Primary Sjögren syndrome and development of another autoimmune rheumatic disease during the follow-up.

BACKGROUND: Primary Sjögren syndrome (pSS) is a chronic autoimmune disease with its main target being exocrine glands, and is the connective tissue disease more frequently associated with other autoimmune diseases. The aim of this study was to assess the frequency of another autoimmune rheumatic disease (ARD) developed in primary Sjögren syndrome (pSS) patients and to describe it's clinical, serological and histologic characteristics. MATERIALS AND METHODS: This is a retrospective cohort study. Data of patients with pSS diagnosis (American-European criteria 2002), included in the GESSAR database (Grupo de Estudio Síndrome de Sjögren, Sociedad Argentina de Reumatología) were analyzed. The development of a second ARD was registered during the follow up. RESULTS: 681 patients were included, 94.8% female. The mean age was 54 (SD 14) years and mean age at diagnosis of 50 (SD 13) years. The mean follow-up was 4.7 (SD 4.9) years; 30 patients (4.41%, CI 95%: 3.1-5.7) developed a second ARD during the follow up, incidence rate was 9.1/1000 patients-year (IR 95%: 5.8-12.4/1000 patients-year), the most frequent being rheumatoid arthritis (RA). 96% out of these 30 patients had xerophthalmia, 86.2% xerostomia, 92% positive Schirmer test, 88.24% positive Rosa Bengala test, lisamine green or Ocular Staining Score, 81.2% positive unstimulated salivary flow, 82.1% Ro(+) and 33.33% La(+). Minor salivary gland biopsy had been performed in 14 of the 30 patients, 12 with positive results. There were no statistically significant differences respect baseline characteristics when comparing the patients who developed another ARD to the ones that did not. CONCLUSIONS: Of all the patients analyzed, 4.4% presented another ARD during their follow-up. It is important to be aware of this, to make an early and proper diagnosis and treatment of our patients.

Primary Sjögren syndrome and development of another autoimmune rheumatic disease during the follow-up

Abstract Background: Primary Sjögren syndrome (pSS) is a chronic autoimmune disease with its main target being exocrine glands, and is the connective tissue disease more frequently associated with other autoimmune diseases. The aim of this study was to assess the frequency of another autoimmune rheumatic disease (ARD) developed in primary Sjögren syndrome (pSS) patients and to describe it's clinical, serological and histologic characteristics. Materials and methods: This is a retrospective cohort study. Data of patients with pSS diagnosis (American-European criteria 2002), included in the GESSAR database (Grupo de Estudio Síndrome de Sjögren, Sociedad Argentina de Reumatología) were analyzed. The development of a second ARD was registered during the follow up. Results: 681 patients were included, 94.8% female. The mean age was 54 (SD 14) years and mean age at diagnosis of 50 (SD 13) years. The mean follow-up was 4.7 (SD 4.9) years; 30 patients (4.41%, CI 95%: 3.1-5.7) developed a second ARD during the follow up, incidence rate was 9.1/1000 patients-year (IR 95%: 5.8-12.4/1000 patients-year), the most frequent being rheumatoid arthritis (RA). 96% out of these 30 patients had xerophthalmia, 86.2% xerostomia, 92% positive Schirmer test, 88.24% positive Rosa Bengala test, lisamine green or Ocular Staining Score, 81.2% positive unstimulated salivary flow, 82.1% Ro(+) and 33.33% La(+). Minor salivary gland biopsy had been performed in 14 of the 30 patients, 12 with positive results. There were no statistically significant differences respect baseline characteristics when comparing the patients who developed another ARD to the ones that did not. Conclusions: Of all the patients analyzed, 4.4% presented another ARD during their follow-up. It is important to be aware of this, to make an early and proper diagnosis and treatment of our patients. Key points Patients with primary Sjögren's Syndrome may develop another connective tissue disease during follow-up. The most frequently connective tissue disease developed during follow-up in the population of patients with primary Sjogren's Syndrome studied was rheumatoid arthritis. It is important to be aware of this to make an early and proper diagnosis.

Transcultural adaptation of the EULAR activity index for primary Sjogren's syndrome in Argentine.

OBJECTIVE: To adapt the EULAR Activity Index for primary Sjögren's syndrome (ESSDAI) to the Argentine population. METHODS: observational, cross-sectional study that included patients in a period of ten months. Three Argentine rheumatologists adapted and translated to Spanish the original version in English and the final version was translated back into English by a research associate whose mother language was English. In order to estimate the constructive validity of the index, the visual analogous scale (VAS) of disease activity was used by experts. A subgroup of patients attended a second visit in order to evaluate test-retest reliability. RESULTS: 51 patients were included, 49 (96.1%) were female, the median age was 58 ((interquartile range (IQR): 49-69)). The median global VAS was 10 (IQR: 4-22.25) and the median total ESSDAI score was 5 (IQR: 3-9). The correlation between the global VAS and the total ESSDAI score of the scale was 0.79. The intraclass correlation coefficient was 0.67 (95% CI: 0.32-0.92) for the total score and 0.98 (95% CI: 0.92-0.995) for the global VAS. The results of the correlation coefficient between the VAS and the scale for each domain were: constitutional symptoms: 0.46; lymphadenopathy: 0.76; glandular: 0.78; joint: 0.61; skin: 1; respiratory: 0.83; renal: 1; muscular:- (no patient had myositis); peripheral nervous system: 0.72; central nervous system: 0.67; hematological: 0.96; biomarkers: 0.86. CONCLUSION: The results of this study showed that the ESSDAI is a reliable and valid index for this pSS argentinian population.

Reliability of OMERACT ultrasound elementary lesions in gout: results from a multicenter exercise.

The aim of this study was to evaluate the reliability of the outcome measures in rheumatology (OMERACT) definitions for ultrasound (US) elementary lesions in gout through an image reading exercise. Images from patients with gout (static images and videos) were collected. As an initial step, we carried out a image reading exercise within the experts of the Pan-American League of Associations for Rheumatology (PANLAR) US Study Group (n = 16). The following step consisted in a web-based exercise with the participation of larger number of sonographers (n = 63) from different centers. Images were rated evaluating the presence/absence of any US elementary lesion. Inter- and intra-reader reliabilities were analyzed using kappa coefficients. Participants were stratified according to their level of experience. In the first exercise, inter-reader kappa values were 0.45 for aggregates, 0.57 for tophus, 0.69 for erosions, and 0.90 for double contour (DC). Intra-reader kappa values were 0.86, 0.76, 0.80, and 0.90, respectively. The web-based exercise showed inter-reader kappa values for aggregates, tophus, erosions, and DC of 0.42, 0.49, 0.69, and 0.79, respectively. The intra-reader kappa values were 0.62, 0.69, 0.77, and 0.85, respectively. Reliability was not influenced by the sonographer's level of experience. The reliability of the new OMERACT US definitions for elementary lesions in gout ranged from moderate to excellent, depending on the type of lesion.

Latest Advances in Ultrasound Assessment of Salivary Glands in Sjögren Syndrome.

OBJECTIVE: There are different imaging techniques to assess the parotid glands (i.e., sialography, salivary gland scintigraphy) in patients with Sjögren syndrome (SS). However, their use is limited by the invasive character or high cost. Ultrasound (US) is gaining interest by rheumatologists as a complementary diagnostic tool for SS. To date, there is an increasing body of evidence supporting its sensitivity in the assessment of salivary glands in SS. The aim of our study was to analyze the potential role of US as a diagnostic and prognostic tool in SS and to discuss existing evidence to support its application use. METHODS: A systematic search was performed in the electronic database PubMed, using the following search terms: (salivary glands OR parotid glands OR submandibular glands) AND Sjögren's syndrome AND (ultrasonography OR ultrasound OR sonography). Titles, abstracts, and full reports were systematically screened. RESULTS: The results of the studies analyzed in this review show encouraging results in terms of accuracy, validity, and diagnostic value, which leads us to believe that in the future US could become the reference imaging tool to assess SS. The studies include a small cohort of patients, and there is no standardized approach in terms of US techniques for the assessment of salivary glands. CONCLUSIONS: Ultrasound of major salivary glands is a useful tool for diagnosis, prognostic evaluation, and response to treatment in SS. The use of this imaging technology is still under development, and more multicentric studies are needed to validate this tool.

Utilidad de los anticuerpos y de la biopsia de glándula salival menor en el estudio del complejo sicca en la práctica diaria / Usefulness of antibodies and minor salivary gland biopsy in the study of sicca syndrome in daily clinical practice

Objetivos: Evaluar la asociación entre los hallazgos histológicos de la biopsia de glándula salival menor (BGSM) y los anticuerpos anti La (La/SS-B), anti Ro (Ro/SS-A), anticuerpos antinucleares (FAN) y factor reumatoideo (FR), y comparar el valor de estos como test diagnóstico con la BGSM considerada como patrón oro. Material y métodos: Se incluyeron pacientes con sospecha de síndrome de Sjögren primario (SSp) derivados para realización de BGSM. Se realizó medición de anticuerpos y se consideró BGSM positiva a los grados III y IV de la clasificación de Chisholm. Resultados: Se incluyeron 218 pacientes, 95% género femenino, con una mediana de edad de 54 años y de tiempo de evolución de los síntomas sicca de 12 meses. El 36% de las biopsias fueron positivas. El 33% de los pacientes presentaban anticuerpos anti Ro/SS-A anti La/SS-B positivos, 62% FAN positivo y el 31% FR positivo. Se encontró asociación estadísticamente significativa entre la BGSM y anti Ro/SS-A, anti La/SS-B, FAN y FR. El FAN resultó ser el anticuerpo más sensible (84% IC95%: 75-92), siendo los más específicos: anti Ro/ SS-A y/o anti La/ SS-B (78% IC95%: 71-85) y el FR (78% IC95%: 69-87). Conclusión: Ante la sospecha clínica de SSp, los anticuerpos anti Ro/ SS-A y anti La/ SS-B son de gran valor para arribar al diagnóstico, siendo la BGSM especialmente útil en los pacientes seronegativos. Los resultados también sugieren la utilidad del FAN y el FR para la clasificación de SSp (AU)

Objectives: To assess the association between histologic findings in the minor salivary gland biopsy (MSGB) and anti La (La/SS-B) y antiRo antibodies (Ro/SS-A), antinuclear antibodies (ANA) and Rheumatoid Factor (RF), and compare the value of the latter as diagnostic tests with MSGB, considered as the gold standard. Material and method: Patients with suspected Primary Sjögren Syndrome (PSS) referred for MSGB were included. Antibody measurements were performed. Grade III and IV biopsy results were considered positive. Results: Two hundred and eighteen (218) patients were included, 95% females, with a median age of 54 years and 12 months median duration of sicca symptoms. 36 of the biopsies were positive. 33% of patients had positive anti Ro/SS-Aanti La/SS-B antibodies, 62% had positive ANA, and 31% positive RF. Astatistically significant association was found between MSGB and anti Ro/SS-A anti La/SS-B, ANA and RF. ANA were the most sensitive antibodies (84%. 95% CI: 75- 92), and the most specific were: Anti Ro/ SS-A and/or anti La/ SS-B (78%. 95% CI: 71-85) and RF (78%. 95% CI: 69-87) (AU)

Usefulness of antibodies and minor salivary gland biopsy in the study of sicca syndrome in daily clinical practice.

OBJECTIVES: To assess the association between histologic findings in the minor salivary gland biopsy (MSGB) and anti La (La/SS-B)y antiRo antibodies (Ro/SS-A), antinuclear antibodies (ANA) and Rheumatoid Factor (RF),and compare the value of the latter as diagnostic tests with MSGB, considered as the gold standard. MATERIAL AND METHOD: Patients with suspected Primary Sjögren Syndrome (PSS) referred for MSGB were included. Antibody measurements were performed. Grade III and IV biopsy results were considered positive. RESULTS: Two hundred and eighteen (218) patients were included, 95% females, with a median age of 54 years and 12 months median duration of sicca symptoms. 36 of the biopsies were positive. 33% of patients had positive anti Ro/SS-A anti La/SS-B antibodies, 62% had positive ANA, and 31% positive RF. A statistically significant association was found between MSGB and anti Ro/SS-A anti La/SS-B, ANA and RF. ANA were the most sensitive antibodies (84%. 95% CI: 75- 92), and the most specific were: Anti Ro/ SS-A and/or anti La/ SS-B (78%. 95% CI: 71-85) and RF (78%. 95% CI: 69-87). CONCLUSION: On PSS clinical suspicion, anti Ro/ SS-A y anti La/ SS-B antibodies have a great value to achieve the diagnosis, with MSGB useful for diagnosis of seronegative patients. The results also suggest the importance of ANA and RF for PSS classification.

Frecuencia de complicaciones y rédito de la biopsia de glándula salival menor / Frequency of complications and usefulness of the minor salivary gland biopsy

El hallazgo de anticuerpos específicos y datos histopatológicos son indispensables para llegar al diagnóstico de síndrome de Sjögren (SS). La biopsia de glándulas salivales menores (BGSM), si bien es un procedimiento sencillo, debe ser realizada en una institución a fin de evitar complicaciones. Objetivo: Estimar la frecuencia de complicaciones mediatas e inmediatas y el rédito de la técnica. Materiales y métodos: Se incluyeron los pacientes derivados al Hospital Rivadavia para realización de biopsia, entre octubre del 2007 y mayo del 2010. Los pacientes fueron citados a la semana y al mes del procedimiento para control de la lesión. Resultados: Frecuencia de complicaciones inmediatas (n = 186): 15 pacientes: 8,1%, IC del 95%, 4,7-13,2 (sangrado 7,5%, lipotimia 3,2%, hematomas 2,7%; no hubo accidentes). Complicaciones mediatas (n = 164): 16 pacientes: 9,75%, IC del 95%, 5,9-15,6 (dolor 7,32%, signos inflamatorios 3,66%, trastornos de sensibilidad 3,05%, granuloma 1,22%). No hubo casos de infecciones, ni dehiscencia del punto de sutura. Rédito microscópico: total 154 biopsias: se obtuvo tejido glandular en el 90,9%, IC del 95%, 85-95 (típica, sialoadenitis, infiltrado grado III y IV). Conclusiones: La BGSM presenta una baja frecuencia de complicaciones mediatas e inmediatas y un alto rédito en el estudio anatomo-patológico (AU)

Findings of specific antibodies and histopathology data are essential for the diagnosis of Sjögren syndrome (SS). Although the minor salivary gland biopsy (MSGB) is technically simple, it needs to be performed in a medical institution to avoid complications. Objective: To determine the frequency of complications and the usefulness of this technique. Materials and methods: Patients who underwent a minor salivary gland biopsy for a possible diagnosis of SS at Rivadavia Hospital between October 2007 and May 2010 where included. The patients were seen a week and a month after the procedure for follow up. Results: Frequency of acute complications (n = 186): 15 patients; 8.1%, 95%CI: 4.7-13.2 (Bleeding 7.5%, syncope 3.2%, hematoma 2.7%. No accidents occurred). Medium term complications (n = 164): 16 patients: 9.75%, 95%CI: 5.9-15.6 (pain 7.32%, inflammation 3.66%, sensitivity disorders 3.05%, granuloma 1.22%,). No infections or suture dehiscence occurred. Microscopic results: 154 biopsy reports were received: glandular 90.9%, 95%CI: 85-95 (typical, sialadenitis, grade III and IV infiltration). Conclusions: MSGB has very low frequency of medium term and acute complications and it has high usefulness (AU)

Sonoanatomía de la rodilla / Knee sonoanatomy

La rodilla es una región anatómica vasta en estructuras que pueden ser afectadas por diversas enfermedades de etiología diversa. La exploración física no siempre brinda un diagnóstico certero. La ultrasonografía es una técnica de imagen que ha demostrado validez y reproducibilidad para el estudio de la rodilla tanto para complementación diagnóstica como para evaluar la respuesta al tratamiento en varias enfermedades, así como servir de guía para aspiración o infiltraciones. Por ello es importante conocer la anatomía y la exploración por ultrasonografía de la región.

The knee is a vast region in anatomical structures that may be affected by various diseases of diverse etiology. Physical examination does not always provide an accurate diagnosis. Ultrasonography is an imaging technique that has proven validity and reproducibility for the study of the knee for both diagnostic and complementation to assess response to treatment in various diseases and to guide aspiration or infiltration. It is therefore important to know the anatomy and U.S. exploration of the region.