THU0332 ULTRASONOGRAPHIC EVALUATION FOR SALIVARY GLAND INVOLVEMENT IN SYSTEMIC SCLEROSIS
Authors: J. S. Kim, H. S. Kim, K. A. Lee
Journal: Annals of the Rheumatic Diseases (2020)

Background: While salivary gland ultrasound (SGUS) has widely used for evaluating Sjögren’s syndrome, information on SGUS findings of systemic sclerosis (SSc) is limited. Objectives: We aimed to evaluate the salivary gland involvement in patients with SSc using SGUS. Methods: We consecutively included patients with SSc fulfilling American College of Rheumatology/European League against Rheumatism (ACR/EULAR) 2013 classification criteria, primary Sjögren’s syndrome (pSS) fulfilling ACR/EULAR 2016 classification criteria, and idiopathic sicca syndrome. All patients underwent SGUS examination using the Outcome Measures in Rheumatology (OMERACT) definition of a SGUS scoring system. The hyperechoic bands using 0-3 scoring system (none/&lt;25% of the parenchyma/25-50% /&gt;50%) and intraglandular power Doppler signal (PDS) were assessed. Hocevar scoring system (0-48) comprising parenchymal echogenicity, homogeneity, hypoechoic areas, hyperechogenic reflections, and clearness of posterior borders were also evaluated. Results: A total of 147 patients were included in the study: SSc (n=59), pSS (n=56), and idiopathic sicca syndrome (n=32). The proportion of the highest OMERACT grades among the four glands≥ 2 were significantly higher in SSc (54.2%) and pSS (62.5%) than idiopathic sicca syndrome (3.1%). Total OMERACT SGUS scores, total fibrosis scores, Hocevar score were significantly higher in SSc and pSS compared to idiopathic sicca syndrome (Table 1). The proportion of the highest fibrosis grades among the four glands ≥2 were significantly higher in SSc (79.7%) than pSS (62.5%) and idiopathic sicca syndrome (46.9%). There were no significant differences in PDS among 3 groups. Twenty-one patients (65.6%) of 32 SSc patients with OMERACT grade ≥2 were anti-centromere antibody (ACA)-positive compared with 9/27 (33.3%) SSc patients with scores of 0–1. The positivity of anti-Ro-60/SSA were also significantly higher in SSc patients with SGUS grade ≥2 (37.5%) than those with SGUS scores of 0–1 (3.7%). In SSc group, there was no significant difference in auto-antibody profile and organ involvement between patients with fibrosis scores ≥2 and those with scores 0-1. Table 1. Characteristics of the study population included in the study SSc (n =59) pSS (n =56) Idiopathic sicca syndrome (n =32) P - value (SSc vs pSS) P - value (SSc vs idiopathic sicca) P - value (pSS vs idiopathic sicca) Age, mean (SD), years 54.8 (12.1) 60.5 (11.9) 62 (11.2) 0.013 0.006 0.559 Female, n (%) 53 (89.8) 56 (100) 28 (87.5) 0.028 0.737 0.015 Anti-Ro-60/SSA, n (%) 13 (22.0) 39 (69.6) 7 (21.9) &lt;0.001 0.986 &lt;0.001 ACA, n (%) 30 (30.8) 8 (14.3) 2 (6.3) &lt;0.001 &lt;0.001 0.238 Anti-topoisomerase, n (%) 16 (27.1) 0 (0) 0 (0) &lt;0.001 &lt;0.001 1.000 Max OMERACT US grade ≥ 2, n (%) 32 (54.2) 35 (62.5) 1 (3.1) 0.369 &lt;0.001 &lt;0.001 Total SGUS scores, median (IQR) 4.0 (6) 7.0 (8) 0 (1) 0.231 &lt;0.001 &lt;0.001 Max fibrosis US grade ≥ 2, n (%) 47 (79.7) 35 (62.5) 15 (46.9) 0.042 0.004 0.263 Total fibrosis scores, median (IQR) 6 (3) 6 (6) 4 (4) 0.674 &lt; 0.001 0.006 PDS sum scores of four salivary glands, median (IQR ) 2 (5) 0 (4) 0 (2) 0.131 0.152 1.000 Conclusion: Based on OMERACT definitions for SGUS, more than half of the patients with SSc, especially those with ACA, had salivary gland involvement. Salivary glandular fibrosis is more prominent in patients with SSc than those with pSS and idiopathic sicca syndrome. References: [1]Jousse-Joulin S, et al. Video clip assessment of a salivary gland ultrasound scoring system in Sjogren’s syndrome using consensual definitions: an OMERACT ultrasound working group reliability exercise. Ann Rheum Dis. 2019;78(7):967-73. Disclosure of Interests: None declared