SAT0443 Diagnostic and predictive evaluation using salivary gland ultrasonography in primary sjogren’s syndrome
Authors: K.-A. Lee, S.-H. Lee, H.-R. Kim
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> There is an increasing need for alternative, non-invasive and reliable diagnostic tools with the potential to improve and simplify the diagnostic process for primary Sjogren's syndrome (pSS). The main advantage of salivary gland ultrasonography (SGUS) is the direct visualisation of structural abnormalities of the salivary glands. Despite these advantages of SGUS, a number of obstacles remain. Different SGUS scoring systems in B-mode were used in previous studies. The diagnostic usefulness of Doppler analysis and glandular size measurement has not been established. Indeed there is no proven prognostic factor for glandular damage in pSS, although a number of studies have revealed the risk factors for lymphoma. <h3>Objectives</h3> We aimed to assess the diagnostic value of SGUS as a single test for the detection of pSS in an integrated manner. We assessed the diagnostic accuracy of three SGUS parameters: the ultrasound (US) grey-scale scoring system, glandular volume measurement, and intraglandular power Doppler US. The secondary aim was to examine the prognostic factors for severe structural changes in major salivary glands based on the SGUS scoring system. <h3>Methods</h3> Patients with pSS (n=94) and idiopathic sicca syndrome (n=44) were evaluated using the SGUS 0–48 scoring system, which comprises five parameters: parenchymal echogenicity, homogeneity, hypoechoic areas, hyperechogenic reflections, and clearness of posterior borders (figure 1). The salivary gland volume and intraglandular power Doppler signal (PDS) were also assessed. A multivariate linear regression analysis was performed to determine the factors associated with SGUS score. <h3>Results</h3> Patients with pSS showed a significantly higher SGUS score than controls [median (IQR): 24.5 (13.0) vs 6 (3.75), p<i>&lt;</i>0.001]. An SGUS cut-off of ≥14 had a sensitivity of 80.9% and a specificity of 95.5% for the diagnosis of pSS. There were no significant differences in the measured volumes and PDS between pSS patients and controls. The SGUS score correlated with unstimulated salivary flow rate (USFR), serum rheumatoid factor and IgG. Double seropositivity with anti-Ro/SS-A and anti-La/SS-B (β=6.060, p<i>=</i>0.001) and USFR (β=−1.913, p<i>&lt;</i>0.001) were independently associated with the SGUS score. <h3>Conclusions</h3> The SGUS scoring system is a valuable diagnostic method for pSS. Double seropositivity of anti-Ro/SS-A and La/SS-B is an independent predictive factor for structural damage of the salivary glands. <h3>References</h3> [1] Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, et al. 2016American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjogren's syndrome: A consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis2017;76:9–16. [2] Jousse-Joulin S, Milic V, Jonsson MV, Plagou A, Theander E, Luciano N, et al. Is salivary gland ultrasonography a useful tool in Sjogren's syndrome? A systematic review. Rheumatology (Oxford)2016;55:789–800. <h3>Acknowledgements</h3> This paper was supported by Konkuk University in 2017 <h3>Disclosure of Interest</h3> None declared