Clinical significance of quantitative immunohistology in labial salivary glands for diagnosing Sjogren's syndrome.

OBJECTIVES Because patients with primary Sjögren's syndrome (pSS) are at risk of developing other autoimmune phenomena and malignant lymphoma, it is important to distinguish pSS from non-Sjögren's (nSS) sicca syndrome. However, this distinction might be difficult because of the lack of a gold standard for pSS. We studied the clinical significance of quantitative immunohistology (QIH) in labial salivary glands for diagnosing pSS. METHODS In a model mimicking the making of a clinical diagnosis, five experts diagnosed 396 patients as nSS, 'indefinite', pSS or secondary SS (sSS) using 25 clinical parameters. Patients were diagnosed twice, namely without (yielding gold-standard diagnoses) and with knowledge of QIH. The numbers of changes in diagnosis from 'indefinite' to 'definite' (nSS, pSS or sSS) or vice versa were compared. Patient groups with vs without a changed diagnosis in the four gold-standard diagnosis groups were compared regarding objective autoimmune parameters. RESULTS Sensitivity, specificity, positive and negative predictive value for abnormal QIH in pSS vs nSS were 93, 86, 76 and 96%, respectively. Changes in diagnosis from 'indefinite' to 'definite' (31%) were found more often (P = 0.00) than changes from 'definite' to 'indefinite' (10%). Knowledge of QIH distinguished patient groups within the gold-standard nSS, indefinite and pSS patient group with regard to autoimmune parameters. CONCLUSION In view of the consequences of distinguishing pSS from nSS, these results point to an additional diagnostic role for QIH in clinical practice.

[1]  L. V. D. van de Putte,et al.  Anti-α-fodrin antibodies do not add much to the diagnosis of Sjögren's syndrome , 2003, Arthritis research & therapy.

[2]  I. Peene,et al.  Diagnostic associations in a large and consecutively identified population positive for anti-SSA and/or anti-SSB: the range of associated diseases differs according to the detailed serotype , 2002, Annals of the rheumatic diseases.

[3]  L. V. D. van de Putte,et al.  The synergistic value of focus score and IgA% score of sublabial salivary gland biopsy for the accuracy of the diagnosis of Sjögren's syndrome: a 10-year comparison. , 2002, Rheumatology.

[4]  R. Jonsson,et al.  Classification criteria for Sjögren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group , 2002, Annals of the rheumatic diseases.

[5]  S. Adelstein,et al.  Autoantibodies to Extractable Nuclear Antigens: Making Detection and Interpretation More Meaningful , 2002, Clinical and Vaccine Immunology.

[6]  L. V. D. van de Putte,et al.  Reversibility of histological and immunohistological abnormalities in sublabial salivary gland biopsy specimens following treatment with corticosteroids in Sjögren's syndrome , 2001, Annals of the rheumatic diseases.

[7]  L. Jacobsson,et al.  Lower frequency of focal lip sialadenitis (focus score) in smoking patients. Can tobacco diminish the salivary gland involvement as judged by histological examination and anti-SSA/Ro and anti-SSB/La antibodies in Sjögren's syndrome? , 2000, Annals of the rheumatic diseases.

[8]  Y. Hayashi,et al.  Identification of α-Fodrin as a Candidate Autoantigen in Primary Sjögren's Syndrome , 1997 .

[9]  A. van der Heide,et al.  Long-term followup of patients with Sjögren's syndrome. , 1996, Arthritis and rheumatism.

[10]  J. B. Matthews,et al.  Plasma cell populations in labial salivary glands from patients with and without Sjögren's syndrome , 1993, Histopathology.

[11]  L. V. D. van de Putte,et al.  Quantitative immunohistologic criteria are superior to the lymphocytic focus score criterion for the diagnosis of Sjögren's syndrome. , 1992, Arthritis and rheumatism.

[12]  P. Speight,et al.  Quantification of plasma cells in labial salivary glands: increased expression of IgM in Sjögren's syndrome. , 1990, Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology.

[13]  J. Baak,et al.  A new and highly sensitive immunohistologic diagnostic criterion for Sjögren's syndrome. , 1989, Arthritis and rheumatism.

[14]  F. Arnett,et al.  Anti-Ro (SS-A) and anti-La (SS-B) in patients with Sjögren's syndrome. , 1986, Arthritis and rheumatism.

[15]  Y. Takeda,et al.  Focal lymphocytic infiltration in the human labial salivary glands: a postmortem study. , 1986, Journal of oral pathology.

[16]  J. Greenspan,et al.  The histopathology of Sjögren's syndrome in labial salivary gland biopsies. , 1974, Oral surgery, oral medicine, and oral pathology.

[17]  T. Tomasi,et al.  Salivary gland immunoglobulin and rheumatoid factor synthesis in Sjögren's syndrome. Natural history and response to treatment. , 1972, The American journal of medicine.

[18]  D. Chisholm,et al.  Labial salivary gland biopsy in Sjögren's disease , 1968, Journal of clinical pathology.

[19]  M. Taussig,et al.  Autoantibodies to alpha-fodrin in primary Sjögren's syndrome and SLE detected by an in vitro transcription and translation assay. , 2003, Clinical and experimental rheumatology.

[20]  N. Talal,et al.  Immunoglobulin synthesis by salivary gland lymphoid cells in Sjögren's syndrome. , 1970, The Journal of clinical investigation.