AB0813 POWER DOPPLER AND GREYSCALE CHANGES ON SALIVARY GLAND ULTRASONOGRAPHY IN SJOGREN’S DISEASE: AN OBSERVATIONAL STUDY
Authors: M. Ohshima, T. Suzuki, A. Suzuki
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The Outcome Measures in Rheumatology (OMERACT) developed a scoring system for salivary gland parenchymal inflammation based on power Doppler ultrasound signals (PDs) in Sjogren's disease (SjD) in 2021. However, limited evaluation has been conducted so far, necessitating further studies for broader use in daily practice. <h3>Objectives:</h3> We aimed to investigate changes in PDs and greyscale (GS) of parotid (PG) and submandibular glands (SMG) in real-world medical practice and assess the usefulness of PDs in patients with SjD. <h3>Methods:</h3> Patients diagnosed with SjD by the 2016 ACR/EULAR classification criteria or the revised Japanese Ministry of Health criteria (1999) were included in our hospital study. Data was collected annually for three years following the initial visit. We assessed OMERACT-scored GS and PDs, shear wave elastography (SWE), and shear wave velocity (SWV) in PG and SMG using ultrasound. We also evaluated correlations with the EULAR Sjogren's Syndrome (SS) disease activity index (ESSDAI), the EULAR Sjogren's Syndrome Patient Reported Index (ESSPRI), stimulated salivary flow rate (SSFR) by Saxon's test, Greenspan focus score by labial salivary gland biopsy, anti-SS-A, -SS-B, and -centromere antibodies. Treatments were decided by attending physicians. <h3>Results:</h3> Data were analyzed for 147, 85, 56, and 31 SjD patients at initiation, one, two, and three years later, respectively. Forty-eight cases were secondary SjD. Ninety patients (61%) received immunosuppressants (including mizoribine [42 patients], glucocorticoids [42 patients], hydroxychloroquine [28 patients], abatacept [14 patients], etc.) for over four months, 33 received Japanese-Kampo medicine, five received saliva secretion stimulants, and 35 received no medication. Initial PG PDs scores correlated with initial ESSDAI, and initial SMG PDs scores correlated with initial SSFR, SWE, and SWV. Over two years, SMG PDs scores decreased (initiation: 1.03, two years later: 0.77, <i>p=</i>0.018), while GS scores increased (PG: initiation: 1.45, one year later: 1.68, <i>p=</i>0.017; SMG: initiation: 2.06, one year later: 2.45, <i>p=</i>0.005, two years later: 2.45, <i>p=</i>0.008). PG PDs correlated with future GS (initial PDs with GS at one and two years later, one-year PDs with GS at two years later). Conversely, initial PG and SMG PDs, and one-year SMG PDs, negatively correlated with ESSPRI two years later. In patients receiving immunosuppressants, PDs significantly improved in PG at one year later and SMG at one and two years later, respectively, similar to ESSDAI and ESSPRI trends. SMG GS deteriorated at one year later but recovered at two years later. Unlike initial GS, PDs had no correlation with Greenspan focus score. Among autoantibodies, anti-SS-B correlated with initial PG PDs. <h3>Conclusion:</h3> GS scores worsened, but SMG PD scores decreased over time in SjD patients. PDs correlated with ESSDAI, SSFR, SWE, and SWV. PDs presence suggests the possibility of future salivary gland structural changes. Negative correlations between PDs and future ESSPRI suggest treatment efficacy. Future studies are needed to confirm the practical value of PDs. <h3>REFERENCES:</h3> [1] Hocevar A, Bruyn GA, Terslev L, Agustin JJD, et al. Development of a new ultrasound scoring system to evaluate glandular inflammation in Sjogren's syndrome: an OMERACT reliability exercise. Rheumatol (Oxford) 2022; 61(8): 3341-3350 [2] Lee KA, Lee SH, Kim HR, et al. Ultrasonographic changes of major salivary glands in primary Sjogren's syndrome. J Clin Med 2020; 9: 803 <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>