Sialometry and sialochemistry: a non-invasive approach for diagnosing Sjögren's syndrome

Background: Analysis of salivary variables has frequently been proposed as a diagnostic tool for Sjögren's syndrome (SS). Because univocal salivary reference values are lacking, it is currently rather difficult to use sialometry and sialochemistry for diagnosing SS unless major changes have occurred in salivary secretion and composition. Objective: To define reference values of several salivary variables, which offer a possible new and non-invasive means of diagnosing SS. Methods: Cut off points were selected from receiver operating characteristic curves of gland-specific sialometrical and sialochemical variables, which have proved to be potentially relevant for diagnosing SS in a previous study—that is, sodium, chloride, and phosphate concentration in stimulated parotid and submandibular/sublingual (SM/SL) saliva, unstimulated and stimulated SM/SL flow rates, and lag phase of parotid secretion, respectively. By combining the most discriminating variables, two different diagnostic approaches for SS were applied in a group of 100 patients and subsequently evaluated in a second group of 20 patients. The first approach was to combine variables by applying their cut off points into sets of criteria for a positive diagnosis of SS. The second approach was to construct a logistic regression model that predicts the true state of a patient (SS or non-SS). From both approaches, the tests with highest likelihood ratio combined with the smallest number of rejected cases were selected for clinical use. Results: The most accurate test combined the stimulated SM/SL flow rate and parotid sodium and chloride concentration as salivary variables for diagnosing SS; it had a sensitivity of 0.85 and a specificity of 0.96. The selected tests proved equally accurate in the second group of patients. Conclusions: Because the proposed non-invasive diagnostic tools can be easily applied, do not need a laboratory other than for routine blood testing, and are very accurate, gland-specific sialometry and sialochemistry may eventually replace other, more invasive, diagnostic techniques for diagnosing SS.

[1]  B. Sonies,et al.  Xerostomia: evaluation of a symptom with increasing significance. , 1985, Journal of the American Dental Association.

[2]  I D Mandel,et al.  The diagnostic uses of saliva. , 1990, Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology.

[3]  R. Szargel,et al.  Sialochemistry for diagnosis of Sjögren's syndrome in xerostomic patients. , 1981, Oral surgery, oral medicine, and oral pathology.

[4]  J. Prause,et al.  Sjögren's Syndrome , 1981, Allergy.

[5]  M. Schiødt,et al.  Criteria for the salivary component of Sjögren's syndrome. A review. , 1989, Clinical and Experimental Rheumatology.

[6]  T. Daniels.  Clinical assessment and diagnosis of immunologically mediated salivary gland disease in Sjögren's syndrome. , 1989, Journal of autoimmunity.

[7]  D. Isenberg,et al.  Preliminary criteria for the classification of Sjögren's syndrome. Results of a prospective concerted action supported by the European Community. , 1993, Arthritis and rheumatism.

[8]  Jacobs Rm.  Department of Oral Biology. , 1970 .

[9]  I. Mandel,et al.  Sialochemistry in Sjögren's syndrome. , 1976, Oral surgery, oral medicine, and oral pathology.

[10]  J. Atkinson.  The Role of Salivary Measurements in the Diagnosis of Salivary Autoimmune Diseases , 1993, Annals of the New York Academy of Sciences.

[11]  J. Prause,et al.  Sialochemistry in Sjögren's syndrome: a review. , 1989, Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology.

[12]  A. Vissink,et al.  Applicability of Saliva as a Diagnostic Fluid in Sjögren's Syndrome , 1993, Annals of the New York Academy of Sciences.

[13]  M. Zweig,et al.  Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. , 1993, Clinical chemistry.

[14]  I. Blatt.  On sialectasis and benign lymphosialadenopathy: The pyogenic parotitis, Gougerot‐Sjögren's syndrome, Mikulicz's disease complex.) A ten‐year study. , 1964, The Laryngoscope.

[15]  A. Vissink,et al.  Sialometry and sialochemistry: diagnostic tools for Sjögren's syndrome , 2001, Annals of the rheumatic diseases.

[16]  P. Youinou,et al.  Reappraisal of tests for xerostomia. , 1993, Clinical and experimental rheumatology.

[17]  O. Miettinen,et al.  Evaluation of diagnostic imaging tests: diagnostic probability estimation. , 1998, Journal of clinical epidemiology.

[18]  W. Travis,et al.  Major salivary gland function in primary Sjögren's syndrome and its relationship to clinical features. , 1990, The Journal of rheumatology.

[19]  E. Benedek-Spät,et al.  A sialochemical study on patients with Sjögren's syndrome. , 1975, Archives of oral biology.

[20]  J. J. Bunim,et al.  SJÖGREN'S SYNDROME: A Clinical, Pathological, and Serological Study of Sixty-two Cases , 1965, Medicine.