AB0321 SALIVARY GLANDS ULTRASONOGRAPHY AS A DIAGNOSTIC TOOL IN PRIMARY SJÖGREN’S SYNDROME ON THE RUSSIAN COHORT OF PATIENTS
Authors: J. Khvan, A. Torgashina, B. Chalcev, E. Sokol
Journal: Annals of the Rheumatic Diseases (2021)

Background: In the international scientific community there has been a long discussion about the role of ultrasound and ultrasound scores for assessing the structure of the salivary glands in Sjögren’s syndrome. Stomatological examination according to The American College of Rheumatology (ACR) 2012 classification criteria of primary Sjögren’s syndrome (pSS) includes only labial salivary gland biopsy (focus score - FS) and the ACR with European League Against Rheumatism (ACR/EULAR) 2016 criteria include FS and unstimulated saliva flow test (SFT). Objectives: to compare the diagnostic value of ultrasonography salivary glands (SGUS) with other methods (sialography, stimulated SFT, FS). Methods: From 2016 to 2020, we examined 94 patients (93 women, 1 man) with the mean age 48.6 ± 14.3 years (minimum 18, maximum 78) with newly diagnosed pSS according to Russian criteria 2001, 86% of patients fulfilled ACR 2012 criteria and 87% - the ACR/EULAR 2016 criteria. All patients underwent classical examination (stomatological, ophthalmological, immunological), and SGUS was performed using GE LOGIQ 9 on the two parotid and two submandibular glands. Ultrasound images were evaluated with the OMERACT SS severity scoring system from grades 0 to 3 (1). Statistical analyses (Spearman coefficient p &lt;0.05) were performed using STATISTICA version 12. Results: All patients in SGUS had inhomogeneity structure from mild to diffuse with hypoechoic areas from single to multiple. 4 patients had no signs of sialectasia on sialography, however, in ultrasound we found SGUS grade 2. In 5 patients with SGUS grade 0 we determined punctate sialectasia. Detailed characteristics of patients are presented in Table 1. Table 1. Parameters N % Oral dryness 78 83,0 Enlargement of parotid salivary glands 32 34,0 Recurrent parotitis 19 20,2 Retention pain 31 33,0 RF positive &gt;2UNL (&gt;30 IU/ml) 51 54,2 anti-SSA (anti-Ro) positive (&gt;25 IU/ml) 81 86,1 anti-SSB (anti-La) positive (&gt;25 IU/ml) 48 51,0 ANA ≥ 1:320 94 100,0 SGUS 0 8 8,5 SGUS 1 1 1,0 SGUS 2 20 21,2 SGUS 3 65 69,1 Stimulated SFT &lt; 2,5ml/5 min 59 62,8 Sialectasia on parotid sialography 90 94,7 Punctate sialectasia 12 12,6 Globular sialectasia 63 66,3 Cavitary sialectasia 10 10,5 Distructive sialectasia 6 6,3 FS ≥ 1foci/4 mm2 83 88,2 Correlation was calculated for each SGUS (0-3) with clinical and classical methods of examination of the salivary glands. Pronounced changes in SGUS 3 correlated with recurrent parotitis r = 0.22 (p = 0.03), enlargement of parotid salivary glands r = 0.23 (p = 0.02) and cavitary sialectasia r = 0.23 (p = 0.02). Histological changes FS ≥ 1 correlated with all grades on ultrasound (SGUS 0 r = -0.24 (p = 0.01), SGUS 1 r = 0.41 (p = 0.000027), SGUS 2 r = - 0.21 (p = 0.03), SGUS 3 r = 0.40 (p = 0.00006)). The punctate sialectasia correlated with SGUS 1 r = -0.28 (p = 0.005) and SGUS 0 r = 0.45 (p = 0.000004). Stimulated SFT didn’t correlate with ultrasound changes. Conclusion: : Probably, in everyday clinical practice, SGUS can be used as an additional method for salivary gland assessment, given the availability and safety of the method. The most convenient system for assessing the salivary glands, at present, is the OMERACT SS severity scoring system, however, now we don’t have a score for the complete differentiation in pSS and lymphoproliferative complications. References: : [1]Jousse-Joulin, Sandrine et al. “Video clipassessment of a salivary gland ultrasound scoring system in Sjögren’s syndrome using consensual definitions: an OMERACT ultrasound working group reliability exercise.” Annals of therheumatic diseases vol. 78,7 (2019): 967-973. doi:10.1136/annrheumdis-2019-215024 Disclosure of Interests: None declared