News - Sjogren's Syndrome Frequently Misdiagnosed

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Sjogren's Syndrome Frequently Misdiagnosed

05/14/2002

By Anne MacLennan

Doctors too often miss diagnosis of Sjogren's syndrome resulting in delayed

treatment. At other times, the condition is identified where it does not

exist.

These are the findings of a study by Frederick B. Vivino and colleagues from

Jefferson University and Albert Einstein Medical Center,

Philadelphia, Pennsylvania. United States.

The crux of the problem may be widespread cross-institutional failure to

apply the focus scoring system in the interpretation of labial salivary

gland biopsies, these authors suggest.

This research group evaluated the diagnostic accuracy of labial salivary

gland specimens from a group of 58 people, 52 women and six men, referred

for a second opinion on diagnosis and/or management of Sjogren's syndrome

(SS).

Most of the patients, aged from 19 years to 90 years (median 54.5 years),

were referred by university and community hospitals. All had symptoms or

signs of dry mouth and/or dry eyes.

The patients had all previously undergone at least one (two had undergone

two) labial salivary gland biopsies, serologic studies and objective tests

for dry eyes and/or dry mouth to diagnose possible SS.

Blinded review was done on all biopsy specimens to measure aggregate

glandular area, identify lymphocytic foci and calculate focus scores that

might verify the submitted diagnoses.

Researchers then classified the results according to histologic criteria.

On re-examination, the initial diagnosis was revised in 32 of 60 accessions

(53 percent). Application of the focus scoring system combined with the

clinical features revealed 12 hitherto undocumented cases of SS and refuted

the diagnosis of SS in eight instances.

Failure to apply the focus scoring system in 58 of 60 instances was the

principal reason for inaccurate initial interpretation, authors note.

Median diagnostic delay for the 12 SS cases was 302 days (range 55 days to

2,821 days).

J Rheumatol 2002;29:938-44.