A retrospective, multicenter study evaluating the prognostic value of minor salivary gland histology in a large cohort of patients with primary Sjögren’s syndrome

Carubbi, F
Alunno, A
Cipriani, P
Bartoloni, E
Baldini, C
Quartuccio, L
Priori, R
Valesini, G
De Vita, S
Bombardieri, S
Gerli, R
Giacomelli, R

¹Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L’Aquila, L’Aquila, Italy
²Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Italy
³Rheumatology Unit, University of Pisa, Pisa, Italy
⁴Rheumatology Clinic, DSMB, University of Udine, Udine, Italy
⁵Rheumatology Unit, La Sapienza University of Rome, Rome, Italy

F.C. and A.A. contributed equally to this article.

Francesco Carubbi, Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L’Aquila, 67100 L’Aquila, Italy. Email: [email protected]

Received August 5, 2014

Received in revised form August 26, 2014

Accepted September 10, 2014

Lupus 24(3):p 315-320, March 2015. | DOI: 10.1177/0961203314554251

Objective

The objective of this report is to investigate the prognostic value of minor salivary glands (MSG) assessment, routinely performed with hematoxilin-eosin (H&E) staining, for the diagnosis of primary Sjögren’s syndrome (pSS).

Methods

We retrospectively evaluated clinical, serological and histological features of 794 pSS patients. H&E-stained sections were assessed using the Chisholm and Mason grading system and/or the focus score (FS).

Results

FS allowed the identification of a number of differences in the disease spectrum, and its prognostic role was further confirmed by quantifying the association between FS value and clinical/serological variables with binary logistic regression. Moreover, hypocomplementemia and FS resulted the only variables associated with lymphoma at univariate analysis, and FS appeared to be associated with lymphoma independently on complement fraction concentrations. Conversely, when patients were divided according to the Chisholm and Mason grading system, we failed to observe any significant difference between subgroups.

Conclusion

In addition to its diagnostic role, our data seem to support that the routine assessment of MSG-FS with H&E staining is useful to predict at the time of diagnosis the adverse outcomes, such as lymphoma and extraglandular manifestations, that complicate the pSS course. On this basis, it should be recommended that an MSG biopsy be performed even in those patients displaying clinical and serological criteria, allowing the diagnosis of pSS independent of histological status.