Background/Purpose: Primary SjogrenÕs syndrome (pSS) is a chronic autoimmune disorder that is characterized clinically by dryness of the eyes (xerophthalmia) and mouth (xerostomia). The assayÕs purpose was to observe which laboratory tests, clinical characteristics or activity index could have correlation with ultrasonography (US) glandular scores in a cohort of 66 patients with xerostomia in pSS, prospectively enrolled from September 2013 to May 2016 in two medical centers.  

Methods: The glandular US score was correlated with clinical and laboratory data in 66 patients with pSS according to American-European Consensus Group. criteria (AECG) (male/female ratio 2/64, mean age 55,55 (11.15) years) and median of disease duration 6.0(2.0-10.0). Imaging findings of US were graded using an ultrasonography score ranging from 0 to 4(1), which was obtained considering the worst score between each parotid and submandibular gland. All laboratory tests were done including Immunoglobulin G  (IgG) level and salivary beta 2 microglobulin. Stimulated salivary flux was measured in the same conditions and hour for every patient, with <0,5 ml/min considered abnormal. The xerostomia inventory validated for portuguese language was applied for all patients by a blind investigator(2). One single rheumatologist was responsible for applying the European Sjšgren Syndrome Disease Activity Index (ESSDAI).

Results: Considering each score value in US, our cohort had almost the majority with 3 an 4 scores (83%).  The correlation between higher US scores and clinical and laboratorial parameters was not found. However, higher US scores were correlated with high IgG levels (p=0,0134) and low salivary flux (p=0,0059).

Conclusion: Salivary gland US is a useful method in visualizing glandular structural changes in patients suspected of having pSS and it may represent a good option as a first-line imaging tool in the diagnostics of the disease. In our cohort it was important to show that more important changes matched with lower salivary flux and more inflammatory process. Maybe the ultrasonographic approach in earlier times of disease can change this scenario.

References: 1.   Cornec D et al. Contribution of Gland Salivary Ultrasonography to the Diagnosis of Sjšgren Syndrome. Arthritis Rheum 2013;65:216-225.

2.   Mata ADSP et al. Translation, validation, and construct reliability of a Portuguese version of the Xerostomia Inventory. Oral Diseases 2012;18:293-298.