Background/Purpose: Recently, convincing data have been published on the diagnostic value of salivary gland ultrasonography (SGUS) in primary Sjögren’s syndrome (pSS). However, a limited number of information are available on the contribution of SGUS in the patients’ prognostic assessment and in the monitoring of the response to therapy during the follow-up. Aim of the study was to prospectively evaluate if SGUS might have a role in the prognostic stratification and in the monitoring of the disease activity in patients with pSS over the follow-up.

Methods:

The study population consisted of consecutive patients with a diagnosis of pSS (AECG 2002) who prospectively underwent clinical, laboratory and SGUS assessment at baseline, at 12 and at 24 months. An experienced rheumatologist scored the EULAR Sjögren’s Syndrome Activity Index (ESSDAI) at each follow-up time point. Patients received the “best-available-therapy” according to the clinical practice.  SGUS was performed by the same radiologist blinded to the rheumatologist clinical assessment. The parotid and submandibular glands  were  scanned on both sides by using a real-time US scanner (Esaote Technos MPX) with a 7.5-12.5 MHz transducer and the following US parameters were recorded: size, parenchymal echogenicity and inhomogeneity in the parotid and submandibular glands on both sides. A previously reported ultrasound scoring system (De Vita et al 1992) was used to grade the echostructure alterations of the salivary glands. Baseline, 12 months and 24 months SGUS results were compared using the non-parametric Friedman test for multiple comparisons. Correlation between SGUS and ESSDAI changes throughout the follow-up period was assessed using the Spearman linear correlation coefficient. Statistical significance was accepted at p<0.05.

Results:

From January 2012 and January 2014, 68 pSS patients were enrolled in this study (median (IQR) age: 54 (45-64) years). At the baseline 28/68 (41.2%) presented a SGUS score ≥2. These patients, when compared to the group of patients with a SGUS score <2, presented more frequently low C4 levels (p=0.04), positivity for anti-Ro/SSA (p<0.0001) and higher mean ESSDAI scores, with the ESSDAI positively correlating with the SGUS score (r=0.571, p<0.0001). Over the follow-up we still observed a positive correlation between the changes in the ESSDAI and the changes in the SGUS score (r=0.490, p<0.0001). However, no statistically significant differences were detected over the follow-up in the SGUS score across the multiple test performed and at the end of the study patients with grossly inhomogenous glands still presented evident inhomogeneities.

 Conclusion: This study highlighted the positive correlation between SGUS score and pSS disease activity. However, further research is needed before a conclusion can be made regarding the possibility of using SGUS in the assessment of the response to therapy in pSS.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/longitudinal-examination-with-salivary-gland-ultrasonography-sgus-of-patients-with-primary-sjogrens-syndrome-a-single-center-experience/