SAT0310 Ultrasonographic scoring of the major salivary glands in sjogren's syndrome: a comparative study with disease activity indexes

Background:Primary Sjögren’s syndrome (pSS) is a chronic autoimmune disease that affects exocrine systems. Xerostomia is one of representative clinical features which contributes to an accelerated destruction of the mucosal epithelium. Atrophic lesions of the oral mucosa is a common observation in pSS cases.Objectives:To develop a modified ultrasonography scoring system which included the buccal mucosa and major salivary glands in patients with pSS and assess the ultrasonography characteristics of buccal mucosa.Methods:Ultrasonography of buccal mucosa and major salivary glands were conducted for 53 pSS patients and 44 patients with SS-related manifestation but without pSS. The thickness of buccal mucosa and the echogenicity of the buccal mucosa were scored using the 0-2 scoring system. The sonographic features of major salivary glands were scored using the 0-16 scoring system. Differences of buccal mucosa thickness between groups were compared with Mann-Whitney test. The 2 methods (0-16 scoring system, modified 0-18 scoring system) were compared and statistical cutoffs were identified using receiver operating characteristic (ROC) curve analysis.Results:The thicknessr the pSS group was significantly thinner than that for the non-pSS group (p< 0.001), and the best score cut-off was 0.38mm. The echogenicity of buccal epithelium was heterogeneously hyperechoic in 32 (60.4%) of the 53 patients, and was 5(11.4%) of the control group. The optimal cutoff point to distinguish between pSS and non-pSS was 7 in the modified scoring system (sensitivity 79.2%, specificity 95.5%), and it was 6 in the 0-16 system (sensitivity 81.1%, specificity 86.4%). Compared with the 0-16 system, modified scoring system improved the diagnostic specificity.Conclusion:The thickness of the oral mucosa in patients with pSS is thinner and the echogenicity in buccal epithelium increases compared with that of non-pSS. The modified ultrasonography scoring system integrated oral mucosa and major salivary glands is able to improve the diagnostic specificity of patients with pSS.Figure 1.Ultrasonography image of the normal buccal tissue. E = epithelial membrane of buccal mucosa; ST = subepithelial connective tissue; M = buccinator muscle.Figure 2.Ultrasonography image of pSS patient reveals decreased thickness and heterogeneous hyperechogenicity of buccal mucosa. E = epithelial membrane of buccal mucosa; ST = subepithelial connective tissue; M = buccinator muscle.References:[1]Belkacem Chebil R, Oueslati Y, Marzouk M, Ben Fredj F, Oualha L, Douki N. Oral Lichen Planus and Lichenoid Lesions in Sjögren’s Syndrome Patients: A Prospective Study. Int J Dent. 2019:1603657.[2]De Vita S, Lorenzon G, Rossi G, Sabella M, Fossaluzza V. Salivary gland echography in primary and secondary Sjögren’s syndrome. Clin Exp Rheumatol 1992;10(4):351-6.[3]Liu Y, Zhu J, Guo H, Li W, Li J, Wang Y, et al. Buccal Mucosa Assessed by Ultrasonography in Healthy Adults: Methodology and Determination of Normal Appearance. Ultrasound Med Biol. 2019;45(5):1297-1305.Acknowledgments:This work was partly supported by National Natural Science Foundation of China (No. 81571684)Disclosure of Interests:None declared

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SAT0214 ULTRASONOGRAPHIC CHANGES OF SALIVARY GLANDS IN PRIMARY SJOGREN’S SYNDROME: A LONGITUDINAL PROSPECTIVE STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.337 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1050.2-1050

Author(s):

H. R. Kim ◽

K. A. Lee ◽

S. H. Lee ◽

S. H. Kim

Keyword(s):

Salivary Gland ◽

Salivary Glands ◽

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

Primary Sjögren’S Syndrome ◽

Sicca Syndrome ◽

Major Salivary Glands ◽

Sjögren‘S Syndrome

Background:In the diagnosis of primary Sjogren’ syndrome (SS), salivary gland ultrasound is useful tool. Until now, there is no data for ultasonographic changes of major salivary glands over time.Objectives:This study aimed to evaluate the changes in abnormalities of salivary gland ultrasound (SGUS) over time in patients with pSS.Methods:Patients with pSS (n=70) and idiopathic sicca syndrome (n=18) underwent SGUS twice at baseline and 2 years later. The semi-quantitative SGUS score (0-48) was used, which comprises five parameters: parenchymal echogenicity, homogeneity, hypoechoic areas, hyperechogenic reflections, and clearness of posterior borders. The intraglandular power Doppler signal (PDS) was also assessed. The changes of these SGUS variables were compared in patients with pSS and idiopathic sicca syndrome.Results:The median (interquartile range) total SGUS scores at baseline was 27 (14) in patients with and 4 (3) in those with idiopathic sicca syndrome (p<0.001). In the pSS group, the total SGUS scores and the SGUS scores for bilateral parotid glands were significantly increased during median 23.4 month follow-up (p=0.013 andp=0.011, respectively). Homogeneity and hypoechoic areas were the domain to show statistically significant progression of SGUS scores. None of the SGUS scores changed significantly in the patients with idiopathic sicca syndrome. In patients with pSS, baseline and follow-up PDS sum scores of four salivary glands were significant higher in worsening SGUS group (n=13) than no change/improvement SGUS group (n=55/2).Conclusion:The structural abnormalities in major salivary glands assessed using SGUS scores progressed significantly in patients with pSS. In pSS group, 18.6% patients had worsening SGUS scores during 2 years. Intra-glandular hypervascularity was associated with worsening of salivary gland abnormalities.References:[1]Delli K, Dijkstra PU, Stel AJ, Bootsma H, Vissink A, Spijkervet FK. Diagnostic properties of ultrasound of major salivary glands in Sjogren’s syndrome: a meta-analysis. Oral diseases. 2015;21(6):792-800.[2]Jousse-Joulin S, Devauchelle-Pensec V, Cornec D, Marhadour T, Bressollette L, Gestin S, et al. Brief Report: Ultrasonographic Assessment of Salivary Gland Response to Rituximab in Primary Sjogren’s Syndrome. Arthritis & rheumatology (Hoboken, NJ). 2015;67(6):1623-8.[3]Gazeau P, Cornec D, Jousse-Joulin S, Guellec D, Saraux A, Devauchelle-Pensec V. Time-course of ultrasound abnormalities of major salivary glands in suspected Sjogren’s syndrome. Joint, bone, spine: revue du rhumatisme. 2018;85(2):227-32.[4]Lee KA, Lee SH, Kim HR. Diagnostic and predictive evaluation using salivary gland ultrasonography in primary Sjogren’s syndrome. Clinical and experimental rheumatology. 2018;36 Suppl 112(3):165-72.Acknowledgments: :This work was funded by the Konkuk University Medical Center Research Grant 2019.Disclosure of Interests:None declared

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