Salivary gland ultrasonography improves the diagnostic performance of the 2012 American College of Rheumatology classification criteria for Sjögren's syndrome

Rheumatology (Oxford). 2014 Sep;53(9):1604-7. doi: 10.1093/rheumatology/keu037. Epub 2014 Apr 4.


Objective: The aim of this study was to evaluate whether salivary gland ultrasonography (SGUS) improves the diagnostic performance of the 2012 ACR classification criteria for SS.

Methods: We studied a cohort of 101 patients with suspected SS seen at a single centre in Brittany, France. An SGUS echostructure score ≥2 was considered abnormal. The reference standard was a clinical diagnosis of SS made by a group of experts blinded to SGUS findings.

Results: SS was diagnosed in 45 patients. Similar proportions of patients with and without SS had an ocular staining score ≥3. Adding RF positivity and ANA titre ≥1:320 as an alternative to anti-SSA/SSB positivity increased the sensitivity of the serological item without modifying specificity compared with using anti-SSA/SSB alone. SGUS was 60.0% sensitive and 87.5% specific for SS. Adding the SGUS score to the ACR criteria increased sensitivity from 64.4% to 84.4% and only slightly decreased specificity, from 91.1% to 89.3%.

Conclusion: The diagnostic performance of the ACR classification criteria for SS is notably improved by adding the SGUS score. SGUS should be included in future classification criteria for SS.

Keywords: Sjögren’s syndrome; classification criteria; diagnosis; sensitivity; specificity; ultrasonography.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Antibodies, Antinuclear / blood
  • Biomarkers / blood
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Rheumatoid Factor / blood
  • Salivary Glands / diagnostic imaging*
  • Sensitivity and Specificity
  • Sjogren's Syndrome / diagnosis
  • Sjogren's Syndrome / diagnostic imaging*
  • Ultrasonography


  • Antibodies, Antinuclear
  • Biomarkers
  • Rheumatoid Factor