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Adv Ther. 2017 Apr;34(4):799-812. doi: 10.1007/s12325-017-0501-3. Epub 2017 Mar 10.

The Potential Role for Early Biomarker Testing as Part of a Modern, Multidisciplinary Approach to Sjögren's Syndrome Diagnosis.

Author information

1
Comprehensive EyeCare of Central Ohio, Westerville, OH, USA. kenbeckman22@aol.com.
2
Ohio State University, Columbus, OH, USA. kenbeckman22@aol.com.
3
Hofstra University School of Medicine, Hempstead, NY, USA.
4
South Shore Eye Care, Wantagh, NY, USA.
5
The Eye Center of Southern Connecticut, PC, Hamden, CT, USA.
6
Yale University School of Medicine, New Haven, CT, USA.
7
Division of Allergy, Immunology and Rheumatology, Department of Medicine, SUNY at Buffalo School of Medicine, Buffalo, NY, USA.

Abstract

Sjögren's syndrome (SS) is a chronic and progressive multisystem autoimmune disease typically managed by rheumatologists. Diagnostic delays are common, due in large part to the non-specific and variable nature of SS symptoms and the slow progression of disease. The hallmark characteristics of SS are dry eye and dry mouth, but there are a broad range of other possible symptoms such as joint and muscle pain, skin rashes, chronic dry cough, vaginal dryness, extremity numbness or tingling, and disabling fatigue. Given that dry eye and dry mouth are typically the earliest presenting complaints, eye care clinicians and dental professionals are often the first point of medical contact and can provide critical collaboration with rheumatologists to facilitate both timely diagnosis and ongoing care of patients with SS. Current diagnostic criteria advocated by the American College of Rheumatology are predicated on the presence of signs/symptoms suggestive of SS along with at least two objective factors such as traditional biomarker positivity, salivary gland biopsy findings, and/or presence of keratoconjunctivitis sicca. Traditional biomarkers for SS include the autoantibodies anti-Sjögren's syndrome-related antigen A (SS-A/Ro), anti-Sjögren's syndrome-related antigen B (SS-B/La), antinuclear antibody (ANA) titers, and rheumatoid factor (RF). While diagnostically useful, these biomarkers have low specificity for SS and are not always positive, especially in early cases of SS. Several newly-identified biomarkers for SS include autoantibodies to proteins specific to the salivary and lacrimal glands [SP-1 (salivary gland protein-1), PSP (parotid secretory protein), CA-6 (carbonic anhydrase VI)]. Data suggest that these novel biomarkers may appear earlier in the course of disease and are often identified in cases that test negative to traditional biomarkers. The Sjö® test is a commercially available diagnostic panel that incorporates testing for traditional SS biomarkers (anti-SS-A/Ro, anti-SS-B/La, ANA, and RF), as well as three novel, proprietary early biomarkers (antibodies to SP-1, PSP, and CA-6) which provide greater sensitivity and specificity than traditional biomarker testing alone. Timely diagnosis of SS requires appropriate clinical vigilance for potential SS symptoms, referral and collaborative communication among rheumatology, ophthalmology, and oral care professions, and proactive differential work-up that includes both physical and laboratory evaluations.

KEYWORDS:

Autoantibodies; Diagnosis; Keratoconjunctivitis sicca; Novel biomarkers; Salivary gland biopsy; Sjö test; Sjögren’s syndrome; Traditional biomarkers

PMID:
28283891
DOI:
10.1007/s12325-017-0501-3
[Indexed for MEDLINE]

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