Ab0321 salivary Glands Ultrasonography as a Diagnostic Tool in Primary Sjögren’s Syndrome on the Russian Cohort of Patients

Abstract

Background:In the international scientific community there has been a long discussion about the role of ultrasound and ultrasound scores for assessing the structure of the salivary glands in Sjögren’s syndrome. Stomatological examination according to The American College of Rheumatology (ACR) 2012 classification criteria of primary Sjögren’s syndrome (pSS) includes only labial salivary gland biopsy (focus score - FS) and the ACR with European League Against Rheumatism (ACR/EULAR) 2016 criteria include FS and unstimulated saliva flow test (SFT).Objectives:to compare the diagnostic value of ultrasonography salivary glands (SGUS) with other methods (sialography, stimulated SFT, FS).Methods:From 2016 to 2020, we examined 94 patients (93 women, 1 man) with the mean age 48.6 ± 14.3 years (minimum 18, maximum 78) with newly diagnosed pSS according to Russian criteria 2001, 86% of patients fulfilled ACR 2012 criteria and 87% - the ACR/EULAR 2016 criteria. All patients underwent classical examination (stomatological, ophthalmological, immunological), and SGUS was performed using GE LOGIQ 9 on the two parotid and two submandibular glands. Ultrasound images were evaluated with the OMERACT SS severity scoring system from grades 0 to 3 (1). Statistical analyses (Spearman coefficient p <0.05) were performed using STATISTICA version 12.Results:All patients in SGUS had inhomogeneity structure from mild to diffuse with hypoechoic areas from single to multiple. 4 patients had no signs of sialectasia on sialography, however, in ultrasound we found SGUS grade 2. In 5 patients with SGUS grade 0 we determined punctate sialectasia. Detailed characteristics of patients are presented in Table 1.Table 1.ParametersN%Oral dryness7883,0 Enlargement of parotid salivary glands3234,0Recurrent parotitis1920,2Retention pain3133,0RF positive >2UNL (>30 IU/ml)5154,2anti-SSA (anti-Ro) positive (>25 IU/ml)8186,1anti-SSB (anti-La) positive (>25 IU/ml)4851,0 ANA ≥ 1:32094100,0SGUS 088,5SGUS 111,0SGUS 22021,2SGUS 36569,1Stimulated SFT < 2,5ml/5 min5962,8Sialectasia on parotid sialography9094,7Punctate sialectasia1212,6 Globular sialectasia6366,3Cavitary sialectasia1010,5 Distructive sialectasia66,3FS ≥ 1foci/4 mm28388,2Correlation was calculated for each SGUS (0-3) with clinical and classical methods of examination of the salivary glands. Pronounced changes in SGUS 3 correlated with recurrent parotitis r = 0.22 (p = 0.03), enlargement of parotid salivary glands r = 0.23 (p = 0.02) and cavitary sialectasia r = 0.23 (p = 0.02). Histological changes FS ≥ 1 correlated with all grades on ultrasound (SGUS 0 r = -0.24 (p = 0.01), SGUS 1 r = 0.41 (p = 0.000027), SGUS 2 r = - 0.21 (p = 0.03), SGUS 3 r = 0.40 (p = 0.00006)). The punctate sialectasia correlated with SGUS 1 r = -0.28 (p = 0.005) and SGUS 0 r = 0.45 (p = 0.000004). Stimulated SFT didn’t correlate with ultrasound changes.Conclusion: :Probably, in everyday clinical practice, SGUS can be used as an additional method for salivary gland assessment, given the availability and safety of the method. The most convenient system for assessing the salivary glands, at present, is the OMERACT SS severity scoring system, however, now we don’t have a score for the complete differentiation in pSS and lymphoproliferative complications.References: :[1]Jousse-Joulin, Sandrine et al. “Video clipassessment of a salivary gland ultrasound scoring system in Sjögren’s syndrome using consensual definitions: an OMERACT ultrasound working group reliability exercise.” Annals of therheumatic diseases vol. 78,7 (2019): 967-973. doi:10.1136/annrheumdis-2019-215024Disclosure of Interests:None declared