Background/Purpose: Salivary gland ultrasonography (SGUS) has recently appeared as a promising tool for a non-invasive diagnosis of primary Sjögren’s syndrome (pSS). However, it is still debated whether it could be used to monitor clinical response during the follow-up. Objective of this study was to assess the usefulness of SGUS in monitoring salivary gland changes and response to treatment in patients with pSS.

Methods:  In this longitudinal study, performed from January 2012 to February 2016, 111 patients with pSS (AECG 2002) were prospectively included and regularly followed over the time. The same operator performed SGUS by using a real-time US scanner (Esaote Technos MPX) with a 7.5-12.5 MHz transducer. The following US parameters were recorded: size, parenchymal echogenicity and inhomogeneity in the parotid and submandibular glands (SM) on both sides, number and location of hypoechoic areas, calcifications and lymph nodes. Changes in different SGUS items were analyzed by using MacNemar test for nominal variables and Wilcoxon test for continuous variables.

Results:  We included 111 (109 F:2M) patients with pSS (AECG 2002). Out of them, 46/111 patients were enrolled at the diagnosis (i.e inception cohort). Patients were prospectively observed for a median (IQR) follow-up of 2 (1-3) yrs. At the inclusion, 75% of the entire cohort and 65% of the inception cohort presented already abnormalities in the echogenicity (i.e fibrosis) and homogeneity (i.e hyperechoic bands) in at least one of the four glands examined. Over the follow-up, a raise in echogenicity and homogeneity was observed only in less than 10% of the patients (p-value=n.s). Approximately 1/3 of the patients of the entire cohort and 15% of the inception cohort presented either reduced parotid glands or SM glands at the baseline. This percentage increased up to 45% and to 30% in the entire cohort and in the inception cohort respectively, at the end of the follow-up (p<0.001). A score ≥2 in the localization of the hypoechoic areas either in parotid or in submandibular glands was observed at the baseline in 42% of the patients (35% inception cohort) and was associated with anti-Ro/SSA, hypergammaglobulinemia, low C3, low C4 and leucopenia. Submandibular parenchyma echostructure (i.e number and location of hypoechoic areas) but not parotid echostructure tend to improve over the follow-up, although the difference was not significant.

Conclusion: SGUS represents an interesting tool to monitor the natural history of glandular involvement in pSS. The use of SGUS to monitor response to therapy in pSS warrants further investigation.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/changes-in-salivary-gland-echostructure-in-patients-with-primary-sjogrens-syndrome-over-the-time-a-four-year-longitudinal-study/