Background/Purpose:

Sjögren’s syndrome (SS) occurs commonly among rheumatoid arthritis (RA) patients. It may be an indicator of, and even a contributor to, increased RA disease activity and severity. Thus, secondary SS may impact outcome assessment in RA. Diagnosis of SS has traditionally depended on signs and symptoms and serologic test, but also invasive procedures such as minor salivary gland biopsy. Work from several independent groups has shown common, consistent and characteristic findings on parotid and minor salivary gland ultrasound (US) among patients with SS. We used US to assess the parotid and submandibular glands of RA patients, and correlated these findings with clinical characteristics.

Methods:

Patients with an established diagnosis of RA attending UCSD Arthritis clinics were randomly recruited. Parotid and submandibular glands US were performed using a standardized protocol; a total US score was calculated according to an validated system (1,2). This system assesses gland texture (echogenicity), posterior border appearance, and parenchymal homogeneity. The US score was calculated as summation of the grades of 5 parameters for all four glands (range  0 to 48). From the literature, the optimal cut-off score for diagnosing SS was 17. Demographic and clinical information were collected, including the sicca syndrome questionnaire, standard RA patient demographics, functional status (using HAQ), RA disease activity (using RAPID3), dental health assessment (using the oral health impact profile [OHIP] short form; range of scores 0 to 56), and cigarette smoking status. Serologic testing included RF, ACPA, SS-A, SS-B. Schirmer’s test was performed.

Results:

Among the initial 20 patients, half had SS related symptoms per sicca questionairre. Also, 45% patients showed significant ultrasonographic changes (score ≥ 17) in their major salivary glands. Among patients with ultrasonographic salivary changes, 78% had sicca symptoms. The mean dental health assessment score from OHIP short form of patient with US changes was 18.2 compared to 3.2 among patients without US changes. The mean HAQ score was 1.2 among patients with US changes and 0.9 among those without. The mean RAPID3 score of patient with and without US changes was 16.3, and 15.1 respectively. Although ~ 66% patients had abnormal results for Schirmer’s test, there was not a strong correlation with US changes.

Conclusion:

SS related symptoms are common among unselected RA patients, as are abnormalities on parotid and submandibular gland US. Sonographic salivary gland findings correlate with SS related symptoms, and also with overall dental health. Further study to assess the potential correlation between sonographic salivary gland findings and RA disease activity and severity is needed.

References:

1. Cornec D, et al Contribution of salivary gland ultrasonography to the diagnosis of Sjögren’s syndrome: Towards new diagnostic criteria? Arthritis Rheum. 2013 Jan;65(1):216-25

2. Hocevar A, et al Ultrasonographic changes of major salivary glands in primary Sjögren’s syndrome. Evaluation of novel scoring system. Eur J Radiol. 2007 Sep;63(3):379-83

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/parotid-ultrasound-abnormalities-among-rheumatoid-arthritis-patients-prevalence-and-clinical-correlates/