POS1238 LACRIMAL GLAND ULTRA-HIGH FREQUENCY ULTRASOUND IN SJÖGREN’S DISEASE: DIAGNOSTIC ACCURACY AND CLINIC-SEROLOGICAL ASSOCIATIONS OF DISTINCT SONOGRAPHIC PATTERNS
Authors: G. Fulvio, R. Izzetti, V. Donati, C. Porciani, S. Fonzetti, G. La Rocca, I. C. Navarro García, F. Ferro, M. Mosca, C. Baldini
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Sjögren's disease (SjD) is a chronic autoimmune disorder characterized by lymphocytic inflammation and dysfunction of the exocrine glands, particularly the salivary and lacrimal glands. Ultrasonography of Major Salivary Glands (SGUS) is a well-established tool for the identification of the salivary glands' abnormalities in SjD. Recently, a growing interest has arisen in the assessment of the other exocrine glands including lacrimal glands ultrasound (LGUS). However, few studies are available on the employment of ultra-high frequency ultrasound for lacrimal gland evaluation. <h3>Objectives:</h3> i) To evaluate the diagnostic accuracy of lacrimal gland ultra-high frequency ultrasound (LGUHFUS) examination for the diagnosis of SjD and the prediction of LSG biopsy results. ii) To explore possible associations between LGUHFUS, labial histology disease clinico-serological, features. <h3>Methods:</h3> Consecutive patients with suspected SD, undergoing labial salivary gland (LSG) biopsy, were included from Dec 2022 to Dec 2023. Patients were positioned supine with closed eyelids and lacrimal glands were examined using a 48 MHz probe. The following parameters were assessed: dimension, glandular inhomogeneity (Score 0-3), presence of multiple very hypoechoic areas and high perilesional Doppler. Demographic, histological, and clinical features were collected. Serum from each patient was tested for anti-Ro52, anti-Ro60, and anti-SSB/La abs, evaluating the quantitative titer of the autoantibodies with band densitometry. Receiver operating characteristic analysis was calculated to assess the accuracy of UHFUS to predict LSG histology and SjD diagnosis. <h3>Results:</h3> A total of 71 subjects (10 males and 61 females, mean age 53.04±2.03) were evaluated. Out of them, 28 met the ACR/EULAR 2016 criteria for SjD. No demographic differences were observed between SjD patients and no-SjD sicca controls. ROC curve analysis indicated that LGUHFUS greyscale, at the optimal cut-off value of 2, identified SjD and sicca controls with a sensitivity of 89.3 % and a specificity of 82.4% (AUC=0.836, 95%CI: 0.702-0.970). LSG biopsy of subjects with a LGUHFUS Score≥2 showed a higher Focus Score (FS) (0.48 vs 1.71, p&lt;0.0001), a higher number of foci (1.38 vs 5.57, p&lt;0.0001), and of ectopic lymphoid structures (0.38 vs 3.02, p&lt;0.0001). Moreover, LGUHFUS can predict a FS≥1 at the LSG biopsy with a sensitivity of 88.2% and a specificity of 74.7% (AUC= 0.809, 95% CI: 0.700-0.918). Autoantibodies titer was higher in subjects with LGUHFUS Score≥2 (Ro-52/SSA 9.02 vs 59.49, p&lt;0.05; Ro-60/SSA 5.38 vs 48.32, p&lt;0.0001; SSB 2.1 vs 24.86, p&lt;0.05). A trend was observed between the positivity of LGUHFUS and ocular tests abnormalities results (p=0.089). Lacrimal glands with multiple very hypoechoic areas were more frequently enlarged (p&lt;0.001) and characterised by a high perilesional Doppler. Patients with this pattern presented higher antibody titer (IgG 2224 vs 1453, p&lt; 0.05; IgA 208 vs 339, p&lt; 0.05; IgM 136 vs 234, p&lt; 0.05) and higher systemic disease activity measured according to the ESSDAI (4.43 vs 10.25, p&lt;0.12). <h3>Conclusion:</h3> LGUHFUS shows a good diagnostic accuracy for SjD and is associated with both tissue infiltrate in LSG and serological biomarkers. Patients with multiple very hypoechoic areas in their lacrimal glands presented a more severe phenotype characterised by high immunoglobulin levels and clinical activity. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>