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R. N. Swamy, C. A. Utine, J. E. Thorne, A. Baer, E. K. Akpek; Clinical Predictors of Sjögren’s Syndrome Diagnosis in a Population of Individuals With Dry Eye. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3363.
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To determine whether medical history, ocular exam characteristics, and serologic test results of individuals who present with symptoms of dry eye can be used to predict eventual diagnosis of Sjögren’s Syndrome (SS).
Medical records of patients with a primary diagnosis of dry eye syndrome (International Classification of Diseases [ICD] code 375.15, 370.33 and 710.2) were reviewed retrospectively. These individuals had presented to the Dry Eye clinic between January 2002 and May 2009. Among these individuals, those who underwent additional serologic work-up for SS were selected.
Among 1538 individuals who were referred with symptoms of dry eye syndrome, as determined by schirmer levels, 237 underwent additional serologic work-up for suspected SS and were selected for further analysis. Among these 237 individuals, 52.7% tested positive for ANA and 21.6% for rheumatoid factor, 8.3% for SSA antibodies and 7.4% for SSB antibodies. 27% were seronegative and underwent minor salivary gland biopsy and of these, 48.5% had biopsy grade 3 or above. 89 (37.6%) of these individuals were eventually diagnosed with SS based on the European-American criteria. In a univariate analysis, gender, age, duration of symptoms, and presence of other co-morbid rheumatologic conditions (P> 0.05) did not differ significantly between the SS and non-SS groups. Features significantly associated with an eventual SS diagnosis included presence of dry mouth (P=0.015), Raynauds (P = 0.023), corneal staining (P=0.003), family history of SLE (P = 0.044), DM Type I (P = 0.033), SSA (OR = 40.2), SSB (OR = 35.4), and RF (OR = 5.6). ANA correlated in a dose responsive fashion with higher titers associated with an SS diagnosis (titer 1:640, OR = 7.4). A positive biopsy (P<0.000) was also strongly associated with the eventual diagnosis.
Primary SS is a common cause of dry eye and should be the focus of diagnostic evaluations. The study identifies additional factors on review of systems, history, ocular exam and serology to identify individuals who have higher odds of being diagnosed with Sjögren’s Syndrome. The results of the study can be used as a guide to select for individuals who should undergo additional serologic testing to confirm diagnosis and to initiate treatment.
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