with suspected pSS underwent a standardised evaluation, including SGUS, at inclusion into the single-centre Brittany DIApSS cohort. Agreement between the two criteria sets was assessed using Cohen’s κ coefficient. Characteristics of discordantly categorised patients were detailed.ResultsWe prospectively included 290 patients between 2006 and 2016, among whom 125 (43%) met ACR/EULAR criteria and 114 (39%) also met AECG criteria; thus, 11 (4%) patients fulfilled only ACR/EULAR, no patients AECG only, and 165 (57%) patients neither criteria set. Concordance was excellent (κ = 0.92). Compared to patients fulfilling both criteria sets, the 11 patients fulfilling only ACR/EULAR criteria had similar age and symptom duration but lower frequencies of xerophthalmia and xerostomia (p < 0.01 for each) and salivary gland dysfunction (p < 0.01); most had systemic involvement (91%), including three (27%) with no sicca symptoms; 91% had abnormal salivary gland biopsy and 46% anti-Sjögren's-syndrome-related antigen A (anti-SSA); 64% were diagnosed with pSS by the physician. SGUS was abnormal in 12% of the 165 patients fulfilling no criteria set. Including SGUS among the ACR/EULAR criteria increased sensitivity from 87.4% to 91.1% when physician diagnosis was the reference standard.ConclusionsAgreement between AECG and ACR/EULAR criteria sets is excellent. ACR/EULAR criteria are slightly more sensitive and classified some patients without sicca symptoms as having pSS. Including SGUS in the ACR/EULAR criteria may further improve their sensitivity.
Highlights
The objective was to evaluate concordance between 2002 American-European Consensus Group (AECG) and 2016 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for primary Sjögren’s syndrome and to assess how salivary gland ultrasonography (SGUS) might improve the classification of patients
The set of subjective and objective criteria issued by the American-European Consensus Group (AECG) in 2002 has been the main classification system used in clinical studies during the last decade [9]
In 2012, the Sjögren’s International Collaborative Clinical Alliance (SICCA) [10] issued new classification criteria, which were first endorsed by the American College of Rheumatology (ACR) [11]
Summary
The objective was to evaluate concordance between 2002 American-European Consensus Group (AECG) and 2016 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for primary Sjögren’s syndrome (pSS) and to assess how salivary gland ultrasonography (SGUS) might improve the classification of patients. New consensual classification criteria for pSS combining features of the earlier ACR and AECG criteria sets were developed and validated jointly by ACR and EULAR committees [15, 16]. This ACR/ EULAR criteria set excludes the most common differential diagnoses. It differs substantially from the earlier AECG criteria (Table 1) in that it considers systemic manifestations (defined as a EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI) ≥ 1) [17, 18], and sicca symptoms, as entry criteria. A weighted score ≥ 4 classifies the patient as having pSS
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