Diagnostic accuracy of salivary gland ultrasonography with different scoring systems in Sjögren’s syndrome: a systematic review and meta-analysis

Background Sjogren’s syndrome (SS) is a chronic autoimmune epithelitis characterized by disruption of epithelial cells, ensuing lymphoplasmocytic infiltration of exocrine glands, and subsequent dryness of the mouth and eyes. Individuals with SS are more likely to have the thyroid disease. However, this association remains controversial. This meta-analysis aimed to evaluate the risk of thyroid disease in patients with SS. Methods We performed this systematic review by searching both English and Chinese literature databases. Random- or fixed-effects models were used to summarize the association between thyroid disease and SS. The results were subjected to meta-analysis with odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Results The eight articles in this meta-analysis included 988 SS cases and 2,884 controls. Overall, the risk of thyroid disease in patients with SS was significantly increased compared with controls (OR, 3.29; 95% CI [2.08–5.21]). The risk of autoimmune thyroid disease (AITD) and non-AITD were also higher in patients with SS than in controls (OR, 3.48; 95% CI [1.59–7.63]; and OR, 2.90; 95% CI [1.51–5.57], respectively). Conclusions To the best of our knowledge, this systematic review is the first to demonstrate that the risk of thyroid disease was increased in SS compared to controls, suggesting that SS patients should be screened for thyroid disease.

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Salivary Gland Ultrasonography in Sjögren's Syndrome: A European Multicenter Reliability Exercise for the HarmonicSS Project

Frontiers in Medicine ◽

10.3389/fmed.2020.581248 ◽

2020 ◽

Vol 7 ◽

Author(s):

Alen Zabotti ◽

Sara Zandonella Callegher ◽

Annarita Tullio ◽

Arso Vukicevic ◽

Alojzija Hocevar ◽

...

Keyword(s):

Salivary Gland ◽

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Scoring Systems ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

Rater Reliability ◽

Significant Difference ◽

Different Levels ◽

Sjögren‘S Syndrome

Objectives: Salivary gland ultrasonography (SGUS) is increasingly applied for the management of primary Sjögren's syndrome (pSS). This study aims to: (i) compare the reliability between two SGUS scores; (ii) test the reliability among sonographers with different levels of experience.Methods: In the reliability exercise, two four-grade semi-quantitative SGUS scoring systems, namely De Vita et al. and OMERACT, were tested. The sonographers involved in work-package 7 of the HarmonicSS project from nine countries in Europe were invited to participate. Different levels of sonographers were identified on the basis of their SGUS experience and of the knowledge of the tested scores. A dedicated atlas was used as support for SGUS scoring.Results: Twenty sonographers participated in the two rounds of the reliability exercise. The intra-rater reliability for both scores was almost perfect, with a Light's kappa of 0.86 for the De Vita et al. score and 0.87 for the OMERACT score. The inter-rater reliability for the De Vita et al. and the OMERACT score was substantial with Light's Kappa of 0.75 and 0.77, respectively. Furthermore, no significant difference was noticed among sonographers with different levels of experience.Conclusion: The two tested SGUS scores are reliable for the evaluation of major salivary glands in pSS, and even less-expert sonographers could be reliable if adequately instructed.

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Is salivary gland ultrasonography a useful tool in Sjögren’s syndrome? A systematic review

Rheumatology ◽

10.1093/rheumatology/kev385 ◽

2015 ◽

Vol 55 (5) ◽

pp. 789-800 ◽

Cited By ~ 64

Author(s):

Sandrine Jousse-Joulin ◽

Vera Milic ◽

Malin V. Jonsson ◽

Athena Plagou ◽

Elke Theander ◽

...

Keyword(s):

Systematic Review ◽

Salivary Gland ◽

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

Sjögren‘S Syndrome

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The Effectiveness and Safety of Iguratimod in Primary Sjögren's Syndrome: A Systematic Review and Meta-Analysis

10.37766/inplasy2020.9.0060 ◽

2020 ◽

Author(s):

Jincheng Pu ◽

Xuan Wang ◽

Tongyangzi Zhang ◽

Ronglin Gao ◽

Shengnan Pan ◽

...

Keyword(s):

Systematic Review ◽

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Meta Analysis ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

Primary Sjögren’S Syndrome ◽

Primary Sjogren’S Syndrome ◽

Primary Sjögren's Syndrome ◽

Sjögren‘S Syndrome

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FRI0324 Immunosuppression for primary sjogren’s syndrome: a systematic review and meta-analysis

10.1136/annrheumdis-2018-eular.3008 ◽

2018 ◽

Author(s):

L. Chu ◽

K. Cui ◽

J. Pope

Keyword(s):

Systematic Review ◽

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Meta Analysis ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

Primary Sjögren’S Syndrome ◽

Primary Sjogren’S Syndrome ◽

Primary Sjögren's Syndrome ◽

Sjögren‘S Syndrome

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Neurological adverse events related to lip biopsy in patients suspicious for Sjögren’s syndrome: a systematic review and prevalence meta-analysis

Rheumatology ◽

10.1093/rheumatology/ket485 ◽

2014 ◽

Vol 53 (7) ◽

pp. 1208-1214 ◽

Cited By ~ 5

Author(s):

Pablo Varela Centelles ◽

Mariña Sánchez-Sánchez ◽

Julián Costa-Bouzas ◽

Juan Manuel Seoane-Romero ◽

Juan Seoane ◽

...

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Meta Analysis ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

Lip Biopsy ◽

Sjögren‘S Syndrome

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Diagnostic accuracy of salivary gland ultrasound in Sjögren’s syndrome: A systematic review and meta-analysis

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x20973560 ◽

2020 ◽

Vol 12 ◽

pp. 1759720X2097356

Author(s):

Karishma Ramsubeik ◽

Shastri Motilal ◽

Luis Sanchez-Ramos ◽

Laurie Ann Ramrattan ◽

Gurjit S. Kaeley ◽

...

Keyword(s):

Salivary Gland ◽

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Meta Analysis ◽

Sjogren’S Syndrome ◽

Diagnostic Odds Ratio ◽

Sjogren's Syndrome ◽

Likelihood Ratios ◽

Meta Regression ◽

Sjögren‘S Syndrome

Background: To systematically review the diagnostic accuracy of salivary gland ultrasound in primary Sjögren’s syndrome (pSS). Methods: PubMed, Embase, CINAHL, Cochrane Central and Scopus and ClinicalTrials.gov were searched to identify diagnostic or validation studies in patients with pSS meeting the diagnostic criteria. A diagnostic test meta-analysis was performed using a bivariate model to calculate the pooled sensitivity, specificity, positive/negative likelihood ratios, and the diagnostic odds ratio. Meta-regression analyses were done for several pSS covariates. Results: Sixty-five studies met our criteria for the qualitative review. Fifty-four studies with a total of 6087 patients were included in the meta-analysis. Pooled sensitivity for salivary gland ultrasound was 80% [95% confidence interval (CI): 77–83%; I2 = 78%], and specificity was 90% (95% CI: 87–92%; I2 = 76%). The pooled positive and negative likelihood ratios were 8 (95% CI: 6.4–10) and 0.22 (95% CI: 0.19–0.25), respectively. The corresponding pooled diagnostic odds ratio (DOR) was 37 (95% CI: 28–48). Separate meta-regression models resulted in similar diagnostic estimates: (a) adjusted for mean age: sensitivity 81% (95% CI:77–84%; I2 = 99%) and specificity 90% (95% CI: 87–93%; I2 = 99%); (b) adjusted for mean disease duration, sensitivity 79% (95% CI:72–84%; I2 = 99%), and specificity 90% (89–94%; I2 = 99%). The diagnostic estimates were robust to sensitivity analyses by quality criteria, pSS diagnostic criteria and ultrasound scoring systems. Conclusion: Salivary gland ultrasound is a valuable modality for the diagnosis of Sjögren’s syndrome. It is plausible that salivary gland ultrasound can be used as an important criterion for the diagnosis of pSS.

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