Background/Purpose: Sjögren’s disease (SjD) is a chronic systemic autoimmune disease primarily affecting the exocrine glands. There is an increasing use of salivary gland ultrasound in SjD due to its good diagnostic yield and noninvasive, radiation-free, low-cost, and reproducible nature. Limited information exists on lacrimal gland ultrasound. The objective was to determine the usefulness of lacrimal and salivary gland ultrasound in diagnosing patients with primary SjD of recent onset compared to primary sicca syndrome.

Methods: We included primary SjD patients of recent onset (≤5 years) who fulfilled the 2016 ACR/EULAR criteria attending a tertiary reference center. We also included sicca controls matched by age(±5 years), sex, and disease duration (±5 years). An ophthalmologist evaluated keratoconjunctivitis sicca, including Schirmer test, OSS score, and Van Bijsterveld Score. We scored the ESSPRI and the Ocular Surface Disease Index [OSDI] questionnaire. We excluded both patients and controls with diabetes mellitus or with a body mass index ≥30.Ultrasound evaluation of the lacrimal and salivary glands (parotid and submandibular) was performed using a GE LOGIQe device with an 8-18 MHz linear probe. The OMERACT and Hocevar ultrasound scales were used for the salivary glands, and the scale reported by Kim et al. (1) for the lacrimal glands.

Results: We included 15 patients with primary SjD and 15 sicca controls. Patients and controls had similar symptoms, disease duration ( 60 months vs 40 months), and ESSPRI scores (6 points and 5 points). SjD patients had a higher degree of tear dysfunction than sicca controls (46.7% and 53.3% vs. 0% and 80% with moderate and mild damage, respectively; p=0.005). However, both groups had similar OSDI scores. Baseline characteristics are shown in Table 1.The OMERACT score had good diagnostic performance, with an AUC of 0.97 (95% CI: 0.89–1; p < 0.0001). The Hocevar scale, using two cut-off points of 14 and 17 points, had a good, adequate diagnostic performance, with an AUC of 0.93 (95% CI: 0.82-1; p < 0.0001) and 0.9 (95% CI: 0.77-1; p < 0.0001), respectively. Regarding the lacrimal gland, the presence of an intraglandular arterial branch, loss of homogeneity, hypoechoic areas, hyperechoic bands, and loss of glandular demarcation were features mainly observed in patients with SjD vs sicca controls (p < 0.0001 for each of them). Finally, we observed a strong correlation between the tear gland and Hocevar scores (rho = 0.83, p < 0.001).

Conclusion: Ultrasonography of both the lacrimal and salivary glands is a valuable diagnostic tool for identifying patients with primary SjD of recent onset from sicca controls.

TABLE 1. Demographic and clinical characteristics of patients with SjD and SICCA syndrome.

Figure 1. Examples of glandular ultrasounds performed on patients with SjD and sicca syndrome.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/diagnostic-performance-of-the-lacrimal-and-salivary-gland-ultrasound-in-patients-with-primary-sjogrens-disease-of-recent-onset-versus-sicca-controls/