Normal salivary gland ultrasonography could rule out the diagnosis of Sjögren’s syndrome in anti-SSA-negative patients with sicca syndrome

Abstract

ObjectiveTo evaluate the relevance of salivary gland ultrasound (SGUS) and its place in the diagnostic algorithm in patients referred with dry syndrome (DS) for a suspicion of Sjögren’s syndrome (SS).MethodsWe included all patients assessed at our dedicated DS clinic from June 2015 to September 2019 for which a SGUS has been carried out. Images were read blindly and the worst salivary gland was scored according to OMERACT classification. Clinical features, disease activity and treatments were collected.Results337 patients were seen from June 2015 to September 2019. 269 patients underwent SGUS. 77 patients were diagnosed with SS and 192 did not meet the ACR/EULAR criteria for SS: non-Sjögren’s DS (NSDS). Of these 192 patients, 60 had another possible cause of DS, and 132 patients were diagnosed with SAPS (sicca, asthenia, polyalgia syndrome).SGUS abnormalities were significantly higher in patients with SS versus NSDS: 51% vs 8% for a score ≥2 (p<0.0001), and 43% vs 3% for a score ≥3 (p<0.0001). SGUS score ≥2 had a specificity (Sp) of 91%, sensitivity (Se) of 57%, positive predictive value (PPV) of 72% and negative predictive value (NPV) of 82% for SS diagnosis. SGUS’s characteristics in SSA-negative patients were similar to the whole population (Se=42%, Sp=91%, PPV=42%, NPV=92%). The high specificity and NPV in this population could avoid labial salivary gland biopsy (LSGB) in SSA-negative patients with normal SGUS (186 patients, 69%).ConclusionSGUS is useful for SS diagnosis. If anti-SSA antibodies are negative and SGUS score <2, the diagnosis of SS is very improbable and LSGB could be avoided.

Salivary gland ultrasound is associated with the presence of autoantibodies in patients with Sjögren’s syndrome: A Danish single-centre study

“…Only half of the patients with pathological Schirmer’s and sialometry had normal SGUS. This is in line with an ultrasound study of patients referred with dryness syndrome on suspicion of pSS where 49% of the patients diagnosed pSS had SGUS at 0 or 1 [ 17 ].…”

“…In the following study, a patient was classified as having pathological SGUS consistent with pSS if at least one of four salivary glands (PG or SMG) with an OMERACT grade 2 or 3 was found, in line with published data [ 17 , 18 ]. Prior to the study, the ultrasonographer was trained in the OMERACT scoring system with good intra- reliability [ 19 ].…”

Practical guidelines for the early diagnosis of Sjögren's syndrome in primary healthcare

“…Findings such as parenchymal heterogeneity (due to hypoechogenic areas resembling fluid cysts, increased glandular size, hyperechogenic bands, imprecision of the borders, intraglandular calcification, and/or parenchymal inflammation assessed by power Doppler or vascular abnormalities assessed by colour Doppler are evidence of parotid gland damage (38)(39)(40)(41). Recent studies of the potential role of US in the evaluation of parotid involvement in daily practice found it has a potential role in the early non-invasive diagnosis of SS, a correlation with subjective and objective oral and ocular items and systemic features, and an improvement in the diagnostic performance of the SS classification criteria when the salivary gland ultrasonography score was added (42)(43)(44).…”

“All that glitters is not gold”: sialomegaly, xerostomia, and dry eye is not always Sjögren’s syndrome

“…Interpretation of the biopsy results may be not straightforward even for experienced Reumatologia 2021; 59/5 pathologists, mainly due to the lack of an international consensus on salivary gland histopathology. Currently the diagnostic value of salivary gland ultrasonography is being evaluated in SS, and normal salivary gland ultrasonographic findings have been shown to rule out SS in anti-SSA-negative patients with sicca syndrome [4].…”