Salivary Ultrasound Offers Better, Earlier Detection of Sjögren’s

It may be time to update the method by which Sjögren’s syndrome (SS) is diagnosed, going beyond the current criteria of the American-European Consensus Group (AECG). That’s the proposal of rheumatology and immunology experts in the Netherlands, who have authored an editorial on the subject, featured in the January 2013 issue of Arthritis & Rheumatism.

Because SS particularly affects the salivary and lacrimal glands, the authors suggest adding salivary gland ultrasonography (SGUS) to SS diagnostic tools. With SGUS, for example, there could be better evaluation of saliva production and composition, which are already important in SS diagnosis.

SGUS might be of value both for earlier diagnosis and better monitoring of disease progression, and classifying primary SS, they write. Earlier detection could, in turn, nullify the need for invasive salivary gland biopsies, which are not only distressing to the patient but often inconclusive.

The authors suggest another benefit of turning to SGUS: It could replace two tests now considered “inappropriate” by AECG critieria: saloscintigraphy and sialography.

AECG critieria have already been criticized as being too subjective, say the authors, for instance for relying on symptoms of ocular dryness. They point out that adding SGUS to the AECG criteria in one study increased their sensitivity from 78% to 87%, without altering their specificity.

Since the Sjögren’s International Collaborative Clinical Alliance Research Groups have already proposed alternative, more objective, measures for SS diagnosis, the authors recommend extensively examining SGUS in a diagnostic setting to establish its most appropriate role in diagnosis and assessment.