Yu K, Ying GS, Vivino FB, Massaro-Giordano M, Bunya, VY. A New Screening Questionnaire for Sjögren’s Syndrome in a Rheumatology Setting. World Cornea Congress VIII. 2020 May 14-15.

Purpose:

The diagnosis of Sjögren’s syndrome (SS) is complex and often delayed due to the presence of nonspecific symptoms and a lack of screening tools. We utilized data from the Sjögren’s International Collaborative Clinical Alliance (SICCA) study to develop a new screening questionnaire for Sjögren’s syndrome for use in rheumatology clinics. 

Methods:

The Sjögren’s Screening Questionnaire for Rheumatologists (SSQR) was developed using data from 974 patients referred by a rheumatologist to the SICCA study. Patients answered 88 questions on symptoms, medical history, and demographics. They underwent ocular exams, dental exams, and serologic tests to be classified as SS or non-SS using the 2016 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria. We conducted univariate and multivariate logistic regression to identify questions most discriminative of SS for inclusion in the SSQR. We developed a simple point-based scoring system to compute a patient’s likelihood of SS (“SSQR score”).

Results:

Five questions were identified as being most discriminative of SS in the multivariate analysis (p<0.05): 1) Can you eat a cracker without drinking a fluid/liquid? [No = OR 1.39 (95% CI 1.06-1.82)]; 2) How would you describe your dental and oral health in general? [Fair or Poor = OR 1.68 (1.04-2.75)]; 3) During the last week have you experienced tearing? [None of the time = OR 2.26 (1.23-4.34)]; 4) Are you able to produce tears? [No = OR 1.62 (1.12-2.37)]; and 5) Do you currently smoke cigarettes? [No = OR 2.83 (1.69-4.91)]. A SSQR score of greater than or equal to 7 (possible range 0-11) was able to distinguish SS from non-SS patients with a 64% sensitivity and 58% specificity (AUC=0.65).

Conclusion:

The SSQR is a simple, easy-to-use, 5-item questionnaire that will allow rheumatologists to quickly screen patients for possible SS. To our knowledge, it is the first evidence-based screening algorithm for SS in the rheumatology setting and has the potential to reduce delays in the diagnosis of SS after the tool has been validated. 

Kimberley Yu, M2, Perelman School of Medicine at the University of Pennsylvania