Reproducibility of Ocular Surface Staining in the Assessment of Sjögren Syndrome–Related Keratoconjunctivitis Sicca: Implications on Disease Classification

14Citations
Citations of this article
38Readers
Mendeley users who have this article in their library.

This article is free to access.

Abstract

Objective: The objective of this study was to assess the performance and reproducibility of the two currently used ocular surface staining scores in the assessment of keratoconjunctivitis sicca in Sjögren syndrome (SS) research classification. Methods: In a multidisciplinary clinic for the evaluation of sicca, we performed all tests for the American European Consensus Group (AECG) and the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria, including the van Bijsterveld score (vBS) and the Ocular Staining Score (OSS), in 994 participants with SS or with non-SS sicca. We analyzed the concordance between the scores, the diagnostic accuracy and correlation with clinical variables, and interrater and intrasubject reproducibility. Results: A total of 308 (31.1%) participants had a discordant vBS and OSS that was due to extra corneal staining points in the OSS. The presence of one or more of the additional points was highly predictive of SS classification (odds ratio = 3.66; P = 1.65 × 10e-20) and was associated with abnormal results of all measures of autoimmunity and glandular dysfunction. Receiver operating characteristic curves showed optimal cutoff values of four for the vBS (sensitivity = 0.62; specificity = 0.71; Youden's J = 0.33) and five for the OSS (sensitivity = 0.56; specificity = 0.75; Youden's J = 0.31). Notably, there was very poor consistency in interobserver mean scores and distributions (P < 0.0001) and in intrasubject scores after a median of 5.5 years (35% changed status of the ocular criterion). Conclusion: Ocular surface staining scores are useful for SS research classification; however, they are subject to significant interrater and intrasubject variability, which could result in changes in classification in 5%-10% of all subjects. These results highlight the need for objective and reproducible markers of disease that have thus far remained elusive for SS.

References Powered by Scopus

The measurement of observer agreement for categorical data

59325Citations
N/AReaders
Get full text

Intraclass correlations: Uses in assessing rater reliability

18851Citations
N/AReaders
Get full text

A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research

16705Citations
N/AReaders
Get full text

Cited by Powered by Scopus

Ophthalmologic manifestations of primary sjögren’s syndrome

28Citations
N/AReaders
Get full text

Toward better outcomes in Sjögren's syndrome: The promise of a stratified medicine approach

14Citations
N/AReaders
Get full text

Tear metabolomics highlights new potential biomarkers for differentiating between Sjögren's syndrome and other causes of dry eye

14Citations
N/AReaders
Get full text

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Cite

CITATION STYLE

APA

Rasmussen, A., Stone, D. U., Kaufman, C. E., Hefner, K. S., Fram, N. R., Siatkowski, R. L., … Sivils, K. L. (2019). Reproducibility of Ocular Surface Staining in the Assessment of Sjögren Syndrome–Related Keratoconjunctivitis Sicca: Implications on Disease Classification. ACR Open Rheumatology, 1(5), 292–302. https://doi.org/10.1002/acr2.1033

Readers' Seniority

Tooltip

PhD / Post grad / Masters / Doc 13

87%

Professor / Associate Prof. 1

7%

Researcher 1

7%

Readers' Discipline

Tooltip

Medicine and Dentistry 12

71%

Immunology and Microbiology 3

18%

Chemistry 1

6%

Arts and Humanities 1

6%

Save time finding and organizing research with Mendeley

Sign up for free