Pos1454 are Ultrasound Salivary Parenchymal Abnormalities More Severe in Primary Sjögren Patients With a Higher Disease Duration? A Transversal International Study

Abstract

BackgroundSalivary gland ultrasonography (SGUS) is commonly used in primary Sjögren Disease (pSD) as a diagnostic tool [1]. It could also be used to monitor disease activity, but severity of SGUS parenchymal abnormalities in relation to disease duration is not well characterized.ObjectivesTo assess transversally the severity of ultrasound salivary parenchymal abnormalities in relation to pSD duration.MethodsIn this prospective cross-sectional international multicentric study, patients with pSD according to 2002 or 2016 ACR/EULAR classification criteria were included. Parenchymal abnormalities assessed by ultrasound within both parotid and sub-mandibular glands were reported on a standardized form and classified according to the semi-quantitative score of the OMERACT (global score and each item evaluated separately) [2]. Reliability between experts was measured after online training. Demographic, clinical and paraclinical data were also collected and patients were separated into 4 groups according to disease duration from the first buccal dryness symptoms (group A: < 5 years, group B: between 5 and 10 years, group C: between 10 and 20 years, group D: > 20 years of evolution).The association between disease duration groups and SGUS parenchymal abnormalities was quantified in terms of odds ratio and its 95% confidence interval.Results247 patients were consecutively included between May 2019 and February 2022 in 12 international centers. They were 47, 69, 78 and 53 in groups A, B, C and D, respectively. Women represented 94.7% of patients, with a median age of 58 [range 19-89] years old. Oral and ocular dryness were reported by 99.6% and 95.1% of patients, respectively. Salivary flow was abnormal in 74.7% of patients and Schirmer’s test in 82.1%. The focus score was ≥1/4mm2 in 89% of patients. 85% of patients had positive anti-SSA and 59.6% had rheumatoid factor. The median ESSDAI score was 3 [0-48]. Considering for each patient the gland with the highest US OMERACT score, there was a global significant association between disease duration and OMERACT score (OR for 5 years duration: 1.23 [IC95% 1.04; 1.47], p=0.02). When comparing groups A+B versus C+D on the OMERACT score, the OR was 1.95 [IC95% 1.10; 3.46], p=0.02, while no significant difference was found when comparing group A versus B+C+D. Considering each item of the OMERACT score, there was not any statistical difference between the 4 groups in relation to the proportion of an/hypoechoic areas in the gland nor homogeneity or posterior border visibility. The only statistical difference between groups was found regarding the proportion of hyperechoic bands (p = 0.0009). When comparing group A versus B+C+D on this item, the OR was 2.55 [95%CI 1.30-5.01], p=0.006).ConclusionThis large international transversal study in patients with pSD found a positive association between global SGUS lesions evaluated by the OMERACT score and disease duration, with a significant difference only observed in the proportion of hyperechoic bands, when considering separately each item of the score. This may suggest a progressive fibro-adipous evolution of the gland across disease duration. The presence of diffuse hyperechoic bands (grade 3 in the OMERACT scoring system), corresponding to a higher disease duration group, could be useful in the future to stratify patients in clinical trials and to interpret SGUS modifications after treatment.References[1]Jousse-Joulin S, Gatineau F, Baldini C, Baer A, Barone F, Bootsma H, et al. Weight of salivary gland ultrasonography compared to other items of the 2016 ACR/EULAR classification criteria for Primary Sjögren’s syndrome. J Intern Med. 2020 Feb;287(2):180–8.[2]Jousse-Joulin S, D’Agostino MA, Nicolas C, Naredo E, Ohrndorf S, Backhaus M, et al. Video clip assessment of a salivary gland ultrasound scoring system in Sjögren’s syndrome using consensual definitions: an OMERACT ultrasound working group reliability exercise. Ann Rheum Dis. 2019 Jul;78(7):967–73.Acknowledgements:NIL.Disclosure of InterestsNone Declared.