Background/Purpose: Salivary gland ultrasonography (SGUS) is a promising tool in primary Sjögren’s syndrome (pSS). The objective of this study was to investigate SGUS abnormalities in relation to patient characteristics, disease activity and disease damage in patients with pSS in daily clinical practice.

Methods: The REgistry of Sjögren Syndrome LongiTudinal (RESULT) cohort is an ongoing observational prospective cohort study at the University Medical Center Groningen. For the present analysis, we used data from the baseline visit of patients with pSS, fulfilling the ACR-EULAR criteria, who were included between January 2016 and December 2018 (n=186). At baseline, clinical, patient-reported, functional, imaging, histopathological and serological parameters were obtained according to a fixed protocol. Patients underwent ultrasonographic examination according to the Hocevar scoring system (range 0-48)[1]. SGUS score was considered positive if the Hocevar score was ≥15[2]. Patient characteristics, disease activity and disease damage were compared between SGUS positive and SGUS negative pSS patients.

Results: In total, 172 out of 186 patients were included, with a mean age of 53 years (SD 13.9) and median disease duration of 8 years (IQR 4.0-13.0). 136 patients (79%) were SGUS positive. SGUS positive patients had significant longer disease duration (8.5 vs. 5.0 years; p=0.003), higher EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI) (4.0 vs. 2.0; p=0.028) and higher Sjögren’s Syndrome Disease Damage Index (SSDDI) (2.0 vs. 1.5; p=0.018) compared to SGUS negative patients. Furthermore, SGUS positive patients more often had a positive parotid gland biopsy (i.e. focus score≥1) (90.1% vs. 50.0%; p< 0.001), unstimulated whole saliva flow rate (UWS) ≤0.1ml/min (74.8% vs. 45.7%; p=0.001) and ocular staining score (OSS) ≥5 (41.0% vs. 8.3%; p< 0.001). With respect to serological parameters, SGUS positive patients more frequently had anti-SSA/SSB antibodies (94.1% vs. 75.0% and 61.5% vs. 25.0%), higher levels of IgG (16.9 vs. 11.2; p< 0.001) and rheumatoid factor (21.0 vs. 2.1; p< 0.001), and showed lower levels of leucocytes (5.2 vs. 6.3; p=0.002) and complement C3 and C4 (1.10 vs. 1.20; p=0.012 and 0.18 vs. 0.20; p=0.015). Regarding patient-reported outcome measurements, SGUS positive patients experienced significantly less fatigue (7.0 vs. 8.0; p=0.024) and pain (4.5 vs. 7.0; p< 0.001), as measured by EULAR Sjögren Syndrome Patient Reported Index (ESSPRI), and more often rated their symptoms as acceptable (75.6% vs. 58.3%; p=0.042). SGUS total score showed highest correlation with OSS (ρ=0.532) and UWS (ρ=-0.551).

Conclusion: SGUS positive patients had longer disease duration, higher disease activity and more disease damage compared to SGUS negative patients, whereas SGUS negative patients experienced more fatigue and pain. Therefore, SGUS could assist in the stratification of pSS patients and herewith provide another step towards personalized medicine.

Reference:

1         Hocevar A, et al. Rheumatology (Oxford) 2005;44:768–72.

2         Mossel E, et al. Ann Rheum Dis 2017;76:1883–9.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-phenotyping-of-patients-with-primary-sjogrens-syndrome-using-salivary-gland-ultrasonograhpy/