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. 1992 May;51(5):607–610. doi: 10.1136/ard.51.5.607

Sjögren's syndrome: a stepwise approach to the use of diagnostic tests.

J Coll 1, M Porta 1, J Rubiés-Prat 1, J Gutiérrez-Cebollada 1, S Tomás 1
PMCID: PMC1005691  PMID: 1616324

Abstract

One hundred and forty two patients (62 with definite Sjögren's syndrome, 24 with probable Sjögren's syndrome, and 56 in whom Sjögren's syndrome was finally ruled out) were studied. Schirmer's test and rose bengal staining for the diagnosis of keratoconjunctivitis sicca and salivary scintigraphy and a labial biopsy sample for the diagnosis of xerostomaia were studied in all patients. Rose bengal staining showed high specificity (98%) but low sensitivity (55%). All patients with positive rose bengal staining results had associated xerostomia. In the rose bengal staining positive patients, scintigraphy had 100% specificity. A labial biopsy sample showed high sensitivity in the rose bengal staining, salivary scintigraphy positive group, and high specificity in the rose bengal staining positive, salivary scintigraphy negative group. In patients with negative rose bengal staining, salivary scintigraphy showed 96% specificity and 36% sensitivity. A labial biopsy sample had a sensitivity and specificity greater than 90% in rose bengal staining negative patients. Only 29 biopsy samples were needed to achieve a diagnosis of Sjögren's syndrome in 142 patients (20%). Hence the suggested approach may make it unnecessary to take biopsy samples in approximately 80% of patients with suspected Sjögren's syndrome. Using the stepwise approach of first rose bengal staining, then salivary scintigraphy, and eventually a labial biopsy sample in patients with suspected Sjögren's syndrome, the diagnosis is relatively simple.

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Selected References

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  1. Chisholm D. M., Mason D. K. Labial salivary gland biopsy in Sjögren's disease. J Clin Pathol. 1968 Sep;21(5):656–660. doi: 10.1136/jcp.21.5.656. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Coll J., Rives A., Griñ M. C., Setoain J., Vivancos J., Balcells A. Prevalence of Sjögren's syndrome in autoimmune diseases. Ann Rheum Dis. 1987 Apr;46(4):286–289. doi: 10.1136/ard.46.4.286. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Daniels T. E. Labial salivary gland biopsy in Sjögren's syndrome. Assessment as a diagnostic criterion in 362 suspected cases. Arthritis Rheum. 1984 Feb;27(2):147–156. doi: 10.1002/art.1780270205. [DOI] [PubMed] [Google Scholar]
  4. Fox R. I., Howell F. V., Bone R. C., Michelson P. Primary Sjogren syndrome: clinical and immunopathologic features. Semin Arthritis Rheum. 1984 Nov;14(2):77–105. doi: 10.1016/0049-0172(84)90001-5. [DOI] [PubMed] [Google Scholar]
  5. Fox R. I., Robinson C. A., Curd J. G., Kozin F., Howell F. V. Sjögren's syndrome. Proposed criteria for classification. Arthritis Rheum. 1986 May;29(5):577–585. doi: 10.1002/art.1780290501. [DOI] [PubMed] [Google Scholar]
  6. Garry R. F., Fermin C. D., Hart D. J., Alexander S. S., Donehower L. A., Luo-Zhang H. Detection of a human intracisternal A-type retroviral particle antigenically related to HIV. Science. 1990 Nov 23;250(4984):1127–1129. doi: 10.1126/science.1701273. [DOI] [PubMed] [Google Scholar]
  7. Greenspan J. S., Daniels T. E., Talal N., Sylvester R. A. The histopathology of Sjögren's syndrome in labial salivary gland biopsies. Oral Surg Oral Med Oral Pathol. 1974 Feb;37(2):217–229. doi: 10.1016/0030-4220(74)90417-4. [DOI] [PubMed] [Google Scholar]
  8. Homma M., Tojo T., Akizuki M., Yamagata H. Criteria for Sjögren's syndrome in Japan. Scand J Rheumatol Suppl. 1986;61:26–27. [PubMed] [Google Scholar]
  9. Konttinen Y. T., Segerberg-Konttinen M., Szöcsik K., Guseva N., Malmström M., Tuominen S. Oral parameters for the diagnosis of Sjögren's syndrome. Clin Exp Rheumatol. 1989 Mar-Apr;7(2):159–162. [PubMed] [Google Scholar]
  10. Manthorpe R., Oxholm P., Prause J. U., Schiødt M. The Copenhagen criteria for Sjögren's syndrome. Scand J Rheumatol Suppl. 1986;61:19–21. [PubMed] [Google Scholar]
  11. Moutsopoulos H. M., Chused T. M., Mann D. L., Klippel J. H., Fauci A. S., Frank M. M., Lawley T. J., Hamburger M. I. Sjögren's syndrome (Sicca syndrome): current issues. Ann Intern Med. 1980 Feb;92(2 Pt 1):212–226. doi: 10.7326/0003-4819-92-2-212. [DOI] [PubMed] [Google Scholar]
  12. Schall G. L., Anderson L. G., Wolf R. O., Herdt J. R., Tarpley T. M., Jr, Cummings N. A., Zeiger L. S., Talal N. Xerostomia in Sjögren's syndrome. Evaluation by sequential salivary scintigraphy. JAMA. 1971 Jun 28;216(13):2109–2116. [PubMed] [Google Scholar]
  13. Skopouli F. N., Drosos A. A., Papaioannou T., Moutsopoulos H. M. Preliminary diagnostic criteria for Sjögren's syndrome. Scand J Rheumatol Suppl. 1986;61:22–25. [PubMed] [Google Scholar]
  14. Sox H. C., Jr Probability theory in the use of diagnostic tests. An introduction to critical study of the literature. Ann Intern Med. 1986 Jan;104(1):60–66. doi: 10.7326/0003-4819-104-1-60. [DOI] [PubMed] [Google Scholar]
  15. Talal N., Dauphinée M. J., Dang H., Alexander S. S., Hart D. J., Garry R. F. Detection of serum antibodies to retroviral proteins in patients with primary Sjögren's syndrome (autoimmune exocrinopathy). Arthritis Rheum. 1990 Jun;33(6):774–781. doi: 10.1002/art.1780330603. [DOI] [PubMed] [Google Scholar]
  16. Tarpley T. M., Jr, Anderson L. G., White C. L. Minor salivary gland involvement in Sjögren's syndrome. Oral Surg Oral Med Oral Pathol. 1974 Jan;37(1):64–74. doi: 10.1016/0030-4220(74)90160-1. [DOI] [PubMed] [Google Scholar]
  17. Vitali C., Giuggioli C., Monti P., Rossi G., Wu D. H., d'Ascanio A., Chiellini S., Gabriele M., Bombardieri S. Statistical evaluation of different clinical and serological parameters for the diagnosis of Sjögren's syndrome. Clin Exp Rheumatol. 1989 Mar-Apr;7(2):191–195. [PubMed] [Google Scholar]
  18. Youinou P., Moutsopoulos H. M., Pennec Y. L. Clinical features of Sjögren's syndrome. Curr Opin Rheumatol. 1990 Oct;2(5):687–693. doi: 10.1097/00002281-199002050-00002. [DOI] [PubMed] [Google Scholar]

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