AB0520 A COMPARISON OF SHEAR WAVE ELASTOGRAPHIC FINDING OF SUBMANDIBULAR GLANDS IN PATIENTS WITH EARLY-STAGE AND NON-SJÖGREN’S SYNDROME

Primary Sjögren’s syndrome (pSS) is a chronic autoimmune disease characterized by lymphocytic infiltration of exocrine glands. Due to the absence of specific clinical manifestations and biomarkers in the early stage, pSS is generally underrecognized. To elucidate the role of the tissue-specific autoantibodies (TSAs), i.e., anti-CA6, anti-SP1, and anti-PSP antibodies, we enrolled 137 pSS patients, 32 secondary Sjögren’s syndrome (sSS) patients, and 127 healthy controls (HCs), whose serum and saliva samples were collected. TSA levels were detected by ELISA, and the clinical and laboratory data was reviewed from the medical records. The analysis results showed the following: (1) Compared to HCs, the serum IgA levels of anti-CA6, anti-SP1 and anti-PSP were significantly higher in pSS as well as in sSS patients, and anti-CA6 IgG was also notably higher in pSS patients. (2) The positivity of anti-CA6, anti-PSP and all the three antibodies together were significantly increased in anti-SSA-negative pSS patients. (3) The average IgM levels of anti-CA6 and anti-SP1 decreased as the disease duration extended. (4) The anti-CA6-positive patients have significantly higher levels of serum IgA, while the anti-PSP-positive group has a notably higher serum IgM level. (5) Another autoantibody specific to the salivary glands, anti-α-fodrin antibody, was elevated in TSA-positive patients, especially in the anti-CA6-positive group. (6) Preliminary detection of saliva TSAs showed that all the IgG levels of these three antibodies increased significantly in pSS patients. In conclusion, TSAs improve diagnosis of pSS in the early stage, especially in anti-SSA-negative patients, and their tissue-specific nature indicates localized salivary injury, which deserves further studies to clarify the mechanism.

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FRI0380 Assessment of submandibular gland qualitative changes using shear wave elastography in patients with sjÖgren’s syndrome

10.1136/annrheumdis-2018-eular.2589 ◽

2018 ◽

Author(s):

N. Hashimoto ◽

S. Uchiyama ◽

M. Kitano ◽

T. Nakazawa ◽

T. Iwasaki ◽

...

Keyword(s):

Submandibular Gland ◽

Shear Wave ◽

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Shear Wave Elastography ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

Sjögren‘S Syndrome ◽

Qualitative Changes

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THU0190 Ultrasonagraphic assessment of submandibular glands in anti-centromere antibody positive and negative primary sjogren’s syndrome patients

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2012-eular.2155 ◽

2013 ◽

Vol 71 (Suppl 3) ◽

pp. 219.3-220

Author(s):

N. Hashimoto ◽

S. Uchiyama ◽

M. Kitano ◽

T. Iwasaki ◽

H. Sano ◽

...

Keyword(s):

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

Primary Sjögren’S Syndrome ◽

Primary Sjogren’S Syndrome ◽

Primary Sjögren's Syndrome ◽

Submandibular Glands ◽

Sjögren‘S Syndrome

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OP0095 A DECISION MODEL OF LABIAL GLAND BIOPSY BASED ON B-MODE ULTRASONOGRAPHY WITH SHEAR-WAVE ELASTOGRAPHY IN PATIENTS WITH SUSPECTED SJÖGREN’S SYNDROME

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3493 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 62.1-63

Author(s):

Y. Mo ◽

S. Hao ◽

Q. H. LI ◽

J. J. Liang ◽

Y. Luo ◽

...

Keyword(s):

Shear Wave ◽

Sjögren’S Syndrome ◽

Decision Model ◽

Sjögren's Syndrome ◽

Shear Wave Elastography ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

List Type ◽

Labial Gland ◽

Sjögren‘S Syndrome

Background:Focal lymphocytic sialadenitis defined as focus score (FS) ≥1 on labial gland (LG) biopsy plays an integral role in various classification criteria of Sjögren’s syndrome (SS). However, suspected patients often hesitate to receive a biopsy; and rheumatologists hope a decision for biopsy based on a high predicted incidence of FS≥1, or against biopsy based on an absolutely low predicted incidence.Objectives:To build a decision model of LG biopsy based on B-mode ultrasonography (US) with shear-wave elastography (SWE) in patients with suspected SS.Methods:Patients who had at least one symptom of oral dryness (based on AECG questions) or had anti-SSA positive were recruited and signed a written informed consent. Bilateral parotid (PG) and submandibular glands (SMG) were examined with B-mode US which graded the echostructure of each gland on a scoring system scaled 0 to 4 (US score), and SWE which described the elasticity of glands. Then LG biopsy was performed.Results:(1)Ninety-one patients whose mean age was 43±15 years were enrolled and 93% of them were female. Anti-SSA was detected in 77 patients (85%) and 28 patients (31%) showed unstimulated whole saliva flow rate (USFR)≤0.1mL/mim. There were 57 patients (63%) showing FS≥1 on LG biopsy. Sixty-three patients (69%) were classified as primary SS, 10 patients (10%) were secondary SS, 18 patients (20%) were uCTD and one patient was RA without SS.(2)US scores were equal between PG and SMG in 59 patients (65%), while the rest patients showed different US scores between two glands: 7 patients (8%) showed higher US scores in PG and 25 patients (27%) showed higher scores in SMG. In each pair of glands US scores were equal. SWE values in PG or SMG of US score 1, 2 or 3 were significantly higher than those of US score 0, while SWE values in glands of US score 4 became declined and showed no significant difference from those with US score 0 (Figure 1A).(3)Heatmap showed US scores in either major salivary gland of patients with FS≥1 on LG biopsy were significantly higher than those with FS<1 (all p<0.001, Figure 1B). ROC curve showed a total US score (including bilateral PG and SMG) ≥9 and a total SWE value (including bilateral PG and SMG)≥30 could significantly recognize patients with FS≥1, respectively with specificity of 100% and 93% (Figure 1C). In this cohort, among 51 patients with a total US score ≥9 and/or a total SWE value≥30, 49 patients (96%) showed FS≥1 on LG biopsy; while two outliers showed total US scores were both 8 although combined SWE values≥30. Other 29 patients showed total US scores≤6 with total SWE values <30 and only one patient (3%) showed FS≥1 on LG biopsy. The remaining 11 patients showed total US scores were 8 with total SWE values <30 and 64% of them (n=7) showed FS≥1.Conclusion:A preliminary decision model of LG biopsy based on B-mode US with SWE in patients with suspected SS were built in Table 1. For example, rheumatologists should reassess the need for biopsy if the incidence of FS≥1 would be <5%. Another cohort of patients with suspected SS is needed for further validation.Table 1.A preliminary decision model of LG biopsy based on B-mode US with SWE in patients with suspected SSAlgorithm*Comments on the decision of LG biopsyA total US score≥9 and/or a total SWE≥30The specificity of FS≥1 on biopsy is >93%. Biopsy is recommended. In some special cases (e.g. contraindicated to biopsy), this item is a potential alternative to LG biopsy.A total US score 7~8 with a total SWE <30It is hard to predict the result of FS, so biopsy is strongly recommended.A total US score≤6 with a total SWE <30The incidence of FS≥1 would be <5%. Rheumatologists should reassess the need for biopsy.References:NoneDisclosure of Interests:None declared

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Performance Evaluation of Multiple Ultrasonographical Methods for the Detection of Primary Sjögren’s Syndrome

Frontiers in Immunology ◽

10.3389/fimmu.2021.777322 ◽

2021 ◽

Vol 12 ◽

Author(s):

Shihao Xu ◽

Jing Luo ◽

Chengwei Zhu ◽

Jiachun Jiang ◽

Hui Cheng ◽

...

Keyword(s):

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

Primary Sjögren’S Syndrome ◽

Major Salivary Gland ◽

Primary Sjogren’S Syndrome ◽

Primary Sjögren's Syndrome ◽

Submandibular Glands ◽

Sjögren‘S Syndrome

Major salivary gland ultrasonography (SGUS) is increasingly being recognized as having critical roles in differentiating primary Sjögren’s syndrome (pSS) from other connective tissue disorders. Contrast-enhanced ultrasonography (CEUS) has been reported to evaluate microvascularity of lesions in different tissues with objective angiographic index, eliminating the observer-dependent defect of ultrasonography. However, there are few relevant studies concentrating on the application of CEUS in the diagnosis and assessment for pSS, and their clinical utility prospect remains uncertain. In this study, a total of 227 eligible patients were enrolled, including 161 pSS and 66 non-pSS patients with comprehensive ultrasonographic evaluation of the parotid and submandibular glands, including grayscale ultrasonography, color Doppler sonography (CDS), and CEUS. Compared with non-pSS, pSS patients had significantly higher grayscale ultrasound (US) scores and CDS blood grades in the parotid gland and significantly higher grayscale US and CEUS scores in the submandibular glands. Diagnostic model combining ultrasonographic signatures, anti-SSA/Ro60, and keratoconjunctivitis sicca (KCS) tests showed a remarkable discrimination [mean area under the curve (AUC)0.963 in submandibular glands and 0.934 in parotid glands] for pSS, and the nomogram provided excellent prediction accuracy and good calibration in individualized prediction of pSS. A combination of multiple ultrasonographical examinations of the major salivary glands (SGs) is a promising technique that may be used as a practical alternative to minor SG biopsy in the detection of pSS.

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