1371: Are Ultrasound Salivary Parenchymal Abnormalities More Severe in Primary Sjögren Patients with a Higher Disease Duration ? A Cross-sectional International Study

Alice TISON¹, sandrine jousse joulin², Maëlys Consigny³, Philipp Moog⁴, Benedikt Hofauer⁵, Eric Hachulla⁶, Christophe Lamotte⁷, JACQUES MOREL⁸, Gael Mouterde⁹, Vera Milic¹⁰, Hendrika Bootsma¹¹, Alja Stel¹², Benjamin A Fisher¹³, Mark Maybury¹⁴, Alan Baer¹⁵, Dana Direnzo¹⁶, Hae-Rim Kim¹⁷, Hong Ki Min¹⁸, Shin-Seok Lee¹⁹, Sung-Eun Choi¹⁹, Guillermo CARVAJAL ALEGRIA²⁰, Sylvie Boisramé²¹, Dewi Guellec²², Divi Cornec²³, Malin Jonsson²⁴, Daniel Hammenfors²⁵, Alain SARAUX²⁶ and Valerie Devauchelle²⁷, ¹CHU de la Cavale Blanche, Brest, France, ²Rheumatology, CHU Brest, Brest, France, ³Biostatistics, CHU Brest, Brest, France, ⁴Rheumatology, CHU Munich, Munich, Germany, ⁵Otolaryngology, CHU Munich, Munich, Germany, ⁶University of Lille, Lille, France, ⁷Internal Medicine and Clinical Immunology, CHU Lille, Lille, France, ⁸Protocole thérapeutique immuno-rhumatologie, Montpellier, France, ⁹CHU Lapeyronie, Montpellier, France, ¹⁰Rheumatology, University of Belgrade, Medical School, Belgrade, Serbia, ¹¹Department of Rheumatology, University Medical Centre Groningen, Groningen, Netherlands, ¹²Rheumatology and clinical immunology, University Medical Center Groningen, Groningen, Netherlands, ¹³University of Birmingham, Birmingham, United Kingdom, ¹⁴Rheumatology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom, ¹⁵Johns Hopkins University School of Medicine, Baltimore, MD, ¹⁶University of Pennsylvania, Bala Cynwyd, PA, ¹⁷Rheumatology, Konkuk University Medical Center, Seoul, South Korea, ¹⁸Konkuk University School of Medicine, Seoul, South Korea, ¹⁹Chonnam National University Medical School & Hospital, Gwangju, South Korea, ²⁰CHRU de Tours, Tours, France, ²¹Ondontology, CHU Brest, France, Brest, France, ²²CHU de Brest, Brest, France, ²³University of Brest, Brest, France, ²⁴Clinical dentistry, University of Bergen, Bergen, Norway, Bergen, Norway, ²⁵Rheumatology, Haukeland University Hospital, Bergen, Norway, ²⁶CHU Brest, Brest, France, ²⁷UBO, Brest, France

Background/Purpose: Salivary gland ultrasonography (SGUS) is commonly used in primary Sjögren Disease (pSD) as a diagnostic tool. It could also be used to monitor disease activity, but severity of SGUS parenchymal abnormalities in relation to disease duration is not well characterized. The objective was to assess transversally the severity of ultrasound salivary parenchymal abnormalities in relation to pSD duration.

Methods: In 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. Reliability between experts was measured after online training. 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 9 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.

Results: 247 patients were consecutively included between May 2019 and February 2022 in 11 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. Oraldryness was reported by 99.6% of patients with an abnormal salivary flow in 75% of patients. The focus score was ≥1/4mm2 in 89% of patients. 85% of patients had positive anti-SSA. The median ESSDAI score was 3 [0-48]. Considering for each patient the most severe gland, 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). Considering each US parameter, there was not any statistical difference between the 4 groups, notably in relation to the proportion of an/hypoechoic areas in the gland. The only statistical difference between groups was found regarding the proportion of hyperechoic bands (p = 0.002). Proportion of hyperechoic bands was not associated with age (p=0,90) but was associated with visual analogic scale for dryness (p=0,002).

Conclusion: This large international cross-sectional study in patients with pSD found a positive association between the OMERACT score and disease duration, with a significant difference only observed in the proportion of hyperechoic bands, when considering separately each US parameter. This may suggest a progressive fibro-adipous evolution of the gland across disease duration related to pSD itself and not related to older age, while surface of hypoechoic areas could be more linked to inflammation, and could be more usefull in clinical trials to assess SGUS modifications after treatment.


A. TISON: Bristol-Myers Squibb(BMS), 6, galapagos, 2; s. jousse joulin: None; M. Consigny: None; P. Moog: None; B. Hofauer: None; E. Hachulla: Bayer, 2, CSL Behring, 5, GlaxoSmithKlein(GSK), 2, 5, 6, johnson&Johnson, 2, 5, 6, Novartis, 2, 5, Otsuka, 6, Roche-Chugai, 2, 5, 6, sanofi-genzyme, 2, 5, Sobi, 5; C. Lamotte: None; J. MOREL: None; G. Mouterde: Bristol-Myers Squibb(BMS), 6; V. Milic: None; H. Bootsma: None; A. Stel: None; B. A Fisher: Bristol-Myers Squibb(BMS), 2, Celgene, 5, Galapagos, 2, 5, Janssen, 2, 5, Novartis, 2, Roche, 2, Sanofi, 2, Servier, 2, 5, UCB, 2; M. Maybury: GE Healthcare, 2; A. Baer: Bristol-Myers Squibb(BMS), 2; D. Direnzo: None; H. Kim: None; H. Min: None; S. Lee: None; S. Choi: None; G. CARVAJAL ALEGRIA: None; S. Boisramé: None; D. Guellec: None; D. Cornec: None; M. Jonsson: None; D. Hammenfors: None; A. SARAUX: None; V. Devauchelle: None.