Abstract
Purpose :
To determine if the addition of novel Sjogren syndrome (SS) autoantibody data improves the performance of a previously reported algorithm to screen dry eye patients for SS.
Methods :
Inclusion criteria were age ≥18 years, no history of autoimmune disease, and dry eye complaints for ≥ 3 months. Ocular and systemic symptoms were assessed using a questionnaire. Subjects underwent an ocular surface exam, measurement of unstimulated whole salivary rate, serological testing, and a lip biopsy if indicated to diagnose SS. A participant was diagnosed with SS if they met the 2016 American College of Rheumatology/European League Against Rheumatism criteria. The screening algorithm score was originally determined using questionnaire responses, assessment of tear film break-up time and conjunctival staining with lissamine green (Bunya et al Cornea 2021). The presence or absence of IgG, IgM, or IgA isotypes of the novel SS antibodies (anti-salivary protein (SP), anti-parotid secretory protein (PSP), and anti-carbonic anhydrase isoenzyme VI (CA-VI)) was compared between patients with and without SS, and incorporated into the algorithm.
Results :
89 patients (18 SS, 71 no SS) were enrolled, 82% of them female with a mean age (±SD) of 57 (±17.6) years. There was no significant association between the presence of any one novel antibody and a positive SS diagnosis (Table 1). The percent of positive subjects in the following specific immunoglobulin groups: SP IgA, PSP IgM or CA-VI IgM, was higher in those with SS than those without SS (61.1% vs. 25.4%, p=0.0009, Table 1). The area under the ROC curve (95% CI) for SS screening was 0.68 (0.55-0.81) with the likelihood score alone, and significantly (p=0.04) improved to 0.77 (0.65-0.89) when using both the novel antibodies and the likelihood score (Figure 1).
Conclusions :
We found that the inclusion of specific novel autoantibodies (SP IgA, PSP IgM and CA-VI IgM) significantly improved the performance of our previously reported SS screening tool. This likelihood scoring system can be implemented using the brief series of questions alone, or combined with standard ocular surface signs and novel SS antibody testing for improved performance. Once validated, the algorithm may serve as an effective screening tool to determine the likelihood of SS in dry eye patients, potentially allowing for earlier diagnosis and treatment.
This is a 2021 ARVO Annual Meeting abstract.