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We thank Mossel and colleagues for their interest in our work.1 2 They raise a number of limitations that we acknowledge and have discussed. In addition, we agree that an understanding of the pathology underlying the abnormal salivary gland ultrasound findings in Sjögren’s syndrome is an important objective to help establish the validity of this tool as a potential outcome measure in clinical trials. As both we and Mossel and colleagues discuss, we did not observe a difference in hypoechoic areas between rituximab and placebo. Similar hypoechoic areas can be observed in long-standing postradiotherapy salivary glands where inflammatory cell infiltrate is variable and of a differing pattern.3–5 Furthermore, the pattern of hypoechoic areas on ultrasound in Sjögren’s syndrome is reminiscent of sialography findings which are characterised by contrast-defined changes …
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