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Disease activity and damage in patients with primary Sjogren’s syndrome: Prognostic value of salivary gland ultrasonography


Autoři: Vera Milic aff001;  Jelena Colic aff001;  Andja Cirkovic aff002;  Svetlana Stanojlovic aff002;  Nemanja Damjanov aff001
Působiště autorů: Institute of Rheumatology, Belgrade, Serbia aff001;  Faculty of Medicine, University of Belgrade, Belgrade, Serbia aff002;  Department for Medical Statistics and Informatics Faculty of Medicine, Belgrade, Serbia aff003;  Clinic for Eye Diseases, Clinical Centre of Serbia, Belgrade, Serbia aff004
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0226498

Souhrn

Objectives

To assess the association between salivary ultrasonography (sUS) findings and disease activity and damage in patients with primary Sjogren’s syndrome (pSS). We investigated the potential prognostic role of sUS as a tool in the assessment of disease activity.

Methods

In 303 pSS patients, disease activity was assessed by the European League Against Rheumatism (EULAR) Sjogren’s Syndrome Disease Activity Index (ESSDAI), the EULAR Sjogren’s Syndrome Patient Reported Index (ESSPRI), the Sjogren’s Syndrome Disease Activity Index (SSDAI) and the Sjogren’s Syndrome Disease Damage Index (SSDDI). The sUS parenchymal inhomogeneity (de Vita scoring system) was assessed in 303 pSS patients and 111 heathy controls. A receiver operating characteristic (ROC) curve was used to determine the cut-off value of the pathological sUS score. Logistic regression analysis was performed to assess risk factors for moderate and high disease activity.

Results

A pathological sUS score ≥ 2 was recorded in 271 (89.7%) patients and 8 (8.6%) healthy controls. Patients with moderate and high ESSDAI and SSDAI scores had significantly higher US activity in comparison to that of pSS patients with low disease activity (p = 0.006; p = 0.01, respectively). Additionally, pSS patients with moderate and high SSDDI scores had higher US activity (p = 0.031). Pathological sUS correlated with the glandular domain within the ESSDAI and SSDDI (p<0.001). The patients with a severe US score (5–6) had a 3.5 times greater chance of having moderate or high disease activity. The specificity of the severe de Vita sUS score for ESSDAI and SSDAI was 85.1% and 85.2%, respectively. In contrast, the sensitivity of a severe de Vita sUS score for ESSDAI was low, at 29.2%, while the sensitivity for the SSDAI was higher, 42.3%. In the analysis of disease activity, a de Vita score ≥ 5 could be used as a risk factor for moderate and high ESSDAI (p = 0.042) and SSDAI (p = 0.006).

Conclusions

Pathological salivary gland ultrasonography is associated with high disease activity and damage in pSS. Consequently, sUS abnormalities might be surrogate items for glandular domains in the assessment of disease activity and damage. Thus, ultrasonography of the salivary gland combined with clinical and serological markers might be part of the next prognostic and therapeutic algorithm in the near future.

Klíčová slova:

Biopsy – Lymphomas – Methotrexate – Ophthalmology – Salivary glands – Serology – Ultrasound imaging – Sjogren syndrome


Zdroje

1. Jonsson R, Bowman SJ, Gordon TP. Sjogrenꞌ s syndrome. Ch.78 in: Koopman Wj, Moreland LW, eds. Arthritis and allied conditions 15th edition. Lippincott.Williams and Wilkins; 2005:1681–1705.

2. Brito-Zeron P, Ramos-Casals M, Bove A, Sentis J, Font J. Predicting adverse outcomes in primary Sjogren's syndrome: identification of prognostic factors. Rheumatology 2007;46:1359–1362. doi: 10.1093/rheumatology/kem079 17569749

3. Liang Y, Yang Z, Qin B, Zhong R. Primary Sjogren's syndrome and malignancy risk: a systematic review and meta-analysis. Ann Rheum Dis 2014;73:1151–1156. doi: 10.1136/annrheumdis-2013-203305 23687261

4. Theander E, Vasaitis L, Baecklund E, Nordmark G, Warfvinge G, Liedholm R, et al. Lymphoid organisation in labial salivary gland biopsies is a possible predictor for the development of malignant lymphoma in primary Sjogren's syndrome. Ann Rheum Dis 2011;70:1363–1368. doi: 10.1136/ard.2010.144782 21715359

5. Bowman SJ, Everett CC, O'Dwyer JL, Emery P, Pitzalis C, Ng WF, et al. Randomized controlled trial of rituximab and cost-effectiveness analysis in treating fatigue and oral dryness in primary Sjogren's syndrome. Arhtritis Rheum 2017;69:1440–1450.

6. Mariette X, Seror R, Quartuccio L, Baron G, Salvin S, Fabris M, et al. Efficacy and safety belimumab in primary Sjogrenʹs syndrome. Results of the BELISS open-label phase II study. Ann Rheum Dis 2015;74:526–531. doi: 10.1136/annrheumdis-2013-203991 24347569

7. Mariette X, Ravaud P, Steinfeld S, Baron G, Goetz J, Hachulla E, et al. Inefficacy of infliximab in primary Sjogrenꞌ s syndrome: results of the randomized, controlled trial of remicade in primary Sjogrenꞌs syndrome (TRIPSS). Arthritis Rheum 2004;50:1270–1276. doi: 10.1002/art.20146 15077311

8. Seror R, Ravaud P, Bowman SJ, Baron G, Tzioufas A, Theander E, et al. EULAR Sjogren's syndrome disease activity index: development of a consensus systemic disease activity index for primary Sjogrenꞌs syndrome. Ann Rheum Dis 2010; 69:1103–1109. doi: 10.1136/ard.2009.110619 19561361

9. Seror R, Ravaud P, Mariette X, Bootsma H, Theander E, Hansen A, et al. EULAR Sjogren's syndrome patient reported index (ESSPRI): development of a consensus patient index for primary Sjogren's syndrome. Ann Rheum Dis 2011;70:968–972. doi: 10.1136/ard.2010.143743 21345815

10. Vitali C, Palombi G, Baldini C, Benucci M, Bombardieri S, Covelli M, et al. Sjogren's syndrome disease damage index and disease activity index: scoring system for the assessment of disease damage and disease activity in Sjogren's syndrome, derived from an analysis of a cohort of Italian patients. Arthritis Rheum 2007;56:2223–2231. doi: 10.1002/art.22658 17599741

11. Milic V, Petrovic R, Boricic I, Radunovic G, Marinkovic-Eric J, Jeremic P, et al. Ultrasonography of major salivary glands could be an alternative tool to sialoscintigraphy in the American-European classification criteria for primary Sjogren's syndrome. Rheumatology 2012; 51:1081–1085. doi: 10.1093/rheumatology/ker431 22302061

12. van Nimwegen JF, Mossel E, Delli K, van Ginkel MS, Stel AJ, Kroese FMG, et al. Incorporation of salivary gland ultrasonography into the ACR-EULAR criteria for primary Sjogrenꞌs syndrome. Arthritis Care Res (Hoboken) 2019; 29. doi: 10.1002/acr.24017 31254454

13. Takagi Y, Nakamura H, Sumi M, Shimizu T, Hirai Y, Horai Y et al. Combined classification system based on ACR/EULAR and ultrasonographic scores for improving the diagnosis of Sjogrenꞌs syndrome. PLoS One 2018; 13 (4):e0195113. doi: 10.1371/journal.pone.0195113 29614092

14. Lee KA, Lee SH, Kim HR. Diagnostic and predictive evaluation using salivary gland ultrasonography in primary Sjogrenꞌs syndrome. Clin Exp Rheumatol 2018; Suppl 112(3):165–172.

15. Fidelix T, Czapkowski A, Azjen S, Andriolo A, Trevisani VFM. Salivary gland ultrasonography as a predictor of clinical activity in Sjogrenꞌs syndrome. PloS One 2017; 12(8):e0182287. doi: 10.1371/journal.pone.0182287 28783737

16. Theander E, Mandl T. Primary Sjogren's syndrome: diagnostic and prognostic value of salivary gland ultrasonography using a simplified scoring system. Arthritis Res Ther. 2014;66:1102–1107.

17. Jousse-Joulin S, Devauchelle-Pensec V, Cornec D, Marhadour T, Bressollette L, Gestin S, et al. Brief report: ultrasonographic assessment of salivary gland response to rituximab in primary Sjogren's syndrome. Arthritis Rheumatol 2015;67:1623–1628. doi: 10.1002/art.39088 25708147

18. Fisher BA, Everett CC, Rout J, OꞌDwyer JL, Emery P, Pitzalis C et al. Effect of rituximab on a salivary gland ultrasound score in primary Sjogrenꞌs syndrome: results of the TRACTISS randomized double-blind multicenter substudy. Ann Rheum Dis 2018;77:412–416. doi: 10.1136/annrheumdis-2017-212268 29275334

19. Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE et al. Classification criteria for Sjogren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis 2002;61:554–558. doi: 10.1136/ard.61.6.554 12006334

20. De Vita S, Lorenzon G, Rossi G, Sabella M, Fossaluzza V. Salivary gland echography in primary and secondary Sjogren's syndrome. Clin Exp Rheumatol 1992;10:351–356. 1395220

21. Coiffier G, Martel A, Albert JD, Lescoat A, Blunzen A, Perdriger A, de et al. Ultrasonographic damages of major salivary glands are associated with cryoglobulinemic vasculitis and lymphoma in primary Sjogrenꞌ s syndrome: are the ultrasonographic features of the salivary glands new prognostic markers in Sjogrenꞌs syndrome. Ann Rheum Dis 2019; Aug 16.pii:annrheumdis 2019–21622. doi: 10.1136/annrheumdis-2019-216122 31420324

22. Zabotti A, Zandonella Callegher S, Gandolfo S, Valent F, Giovannini I, Cavallaro E et al. Hyperechoic bands detected by salivary gland ultrasonography are related to salivary impairment in established Sjogrenꞌ s syndrome. Clin Exp Rheumatol 2019;37 Suppl 118 (3):146–152. 31365337

23. Inanc N, Sahinkaya Y, Mumcu G, Ture Ozdemir F, Paksoy A, Erturk Z et al. Evaluation of salivary gland ultrasonography in primary Sjogrenꞌ s syndrome: does it reflect clinical activity and outcome of the disease. Clin Exp Rheumatol 2019; 37 Suppl 118 (3):140–145. 31287407

24. Milic VD, Petrovic RR, Boricic I, Radunovic GL, Pejnovic NN, Soldatovic I, et al. Major salivary gland sonography in Sjogren's syndrome: diagnostic value of a novel ultrasonography score (0–12) for parenchymal inhomogeneity. Scan J Rheumatol 2010;39:1891–1898.

25. Martel A, Coiffier G, Bleuyen A, Goasguen J, de Bandt M, Delignz C, et al. What is the best salivary gland ultrasonography scoring system methods for the diagnosis of primary or secondary Sjogrenꞌ s syndrome? Joint Bone Spine 2019;86:211–217. doi: 10.1016/j.jbspin.2018.06.014 30053612

26. Baldini C, Luciano N, Tarantini G, Pascale R, Sernissi F, Mosca M, et al. Salivary gland ultrasonography: a highly specific tool for the early diagnosis of primary Sjogren's syndrome. Arthritis Res Ther 2015;17:146. doi: 10.1186/s13075-015-0657-7 26022533

27. Ramos-Casals M, Font J. Primary Sjogren's syndrome: current and emergent aetiopathogenic concepts. Rheumatology2005;44:1354–1367. doi: 10.1093/rheumatology/keh714 15956090

28. Jousse-Joulin S, Milic V, Jonsson M, Plagou A, Theander E, Luciano N, et al. Is salivary gland ultrasonography a useful tool in Sjogren's syndrome? A systematic review. Rheumatology 2016;55:789–800. doi: 10.1093/rheumatology/kev385 26667216

29. Borchers AT, Naguwa SM, Keen CL, Gershwin ME. Immunopathogenesis of Sjogren's syndrome. Clin Rev Allergy Immunol. 2003;25:89–104. doi: 10.1385/CRIAI:25:1:89 12794264

30. Kimura-Hayama E, Criales-Vera S, Azpeitia-Espinoza L, Pacheco-Molina C, Reyes E, Lima G, et al. Elastrographic ultrasound: an additional image tool in Sjogrenꞌs syndrome. International Journal of Rheumatic Diseases 2018;21:1293–1300. doi: 10.1111/1756-185X.13292 29624878

31. Brito-Zeron P, Kostov B, Solans R, Fraile G, Suarez-Cuervo C, Casanovas, et al. Systemic activity and mortality in primary Sjogrenꞌ s syndrome: predicting survival using the EULAR-SS Disease Activity Index in 1045 patients. Ann Rheum Dis 2016;75:348–355. doi: 10.1136/annrheumdis-2014-206418 25433020

32. Ramos-Casals M, Brito-Zeron P, Solans R, Camps MT, Casanovas A, Sopena B, et al. Systemic-involvement in primary Sjogren's syndrome evaluated by the EULAR-SS disease activity index: analysis of 921 Spanish patients (GEAS-SS Registry). Rheumatology 2014;53:321–331. doi: 10.1093/rheumatology/ket349 24162151

33. Ramos-Casals M, Solans R, Rosas J, Camps MT, Gil A, Del Pino-Montes J, et al. Primary Sjogren's syndrome in Spain: clinical and immunologic expression in 1010 patients. Medicine (Baltimore) 2008; 87:210–219.


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