Objectives To evaluate ultrasonographic (US) changes in major salivary glands associated with primary Sjogren’s syndrome (pSS) and to determine the usefulness of US in pSS assessment at the diagnosis and during the follow-up.
Methods Sonographic images of 46 consecutive cases of patients with a diagnosis of pSS (AECG criteria) were analyzed by the same radiologist recording the following US parameters: size, parenchymal echogenicity and fibrosis of all major salivary glands. The US findings were correlated to pSS patients’ demographic, clinical, histological and serological data. The ESSDAI was employed to assess pSS activity. Visual analogique scales (VAS) were used as measurement instruments for patients’ subjective symptoms (dry eye, dry mouth and fatigue).
Results Forty-six pSS patients (19 newly diagnosed with a disease duration ≤1 yrs and 27 with a disease duration ≥2 yrs) were enrolled in the study. US features of major salivary glands chronic inflammation were found in 31/46 pSS patients (11/19 vs 20/27, p-value=ns). Eight out of 31 had a symptomatic salivary gland enlargement while 23/31 a subclinical asymptomatic involvement. US features of advanced pSS including inhomogeneous salivary glands with scattered small, oval, hypoechoic or anechoic areas were found in 6/46 pSS patients (1/19 vs 5/27; p-value ns). We found a statistically significant correlation between parotid involvement and disease duration (p=0.01). In particular, the size of the parotid glands was smaller in patients with established pSS with respect to newly diagnosed patients (4/19 vs 15/27, p-value=0.027). No differences were detected between the two groups of patients as far as submandibular glands size, hypoechoic, and inhomogeneous US signs and/or enlarged intra-glandular lymphonodes was related. The involvement of submandibular glands was correlated to the ESSDAI and to the presence of hypergammaglobulinemia, leucopenia and lymphocytopenia. US signs of chronic inflammation of both parotid and submandibular glands were more frequent in patients with a positivity for antinuclear antibodies, anti Ro-SSA and Rheumatoid Factor.
Conclusions Major salivary glands US may be an useful tool in the early detection of subclinical glandular involvement in pSS with the advantage of noninvasiveness and ease of use.
Disclosure of Interest None Declared
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