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Comparison of the American-European Consensus Group Sjögren's syndrome classification criteria to newly proposed American College of Rheumatology criteria in a large, carefully characterised SICCA cohort
  1. Astrid Rasmussen1,
  2. John A Ice1,
  3. He Li1,2,
  4. Kiely Grundahl1,
  5. Jennifer A Kelly1,
  6. Lida Radfar3,
  7. Donald U Stone4,
  8. Kimberly S Hefner5,
  9. Juan-Manuel Anaya6,
  10. Michael Rohrer7,
  11. Rajaram Gopalakrishnan8,
  12. Glen D Houston2,
  13. David M Lewis2,
  14. James Chodosh9,
  15. John B Harley10,11,
  16. Pamela Hughes12,
  17. Jacen S Maier-Moore1,
  18. Courtney G Montgomery1,
  19. Nelson L Rhodus13,
  20. A Darise Farris1,
  21. Barbara M Segal14,
  22. Roland Jonsson15,16,
  23. Christopher J Lessard1,2,
  24. R Hal Scofield1,17,18,
  25. Kathy L Moser Sivils1
  1. 1Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
  2. 2Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  3. 3Department of Oral Diagnosis and Radiology, University of Oklahoma College of Dentistry, Oklahoma City, Oklahoma, USA
  4. 4Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  5. 5Hefner Eye Care and Optical Center, Oklahoma City, Oklahoma, USA
  6. 6Center for Autoimmune Diseases Research (CREA), Universidad del Rosario, Bogotá, Colombia
  7. 7Hard Tissue Research Laboratory, University of Minnesota School of Dentistry, Minneapolis, Minnesota, USA
  8. 8Division of Oral Pathology, Department of Developmental and Surgical Science, University of Minnesota School of Dentistry, Minneapolis, Minnesota, USA
  9. 9Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
  10. 10Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  11. 11US Department of Veterans Affairs Medical Center, Cincinnati, Ohio, USA
  12. 12Division of Oral and Maxillofacial Surgery, Department of Developmental and Surgical Science, University of Minnesota School of Dentistry, Minneapolis, Minnesota, USA
  13. 13Department of Oral Surgery, University of Minnesota School of Dentistry, Minneapolis, Minnesota, USA
  14. 14Hennepin County Medical Center, Minneapolis, Minnesota, USA
  15. 15Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
  16. 16Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
  17. 17Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  18. 18Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA
  1. Correspondence to Dr Kathy L Moser Sivils, Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, 825 N.E. 13th Street, MS57, Oklahoma City, OK 73104, USA; sivilsk{at}omrf.org

Abstract

Objective To compare the performance of the American–European Consensus Group (AECG) and the newly proposed American College of Rheumatology (ACR) classification criteria for Sjögren's Syndrome (SS) in a well-characterised sicca cohort, given ongoing efforts to resolve discrepancies and weaknesses in the systems.

Methods In a multidisciplinary clinic for the evaluation of sicca, we assessed features of salivary and lacrimal gland dysfunction and autoimmunity as defined by tests of both AECG and ACR criteria in 646 participants. Global gene expression profiles were compared in a subset of 180 participants.

Results Application of the AECG and ACR criteria resulted in classification of 279 and 268 participants with SS, respectively. Both criteria were met by 244 participants (81%). In 26 of the 35 AECG+/ACR participants, the minor salivary gland biopsy focal score was ≥1 (74%), while nine had positive anti-Ro/La (26%). There were 24 AECG−/ACR+ who met ACR criteria mainly due to differences in the scoring of corneal staining. All patients with SS, regardless of classification, had similar gene expression profiles, which were distinct from the healthy controls.

Conclusions The two sets of classification criteria yield concordant results in the majority of cases and gene expression profiling suggests that patients meeting either set of criteria are more similar to other SS participants than to healthy controls. Thus, there is no clear evidence for increased value of the new ACR criteria over the old AECG criteria from the clinical or biological perspective. It is our contention, supported by this report, that improvements in diagnostic acumen will require a more fundamental understanding of the pathogenic mechanisms than is at present available.

  • Sjögren's syndrome
  • Classification
  • Diagnosis

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