1.Value of Ultrasound in Rheumatologic Diseases.
Taeyoung KANG ; Laura HORTON ; Paul EMERY ; Richard J WAKEFIELD
Journal of Korean Medical Science 2013;28(4):497-507
The use of musculoskeletal ultrasound in rheumatology clinical practice has rapidly increased over the past decade. Ultrasound has enabled rheumatologists to diagnose, prognosticate and monitor disease outcome. Although international standardization remains a concern still, the use of ultrasound in rheumatology is expected to grow further as costs fall and the opportunity to train in the technique improves. We present a review of value of ultrasound, focusing on major applications of ultrasound in rheumatologic diseases.
Humans
;
Magnetic Resonance Imaging
;
Musculoskeletal System/ultrasonography
;
Osteoarthritis/ultrasonography
;
Rheumatic Diseases/*ultrasonography
;
Sjogren's Syndrome/ultrasonography
;
Spondylarthropathies/ultrasonography
;
Synovitis/ultrasonography
;
Tendinopathy/ultrasonography
;
Vasculitis/ultrasonography
2.Psychiatric and central nervous system involvement in Sjogren's syndrome.
Yan WANG ; Song-ling WANG ; Yi-zhuang ZOU ; Guo-ming LUAN
Chinese Journal of Stomatology 2004;39(2):158-160
OBJECTIVETo study psychiatric features and the manifestations of central nervous system involvement in Chinese patients with primary Sjogren's syndrome (PSS).
METHODSThe Minnesota Multiphasic Personality Inventory (MMPI) was used to study 27 PSS female patients and 57 healthy women. The results from two groups were compared. Ten SS patients were evaluated by electroencephalography (EEG), transcranial doppler ultrasound (TCD) and magnetic resonance imaging (MRI).
RESULTSOf 27 patients tested, the three highest clinical mean scales included Hypochondriasis (Hs), Hysteria (Hy), Psychasthenia (Pt) were found. When PSS group was compared with normal control, T scores of SS patients were significantly higher than the healthy women in Hs, Hy. Abnormal EEG was found in 3 of 9 PSS patients. TCD was abnormal in 5 of 9 patients. MRI in 1 patient showed abnormality.
CONCLUSIONSThis study shows that the personality of PSS patients is abnormal, the features are neuroticism. Central nervous system was markedly involved in Chinese patients with PSS, including abnormal EEG and TCD. The changes of central nervous system may be related to abnormalities of psychiatric changes.
Adult ; Aged ; Electroencephalography ; Female ; Humans ; MMPI ; Magnetic Resonance Imaging ; Middle Aged ; Sjogren's Syndrome ; diagnostic imaging ; physiopathology ; psychology ; Ultrasonography, Doppler, Transcranial
3.Diagnostic performances of salivary gland ultrasonography for Sjögren's syndrome.
Yang LIU ; Fang CHENG ; Yan Ling WANG ; Xian Yan AI ; Zhen Hang ZHU ; Fu Tao ZHAO
Journal of Peking University(Health Sciences) 2022;54(6):1123-1127
OBJECTIVE:
To evaluate the diagnostic performances of salivary gland ultrasonography(SGUS)in Sjögren's syndrome(SS).
METHODS:
A total of 246 patients with dry mouth and/or eyes who were treated in the outpatient department and inpatient department of Rheumatology and Immunology Department of the Ninth People's Hospital, Shanghai Jiaotong University School of Medicine from December 2019 to January 2022 were collected. All patients received SGUS examination and scored by 2019 outcome measures in rheumatology clinical trial (OMERACT)ultrasonic scoring system.Their general information, unstimulated saliva flow rate(USFR), Schirmer test and serological test results were recorded. In the study, 193 cases had lip gland biopsy. The 2016 American College of Rheumatology(ACR)/ European League Against Rheumatism(EULAR)classification criteria were adopted as the diagnostic standard of SS. χ2 test was used to compare the difference of salivary gland ultrasonic scores between the two groups. The receiver operating characteristic(ROC) curve was used to evaluate the accuracy of SGUS in diagnosing SS, and the disease characteristics of SGUS positive group and negative group in the SS patients were compared.
RESULTS:
A total of 175 patients were SS group according to the ACR/EULAR classification, and the remaining 71 patients were non-SS group.There was no significant difference in age [(54.2±11.8) years vs. (53.4±14.9) years, P=0.705] and female (94.4% vs.93.1%, P=1.000) between SS and non-pSS groups. A total of 109 patients were SGUS positive (≥ 2 points), of whom 104 patients met the SS diagnosis and 5 patients did not meet the SS diagnosis. The positive rate of SGUS in SS group was significantly higher than that in non-SS group (59.4% vs. 7.0%, P < 0.001). The accuracy of 2019 OMERACT ultrasonic scoring system to predict ACR/EULAR classification was good, with an area under the curve of 0.762 (95%CI 0.701-0.823). The absolute agreement between the SGUS outcome and ACR-EULAR classification was 69.1%(170/246), with a sensiti-vity of 59.4%(104/175), specificity of 93%(66/71), positive predictive value of 95.4%(104/109) and negative predictive value of 48.2% (66/137). A total of 81 patients were positive SGUS combined with anti-SSA antibody, 100% (81/81) fulfilled the ACR-EULAR criteria, 85 patients were negative SGUS and anti SSA antibody, and 60 patients(70.6%, 60/85) did not fulfil the ACR-EULAR criteria. SGUS positive group had higher antinuclear antibody(ANA) positive rate(83.1% vs. 98.1%, P < 0.001) in the patients with SS.
CONCLUSION
The OMERACT ultrasonic scoring system has high diagnostic value in SS. The combination of SGUS and anti-SSA antibody can improve the diagnostic value.
Humans
;
Female
;
Adult
;
Middle Aged
;
Aged
;
Sjogren's Syndrome/diagnostic imaging*
;
Sensitivity and Specificity
;
China
;
Salivary Glands/pathology*
;
Ultrasonography/methods*
4.Application of ultrasonography scoring system in the assessment of IgG4-related sialadenitis.
Xiao Ran NING ; Zi Qiao WANG ; Shan Shan ZHANG ; Xia ZHANG ; Su Mei TANG ; Yan Ying LIU
Journal of Peking University(Health Sciences) 2019;51(6):1032-1035
OBJECTIVE:
To assess the diagnostic value of salivary gland ultrasonography (SGUS) for IgG4-related sialadenitis.
METHODS:
Ultrasonography examination of major salivary glands was conducted for 48 IgG4-related sialadenitis patients and 50 Sjögren's syndrome patients, whose ages and disease duration were matched. The imaging features were graded using two different scoring systems (0-16 and 0-48, respectively) obtained from the grades of bilateral parotid and submandibular glands. The scores were used to further evaluate the features of salivary gland ultrasonography in IgG4-related sialadenitis and to compare them with Sjögren's syndrome patients. The association of SGUS scores of IgG4-related sialadenitis group with serological tests was analyzed.
RESULTS:
The mean age of IgG4-related sialadenitis group and Sjögren's syndrome group was 49.23 years and 50.44 years, respectively. The serum IgG4 level of the patients in the IgG4-related sialadenitis group was increased, with an average (9.60±6.43) g/L. And the serum IgE level was at a median of 251.5 (123.4-543.6) IU/mL. In the 0-16 system, the scores of submandibular glands of the patients in IgG4-related sialadenitis and Sjögren's syndrome were 6.0 (6.0-8.0) and 4.0 (2.0-8.0), and the scores of the total four glands were 10.0 (8.0-14.0) and 8.0 (4.0-12.0) respectively. In the 0-48 system, the scores of submandibular glands with IgG4-related sialadenitis and Sjögren's syndrome were 18.0 (14.5-20.0) and 11.0 (7.0-14.0), and the scores of the total four glands were 26.0 (18.5-34.0) and 21.5 (15.0-26.3) respectively. It suggested that in the 0-16 system and the 0-48 system, scores of submandibular glands and the total of four glands of IgG4-related sialadenitis were higher than those of Sjögren's syndrome. Meanwhile, the association analysis of 0-48 system showed a positive correlation of SGUS scores with serum IgG4, which also showed a positive correlation of SGUS scores with serum IgE in 0-16 system.
CONCLUSION
Semi-quantitative ultrasonography scoring systems can evaluate and quantify the lesions of salivary glands, which can be helpful in the diagnosis and differential diagnosis of IgG4-related sialadenitis combined with the clinical manifestations, serological indicators and/or histopathological manifestations. Ultrasonography can also assess the activity of IgG4-related sialadenitis preliminarily.
Humans
;
Immunoglobulin G
;
Immunoglobulin G4-Related Disease
;
Middle Aged
;
Salivary Glands
;
Sialadenitis
;
Sjogren's Syndrome
;
Submandibular Gland
;
Ultrasonography
5.Update of Sjogren's Syndrome.
Journal of Rheumatic Diseases 2015;22(3):146-153
We reviewed the recent findings in diagnosis, pathogenesis and management of Sjogren's syndrome. New diagnostic classification criteria for Sjogren's syndrome were published by the American College of Rheumatology in 2012, and validation was completed. Salivary gland ultrasonography has been examined as a diagnostic and prognostic marker for Sjogren's syndrome, and the results have revealed that it has high specificity and low sensitivity. Disease activity assessment tools for Sjogren's syndrome have been developed and validated for upcoming clinical trials. Several associated genes were identified by genome-wide association studies, with large cohorts in Europe and China. Several single nucleotide polymorphisms of Sjogren's syndrome are related to germinal center formation and lymphoma development. New treatment modalities, including interleukin-1 receptor antagonist, anti-CD20, anti-BAFF/Blys, and CTLA4-immunoglobulin were investigated, but the optimal therapeutic compounds have yet to be found.
China
;
Classification
;
Cohort Studies
;
Diagnosis
;
Europe
;
Genome-Wide Association Study
;
Germinal Center
;
Interleukin-1
;
Lymphoma
;
Polymorphism, Single Nucleotide
;
Rheumatology
;
Salivary Glands
;
Sensitivity and Specificity
;
Sjogren's Syndrome*
;
Ultrasonography
6.Usefulness of Magnetic Resonance Sialography for Diagnosis of Idiopathic Chronic Sialadenitis.
Jun Ha HWANG ; Ho Jin AHN ; Jeong Seok CHOI ; Ha Young LEE ; Jae Yol LIM
Korean Journal of Otolaryngology - Head and Neck Surgery 2016;59(1):41-48
BACKGROUND AND OBJECTIVES: The symptoms of salivary diseasess are often nonspecific, and a variety of investigative methods can be employed. Conventional sialography, which is still widely used for diagnosis of salivary ductal pathologies, has the withdrawback of invasiveness and radiation exposure, and thus ultrasound and magnetic resonance (MR) sialography can replace the conventional tools. This study was performed to evaluate the usefulness of MR sialography for the diagnosis of idiopathic chronic sialadenitis. SUBJECTS AND METHOD: From November 2013 to June 2014, we have retrospectively analyzed 26 patients who have had swelling and pain of salivary glands and undergone MR sialography for further diagnosis of the idiopathic salivary obstructive symptom. We analyzed the symptom scores, salivary flow rate (SFR) and parameters of salivary gland scintigraphy. Then we evaluated correlation among MR sialography findings (duct visualization, grade of stenosis at main duct, degree of sialectasis and glandular volume size). RESULTS: Among the 26 patients, stenosis of salivary duct was observed in 14 patients (53.8%), chronic sialadenitis without stenosis in 6 patients (23.1%), Sjogren's syndrome in 3 patients (11.5%), Juvenile reccutent parotitis in 1 patient (3.8%), and 2 patients were norma (7.7%). The degree of sialectasis was significantly correlated with Tmin (time interval, in minutes, from stimulation to minimum count), maximum secretion (p<0.05), and glandular volume size was also significantly correlated with unstimulated SFR (p<0.05). But others did not show any significant correlations. From these findings, we report three cases that were useful to diagnose the gland disease using MR sialography. CONCLUSION: Resutls show that MR sialogarphy indirectly reflects the salivary gland function. Therefore MR sialography can be helpful when the differential diagnosis of idiopathic chronic sialadenitis is difficult with conventional tools.
Constriction, Pathologic
;
Diagnosis*
;
Diagnosis, Differential
;
Humans
;
Parotitis
;
Pathology
;
Radionuclide Imaging
;
Retrospective Studies
;
Salivary Ducts
;
Salivary Glands
;
Sialadenitis*
;
Sialography*
;
Sjogren's Syndrome
;
Ultrasonography
7.Electrolyte Imbalances and Nephrocalcinosis in Acute Phosphate Poisoning on Chronic Type 1 Renal Tubular Acidosis due to Sjogren's Syndrome.
Sung Gun CHO ; Joo Hark YI ; Sang Woong HAN ; Ho Jung KIM
Journal of Korean Medical Science 2013;28(2):336-339
Although renal calcium crystal deposits (nephrocalcinosis) may occur in acute phosphate poisoning as well as type 1 renal tubular acidosis (RTA), hyperphosphatemic hypocalcemia is common in the former while normocalcemic hypokalemia is typical in the latter. Here, as a unique coexistence of these two seperated clinical entities, we report a 30-yr-old woman presenting with carpal spasm related to hypocalcemia (ionized calcium of 1.90 mM/L) due to acute phosphate poisoning after oral sodium phosphate bowel preparation, which resolved rapidly after calcium gluconate intravenously. Subsequently, type 1 RTA due to Sjogren's syndrome was unveiled by sustained hypokalemia (3.3 to 3.4 mEq/L), persistent alkaline urine pH (> 6.0) despite metabolic acidosis, and medullary nephrocalcinosis. Through this case report, the differential points of nephrocalcinosis and electrolyte imbalances between them are discussed, and focused more on diagnostic tests and managements of type 1 RTA.
Acidosis, Renal Tubular/*diagnosis/etiology
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Acute Disease
;
Adult
;
Antibodies, Antinuclear/blood
;
Calcium Gluconate/therapeutic use
;
Chronic Disease
;
Female
;
Humans
;
Hydrogen-Ion Concentration
;
Hypocalcemia/*chemically induced/complications/drug therapy
;
Nephrocalcinosis/complications/*diagnosis/ultrasonography
;
Parotid Gland/ultrasonography
;
Phosphates/*adverse effects
;
Salivary Glands/radionuclide imaging
;
Sjogren's Syndrome/complications/*diagnosis/metabolism
;
Submandibular Gland/ultrasonography