## 4 Discussion  
The aim of our study was to investigate the prevalence, clinical significance and changes in the findings observed in routine abdominal ultrasound in a large clinical cohort of SARD patients. To the best of our knowledge, this is the first study evaluating abdominal ultrasound findings in SARD patients systematically. There are only limited data available on the results of abdominal ultrasound examination in patients with SARD. Most frequent findings observed in all SARD entities were hepatic steatosis (26.8% of all patients), pancreatic lipomatosis (14.3% of all patients), aortic sclerosis (13.9% of all patients) and hepato- and splenomegaly (8.1% and15.2% of all patients, respectively). Hepatic steatosis is frequently observed in SLE [7,8] and associated with glucocorticoid use [7,9]. A cohort study on 607 patients with RA, SLE, SS, SSc, PM, DM and MCTD described hepatic steatosis as a possible cause for elevated liver enzymes [10]. Pancreatic lipomatosis has not yet been studied in SARD patients, but it seems to be related to hepatic steatosis [11,12]. Pancreatic lipomatosis is also associated with insulin resistance and diabetes mellitus [13] and with metabolic syndrome [14,15]; the latter condition has been observed to occur frequently in SLE [16,17], RA [18] and PM [19]. Patients with SARD diseases carry a high cardiovascular risk [20,21]. Several recommendations highlight the importance of screening for cardiovascular health in patients with rheumatic diseases [22, 23, 24, 25]. Hence, the finding of hepatic steatosis or pancreatic lipomatosis might prompt the rheumatologist to screen for further cardiovascular risk factors. Splenomegaly is a common condition in SLE [26] and may coexist with hepatomegaly [26]. The cause for splenomegaly in SLE is unknown. In an autopsy study on SLE patients, periarterial fibrosis of the spleen was a frequent finding [27] and has been proposed as a possible cause for splenomegaly [26]. To date, there are little data on the relationship between the enlargement of the spleen or liver and disease activity in SARD patients. A study by [PERSON] et al. examined sonographic measurements of the liver and spleen in 30 SLE patients and 30 healthy controls and observed posterior cranio-caudal measurements of the right hepatic lobe to be significantly higher in SLE patients and correlated with higher disease activity scores [1]. All other hepatic and splenic dimensions did not differ significantly between SLE patients and controls; although, a long disease duration in SLE was found to correlate with spleen atrophy [1]. In our study, we observed a correlation of hepatomegaly and the need for escalating immunosuppressive therapy. Our data are thus in line with data reported by [PERSON] [1] that hepatomegaly might be an expression of disease activity not only in SLE but also in other SARD entities. The idea of hepatomegaly being a dynamic state is also supported by our observation that it sometimes resolved in intermediate examinations. \begin{table}
\begin{tabular}{c c c c c c c c c} \hline \hline  & \begin{tabular}{c} **Number of** \\ **All Cases** \\ \end{tabular}  & \begin{tabular}{c} **Number of** \\ **Class Without** \\ **Increase** \\ \end{tabular}  & \begin{tabular}{c} **Class with Finding** \\ **Within Cases Without** \\ **Increase** \\ \end{tabular}  & \begin{tabular}{c} **Number of** \\ **Cases with** \\ **Increase** \\ \end{tabular}  & \begin{tabular}{c} **Cases with Finding** \\ **Within Cases with** \\ **Increase** \\ \end{tabular}  & \(p\)**Value** \\ \hline \multicolumn{1}{c}{\ \begin{tabular}{c} Pericardial effusion (n = 6) \\ Pleural effusion (n = 78) \\ Astics (n = 19) \\ Hepatomegaly (n = 82) \\ Altered renal edgeicity (n = 82) \\ Altered renal edgeicity (n = 44) \\ Altered renal edgeicity (n = 10) \\ Inhomogeneous pancreatic \\ parenchyma (n = 21) \\ Pancreatitis (n = 1180) \\ Pancreatitis (n = 1180) \\ Aorticins (n = 10) \\ Ctitis (n = 82) \\ Ctitis (n = 82) \\ Aorticité aneurysm (n = 4) \\ Liver cirrhosis (n = 8) \\ \end{tabular}