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Response to: Can ultrasound of the major salivary glands assess histopathological changes induced by treatment with rituximab in primary Sjögren’s syndrome?
  1. Benjamin A Fisher1,2,3,
  2. Paul Emery4,5,
  3. Costantino Pitzalis6,
  4. Michele Bombardieri6,
  5. Simon J Bowman1,2,3
  1. 1National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
  2. 2Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
  3. 3Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  4. 4Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, London, UK
  5. 5NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  6. 6William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK
  1. Correspondence to Dr Benjamin A Fisher, Rheumatology Research Group, University of Birmingham, Birmingham B15 2WB, UK; b.fisher{at}

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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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