Background Sjögren's syndrome is an autoimmune disease that involves the exocrine glands. In the criteria declared in 2002 and 2012, salivary gland biopsy remains crucial in diagnosing the disease, and the aggregation of lymphocytes correlates with the disease activity. However, salivary gland biopsy is invasive and is not recommended for monitoring the disease activity. Ultrasonography provides easy access, low cost and real-time image. Recent systemic review indicated ultrasonography revealing abnormalities of salivary glands, which may be helpful for rheumatologist in diagnosing Sjögren's syndrome, but the reliabilities need to be confirmed among different scoring systems.
Objectives To investigate the usefulness of salivary gland ultrasonography in Sjögren's syndrome and its correlations with EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) questionnaires (Seror R, 2011).
Methods 50 patients, including primary and secondary Sjögren's syndrome, as well as some patients with sicca symptoms were enrolled. Ultrasonography by a 13MHz linear probe was performed at parotid and submandibular glands. Each gland was scored from 0 to 4 according to the criteria proposed by previous study (Takagi Y, 2010), with a total maximum score with 16. ESSPRI questionnaires and blood samplings were also performed within 1 week after ultrasonography.
Results Total 31 primary Sjögren's Syndrome, 8 secondary Sjögren's Syndrome, and 13 patients with sicca symptoms were enrolled. The average score of salivary gland ultrasonography was 8, 8, 5 respectively in each group. A significant correlations between salivary gland ultrasonography summation score with serum anti-La (SSB) (p=0.006) and ESSPRI score (p<0.001) were noted. The score also correlated with the fatigue score (p<0.001) and dry score (p=0.001) in the ESSPRI questionnaire, but not with the pain score (p=0.135). The correlations with serum anti-Ro antibody was not significant (p=0.902).
Conclusions Summation score of salivary gland ultrasonography correlated well with serum anti-La titers and ESSPRI score. Ultrasonography provided real-time, easily accessible information on patients' salivary gland conditions, as well as good correlations with patients' subjective discomfort. The relationship between the ultrasonography images and disease activity deserves further investigations.
Jousse-Joulin S, et al. Rheumatology (Oxford). 2015. [Epub ahead of print]
Takagi Y, et al. Ann Rheum Dis 2010;69:1321–4.
Seror R, et al. Ann Rheum Dis 2011;70:968–72.
Disclosure of Interest None declared