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Open Access Research article

Level of agreement between 2002 American–European Consensus Group and 2012 American College of Rheumatology classification criteria for Sjögren’s syndrome and reasons for discrepancies

Divi Cornec12, Alain Saraux12, Béatrice Cochener3, Jacques-Olivier Pers24, Sandrine Jousse-Joulin12, Yves Renaudineau25, Thierry Marhadour1 and Valérie Devauchelle-Pensec126*

Author Affiliations

1 CedexService de Rhumatologie, CHRU Brest, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest Cedex, France

2 EA 2216 Immunologie et Pathologie, SFR ScinBios, Labex ‘Immunotherapy, Graft, Oncology’, Faculté de médecine de Brest, avenue Camille Desmoulins, 29200 Brest, France

3 Service d'Ophtalmologie, CHRU Brest, Hôpital Morvan, Avenue Foch, 29609 Brest Cedex, France

4 Service d'Odontologie, CHRU Brest, Hôpital Morvan, Avenue Foch, 29609 Brest Cedex, France

5 Laboratoire d'Immunologie, CHRU Brest, Hôpital Morvan, Avenue Foch, 29609 Brest Cedex, France

6 Service de Rhumatologie, Hôpital de la Cavale Blanche, BP 824, F 29609 Brest Cedex, France

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Arthritis Research & Therapy 2014, 16:R74  doi:10.1186/ar4514

Published: 19 March 2014

Abstract

Introduction

The aims of this study were to assess agreement between the currently used 2002 American–European Consensus Group (AECG) classification criteria and the new 2012 American College of Rheumatology (ACR) criteria for Sjögren’s syndrome (SS) and to identify potential sources of disagreement.

Methods

We studied 105 patients between 2006 and 2013 from the Brittany cohort of patients with suspected SS. AECG criteria were applied using only Schimer’s test and unstimulated whole salivary flow (UWSF) to assess objective ocular and oral involvement, since these are the tests most physicians use in clinical practice. Agreement between the two sets of criteria was assessed using Cohen’s κ coefficient.

Results

Of those studied, 42 patients fulfilled AECG and 35 ACR criteria. Agreement between the two sets was moderate (κ = 0.53). Patients fulfilling ACR but not AECG criteria (n = 8) were significantly younger and had shorter symptom durations, but only three of them had SS in the opinion of the evaluating physician. Xerostomia and xerophthalmia (AECG set only) did not discriminate between patients with and without SS. The use of UWSF in the AECG but not the ACR criteria explained part of the disagreement. The serological item in the ACR set (positive rheumatoid factor and antinuclear antibody ≥1:320 or anti-SSA/SSB positivity) did not result in classification differences compared to anti-SSA/SSB antibody alone (AECG set). Agreement between ocular staining score ≥3 (ACR set) and Schirmer’s test ≤5 mm/5 min (AECG set) was very low (κ = 0.14).

Conclusions

Agreement was only moderate between ACR and AECG criteria, suggesting these two sets would not select comparable patient populations. An international consensus about which classification criteria should be used in clinical studies is needed.