University of Oxford, Oxford, UK.
Boston University School of Medicine, Boston, Massachusetts.
Arthritis Care Res (Hoboken). 2020 Oct;72(10):1466-1473. doi: 10.1002/acr.24029.
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.
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.
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%.
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.
唾液腺超声（SGU）在评估干燥综合征方面已得到广泛认可，但关于干燥综合征的潜在模拟疾病，如结节病和淀粉样变性的 SGU 表现，相关信息较少。本研究旨在评估主要 SGU 特征在鉴别干燥综合征、结节病、淀粉样变性和对照组方面的诊断准确性。
我们连续纳入符合 2016 年美国风湿病学会（ACR）分类标准的临床诊断为干燥综合征的成年门诊患者；我们还纳入了临床诊断为结节病或系统性免疫球蛋白轻链（AL）淀粉样变性的患者，这些患者均经任何组织的组织学证实，并纳入了无影响唾液腺的诊断的风湿病门诊患者。所有患者均接受 Hočevar 方案下的主要 SGU 检查，检查结果的视频片段由不知临床诊断的盲法进行评估。
干燥综合征的 SGU 评分高于其他组，但从 SGUS 特征上无法与 AL 淀粉样变性或结节病区分。对照组中没有患者的评分高于 17，这是之前建议用于干燥综合征的截断值，但 27%的 AL 淀粉样变性患者和 19%的结节病患者的评分高于 17。在平行方案中，将 Hočevar SGU 评分≥17 与 2016 年 ACR/欧洲抗风湿病联盟标准相结合，可将干燥综合征的敏感性从 87%提高到 98%，而将这两个标准串联结合则可将特异性从 81%提高到 98%。
干燥综合征、结节病和 AL 淀粉样变性具有共同的 SGU 特征，有助于将这些疾病与无系统性风湿病的患者区分开来。临床医生在解释唾液腺超声结果时应仔细考虑这些潜在的模拟疾病。
