POS0781 PERFORMANCE OF MAJOR SALIVARY GLAND ULTRASOUND FOR THE DIAGNOSIS OF SJÖGREN’S SYNDROME IN CLINICAL PRACTICE
Authors: M. C. Tenazinha, V. C. Romão, J. Polido-Pereira, N. Khmelinskii, R. Barros, F. M. Diamantino Saraiva, J. E. Fonseca
Journal: Annals of the Rheumatic Diseases (2021)

Background: There is no specific test to diagnose Sjögren’s Syndrome (SS) although available classification criteria intended for research purposes help guide the diagnosis. Major salivary gland ultrasound (MSGUS) may contribute to SS diagnosis. Objectives: To study the performance of MSGUS for the clinical diagnosis of SS and its relationship with other relevant markers of disease. Methods: We included patients with a clinical suspicion of SS that underwent MSGUS evaluation at our Department. Parotid and submandibular glands were classified bedside on a 0-4 scale, based on tissue inhomogeneity. The score of the highest graded gland was considered and a score ≥2 was defined as a positive MSGUS. Minor salivary gland biopsy (mSGB) was considered positive if a focus score ≥1 was reported. We compared MSGUS findings across diagnoses and against mSGB result and anti-SSA status. Categorical variables were compared using the chi-square test. Continuous variables were compared using Student’s t-test, Mann-Whitney U test, or ANOVA. P-value was considered significant at &lt;0.05. Results: A total of 219 patients were included (Table 1). MSGUS was positive in a higher proportion of patients with primary and secondary SS, in comparison to non-Sjögren’s sicca syndrome (nSSS) and undifferentiated connective tissue disease (UCTD; p&lt;0.001). Mean MSGUS score was higher in SS patients in comparison to nSSS and UCTD (p&lt;0.001). A positive MSGUS was associated with anti-SSA positivity (61.4% vs 38.6% in anti-SSA negative patients; p&lt;0,001). Patients positive for anti-SSA had a higher mean MSGUS score (2.12 ± 1.03) in comparison with anti-SSA negative patients (1.31 ± 0.97, p&lt;0.001). While MSGUS and mSGB were not significantly associated (p=0.237), the mean MSGUS score was higher in patients with a positive mSGB (1.95 ± 1.17) in comparison with those with a negative mSGB (1.61 ± 0.99; p=0.027). Table 1. General sample characteristics Overall (n=219) pSS (n=131) sSS (n=17) nSSS (n=62) UCTD (n=9) p-value Age , years (mean ± sd) 60 ± 14 58 ± 17 56 ± 19 60 ± 13 48 ± 16 0.07 Female , n (%) 210 (95.9) 127 (97.0) 15 (88.2) 59 (95.2) 9 (100) &lt;0.001 Anti-SSA positive , n (%) 105 (47.9) 91 (69.5) 10 (5.8) 3 (4.8) 1 (11.1) &lt;0.001 Positive mSGB , n (%) 85 (46.4) 69 (63.3) 7 (46.7) 8 (15.7) 1 (12.5) &lt;0.001 MSGUS score , mean ± sd 1.70 ± 1.09 1.98 ± 1.09 1.76 ± 1.11 1.13 ± 1.09 1.44 ± 1.12 &lt;0.001 Grade 0, n (%) 35 (16.0) 17 (13.0) 3 (17.7) 15 (24.2) 0 (0.0) &lt;0.001 Grade 1, n (%) 62 (28.3) 25 (19.1) 4 (23.5) 27 (43.6) 6 (66.7) Grade 2, n (%) 62 (28.3) 39 (29.8) 4 (23.5) 17 (27.5) 2 (22.2) Grade 3, n (%) 54 (24.7) 44 (33.6) 6 (35.3) 3 (4.9) 1 (11.1) Grade 4, n (%) 6 (2.7) 6 (4.6) 0 (0.0) 0 (0.0) 0 (0.0) MSGUS score ≧ 2, n (% ) 122 (55.7) 89 (67.9) 10 (58.8) 20 (32.3) 3 (33.3) &lt;0.001 Conclusion: MSGUS is a valuable resource in the investigation of SS. It is associated with clinical diagnosis, anti-SSA and MSGB findings. Together with these other complementary exams, it can be used to assist in the diagnosis of patients presenting with sicca features suggestive of SS. References: [1]Jousse-Joulin S, Milic V, Jonsson MV, Plagou A, Theander E, Luciano N, et al. Is salivary gland ultrasonography a useful tool in Sjögren’s syndrome? A systematic review. Rheumatology (Oxford). 2016 May;55(5):789–800. [2]Zhou M, Song S, Wu S, Duan T, Chen L, Ye J, et al. Diagnostic accuracy of salivary gland ultrasonography with different scoring systems in Sjögren’s syndrome: a systematic review and meta-analysis. Sci Rep. 2018 Dec;8(1):17128. [3]Cornec D, Jousse-Joulin S, Pers J-O, Marhadour T, Cochener B, Boisramé-Gastrin S, et al. Contribution of salivary gland ultrasonography to the diagnosis of Sjögren’s syndrome: toward new diagnostic criteria? Arthritis Rheum. 2013 Jan;65(1):216–25. Disclosure of Interests: Maria Catarina Tenazinha: None declared, Vasco C Romão: None declared, Joaquim Polido-Pereira: None declared, Nikita Khmelinskii Speakers bureau: GSK, Rita Barros: None declared, FERNANDO MANUEL DIAMANTINO SARAIVA: None declared, Joao Eurico Fonseca: None declared