POS1262 ULTRASONOGRAPHIC CHANGES IN THE MAJOR SALIVARY GLANDS AS A POTENTIAL MARKER OF DISEASE SEVERITY AND LUNG INVOLVEMENT IN PRIMARY SJOGREN’S SYNDROME
Authors: P. Rubortone, S. Piunno, G. Calabrese, A. Capacci, M. A. D’ Agostino
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The exocrine glands, especially the salivary glands, stand as the central target in primary Sjögren's syndrome (pSS). In this context, the salivary epithelial cells actively participate in the abnormal immune response by assuming the role of antigen-presenting cells. This dual action unfolds into the production of autoantibodies with potential pathogenic roles and the concurrent destruction of the salivary glands. In the past few years, ultrasound (US) has become a widely used and easily reproducible method for examining salivary glands in pSS. According to recent data [1], more pronounced ultrasound alterations in the parotid and submandibular glands may be indicative of a higher biologic disease activity. <h3>Objectives:</h3> To assess the association between ultrasonographic alterations of major salivary glands and disease phenotypes in pSS. <h3>Methods:</h3> Fifty-nine (59) patients (54 females and 5 males) diagnosed with pSS according to ACR/EULAR 2016 criteria for pSS [2] underwent gray scale ultrasound evaluation of the parotid and submandibular glands. The gland echostructure was evaluated using the semi-quantitative OMERACT score [3]: grade 0, normal; grade 1, mild US heterogeneity without hypo-anechoic areas; grade 2, moderate heterogeneity with hypo-anechoic areas; grade 3, severe heterogeneity with hypo-anechoic areas occupying the entire gland or complete fibrosis. The gland with the highest score was considered for each patient. Data on organ involvement, serological profile, xerostomia assessed by VAS scale, comorbidities, disease duration, and demographic information were collected for each patient. <h3>Results:</h3> More than one-third of patients (21 patients, 35.6%) showed moderate-severe US alterations (grade 2-3 according to OMERACT). These patients did not differ from those with mild US alterations (38 patients with grade 0-1 according to OMERACT) in terms of sex, age, disease duration, smoking exposure, and VAS xerostomia. However, patients with moderate-severe US alterations had a significantly higher risk of connective tissue-related interstitial lung disease (6/21: 4 NSIP, 1 LIP, 1 pulmonary amyloidosis) compared to patients with mild US alterations (2/38: 1 NSIP, 1 NSIP/BOOP; OR 7.2, 95% CI: 1.47 – 36.8; P=0.019). Additionally, patients with pSS and rheumatoid factor (RF) positivity (22/59) had a significantly higher risk of moderate-severe US alterations compared to RF-negative patients (13/22 vs. 8/37 with grade 2-3 according to OMERACT; OR 5.23, 95% CI: 1.67 – 16.3; P=0.0053). <h3>Conclusion:</h3> The detection of moderate-severe US alterations in major salivary glands in pSS could indicate the presence of a more severe pathology, justifying targeted diagnostic investigations, due to the potential morbidity and often subclinical presentation of lung organ damage. From a pathogenetic standpoint, lung and salivary gland parenchyma might share a common target for the immune response; additional studies could elucidate the causal and temporal immunopathological relationships between the respective organ damages. Finally, the positivity of RF remains a key indicator of the disease's severity. <h3>REFERENCES:</h3> [1] Schmidt NS, et al. PLoS One. 2022 Dec 12;17(12):e0265057. [2] Shiboski CH et al. Arthritis Rheumatol. 2017 Jan;69(1):35-45. [3] Finzel S, et al. Rheumatology (Oxford). 2021 May 14;60(5):2169-2176. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>