Background/Purpose:: Primary Sjögren’s syndrome (pSS) is a chronic autoimmune disease that specifically involves salivary glands. Several complementary tools including salivary gland ultrasonography (SGUS), histology and saliva collection have been proposed to estimate glandular inflammation and dysfunction. Few studies have explored the association between SGUS, salivary gland histology and saliva production. Moreover, it has to be elucidated whether an integrated composite evaluation of salivary gland involvement, based on the combination of these different tools, may improve patients’ stratification and management. Aims of this study were: 1) to analyze the correlation between SGUS, saliva production and gland histology, and 2) to assess the prevalence of different subsets of glandular involvement in pSS defined on the basis of the combination of SGUS, histology and sialometry.

Methods: Newly diagnosed pSS patients were consecutively enrolled. Subjects underwent a complete rheumatologic evaluation, SGUS, minor salivary gland biopsy and sialometry (USFR). SGUS was performed by the same operator who graded the echostructure of each gland on a 5-point scale (0–4), defining as pathological a SGUS score ≥2 . Histology evaluation included the assessment of the focus score (FS) and the reporting of the number of germinal centre (GC)-like structures.

Results: We included 90 newly diagnosed pSS patients. Out of them: 51 presented abnormal findings at SGUS and 39 had a normal SGUS. SGUS score correlated better with FS (r=0.642, p=0.001) and GCs (r=0.492, p=0.001) than with USFR (r=-0.361, p=0.003). When SGUS findings were combined with histology and USFR we distinguished four major patterns of salivary involvement. The most common subset was represented by patients (26/90 (29%)) with abnormal SGUS, preserved USFR and a high FS. In addition, 21/90 (23%) pSS patients presented abnormal SGUS findings, reduced USFR and a high FS; 17/90 (19%) patients had normal SGUS, preserved USFR and a low FS, and 17/90 (19%) had normal SGUS, preserved USFR and a high FS. Nine patients presented characteristics intermediate between the mentioned subsets. Patients included in the first two groups presented a higher frequency of anti-Ro/SSA, Rheumatoid factor, hypergammaglobulinemia and salivary gland swelling. Patients with lower USFR presented a reduced size in their submandibular glands at SGUS examination.

Conclusion: This study suggest that an integrated evaluation of salivary gland involvement may allow to better define the relationship between tissue inflammation/damage and functional dysfunction. This composite approach may be useful in pSS phenotyping as a prerequisite towards personalized interventions.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/correlation-between-salivary-gland-ultrasonography-minor-salivary-gland-histhopatology-and-sialometry-towards-a-composite-assessment-of-salivary-gland-involvement-in-primary-sjogrens-syndro/