Importance of Acoustic Radiation Force Impulse (ARFI) in the diagnosis of primary Sjögren’s syndrome according to American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR)

Introduction The aim of the study is to evaluate ARFI technology in the diagnosis of primary Sjögren’s syndrome (pSS), in view of revised diagnostic criteria by ACR/EULAR and limited sensitivity of the American-European Consensus Group (AECD) diagnostic criteria for the ENT cohort.

Methods In this retrospective study, 157 patients with Sicca symptoms and/or salivary gland swelling were included. The evaluation was carried out on Schirmer test, Unstimulated Whole Saliva (UWS), SS-A antibodies and histology according to ACR/EULAR criteria. Ultrasound and ARFI examinations of Glandula parotis and submandibularis were available for all patients.

Results A total of 57 patients with ACR/EULAR pSS were identified, compared to 70 patients by AECD. Sensitivity and specificity were shown to be almost unchanged for Schirmer test and ARFI technology, increased for SS-A. For UWS, the specificity increased with constant sensitivity. For histology, there was an increase in sensitivity when specificity collapsed.

A good correlation according to Pearson was found between ARFI technology and old and new diagnostic criteria, a low correlation with xerostomy and xerophthalmia and no correlation with histology.

Conclusions The revised diagnostic criteria according to ACR/EULAR focus on objective findings. The sensitive but little specific diagnostic criteria of xerostomy and xerophthalmia have been removed. A determination of the Ocular Staining Score should be made for diagnosis according to recommendation, otherwise diagnosis will be difficult. ARFI as a sensitive and robust method has the potential to enable an earlier diagnosis of pSS, especially for the ENT cohort.

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Publication History

Article published online:
10 June 2020