Value of combined application of the OMERACT scoring system and shear wave elastography for primary Sjögren's syndrome.

OBJECTIVE

To assess diagnostic efficiency when introduce the OMERACT scoring system and shear wave elastography (SWE) into ACR/EULAR criteria for primary Sjögren's syndrome (pSS).

METHODS

One hundred fifteen patients with suspected pSS were enrolled, including 71 pSS and 44 non-pSS patients. Salivary gland ultrasonography (SGUS) was performed on parotid glands (PG) and submandibular glands to obtain the OMERACT scores (range 0-3 for single gland) and SWE values, and diagnostic efficiency was evaluated.

RESULTS

Receiver operating characteristic curves showed that the total OMERACT score of four glands and PG SWE had optimal predictive value for pSS (area under the curve (AUC) = 0.848, 0.852), with cutoff values of 8 and 6.8 kPa, sensitivities of 76.1% and 80.3%, specificities of 86.4% and 81.8%. In addition, the total OMERACT score of 10 and PG SWE value of 9.1 kPa were chosen to get high specificities (97.7% for both). By combining SGUS with current items except labial salivary gland biopsy (LSGB), a modified model was proposed. The modified model significantly distinguished pSS patients form non-pSS patients (AUC = 0.963), provided a sensitivity of 97.2% and specificity of 84.1%. It showed an excellent agreement with ACR/EULAR criteria (Kappa = 0.831, p < 0.001), and no statistical difference in diagnostic performance was observed (p = 0.180).

CONCLUSION

An ultrasound-integrated diagnosis model with comparable diagnostic efficiency was established by introducing the OMERACT scoring system and SWE. SGUS is a viable non-invasive adjunct for pSS and has potential to reduce reliance on LSGB for patients with negative anti-SSA/Ro. Key Points • Introducing the OMERACT scoring system and SWE into ACR/EULAR criteria had no negative effect on efficiency. • Inclusion of SGUS in the classification criteria may help reduce invasive LSGB.