Katja Perdan Pirkmajer, Slovenia
University Medical Centre Ljubljana RheumatologyPresenter of 2 Presentations
RISING INCIDENCE OF SJOGREN SYNDROME? OR JUST MORE SENSITIVE CLASSIFICATION CRITERIA?
Abstract
Background and Aims
Epidemiological data on primary Sjögren syndrome (pSS) are variable and depend on the diagnostic criteria. We determined the incidence rate of pSS in Slovenia using the 2002 American European (AE) and the new ACR/EULAR 2016 classification criteria.
Methods
We included 399 consecutive subjects (365 females, mean age 57.8 +/- 13.8, range: 21.4-88.5) referred for evaluation of pSS at our department, which provides rheumatology services for 704,000 adult residents. Subject assessment included questionnaire about ocular and oral involvement, Schirmer-I test, unstimulated salivary flow (USF) test, Rose Bengal scoring, immunoserological tests, and minor salivary gland biopsy. Gender- and age-specific pSS incidence rates were calculated based on the ACR/EULAR and the AE criteria.
Results
We identified 109 incipient cases of pSS (104 females) according to the ACR/EULAR criteria. Annual incidence rate was 5.2/100,000 adults (95% CI 4.3-6.2), 9.6/100,000 females (95% CI 7.9-11.6) and 0.5/100,000 males 0.5 (95% CI 0.2-1.1). Only 90/109 subjects also fulfilled the AE criteria. The discrepancy in the criteria fulfillment was mainly due to lack of objective sicca symptoms. The 109 subjects with pSS had anti-Ro antibodies in 72%, histologically positive focus score in 83%, while 57 % were positive for both.
Conclusions
The pSS incidence is higher than previously reported in Slovenia, possibly due to the higher sensitivity of the ACR/EULAR 2016 classification criteria in our cohort.
PREDICTIVE VALUE OF ANTIPHOSPHOLIPID ANTIBODIES IN THE ACUTE PHASE OF DEEP VEIN THROMBOSIS
Abstract
Background and Aims
Antiphospholipid syndrome (APS) is an important cause of deep vein thrombosis (DVT), but can be diagnosed by positive antiphospholipid (aPL) test only 24 weeks after DVT. Anticoagulation is usually stopped 3 months after the first DVT episode, which might increase the risk for recurrence in subjects with undiagnosed APS. We evaluated whether APS could be detected by measuring aPL immediately after DVT occurrence.
Methods
196 patients (85 female, 54±2 years) with acute DVT received anticoagulation for 3 months. aPL (aCL IgG/IgM and anti-β2GPI IgG/IgM/IgA) were determined at DVT occurrence and every 4 weeks until week 24. Medium/high aCL titer and/or presence of anti-β2GPI at 24 weeks confirmed APS.
Results
Ultimately, 20/196 (10.2%) patients fulfilled APS classification criteria. Among these, 15/20 (75%) patients had medium or high titer aPL at the time of acute. Two patients (10%) had low positive aCL IgG and one had low titer aCL IgM. Two patients (10%) were negative for aPL, but had later fulfilled APS criteria due to positive LA. Medium/high aCL and/or presence of anti-β2GPI at inclusion had 83% specificity and 90.5% sensitivity for APS. Absence of aPL at inclusion had a negative predictive value of 98.6%.
Conclusions
Here we show that in acute phase of DVT, positive medium or high titer aCL IgG/IgM or anti-β2GPI is suggestive of APS. In these patients continuation of anticoagulation beyond the initial 3 months should be considered.