AB1542 APPLICATION OF THE OMERACT ULTRASOUND SCORING SYSTEM FOR SALIVARY GLANDS IN PATIENTS WITH SUSPECTED SJÖGREN’S SYNDROME

Abstract

BackgroundPrimary Sjogren’s Syndrome (pSS) is a connective tissue disease characterized by the presence of sicca syndrome. Confirmation of pSS requires immunological test and biopsy of the accessory salivary glands[1].Salivary gland ultrasonography (SGUS) allows the detection of structural changes of salivary glands and is proposed as a reliable tool to assess involvement of major salivary glands in patients with pSS. Recently, a new semi- quantitative score have been validated by experts: The OMERACT US score to assess salivary gland involvement in pSS [2].ObjectivesThe aim of our study was to describe salivary gland involvement in patient with suspected of pSS according to the OMERACT ultrasound scoring system for pSS.MethodsAll patients referred for a suspicion of pSS during the last period june 2022-2023 were enrolled. All underwent measurement of salivary flow, minor salivary gland biopsy, SSA antibody. SGUS was performed for all included patients. Both parotid glands and submandibular glands were exanimated using the scoring system 0-3 (OMERACT). Exact Fischer test was used to compare qualitative variables. Sensitivity, specificity and cutoffs were determined by ROC curve analysis.ResultsWe enrolled 73 patients with a suspected pSS. Women represented 80 % of the cohort. Median age was 59 years [Q1 52-Q3 65]. Thirty-four patients were diagnosed with primary SS (pSS) and all fulfilled the 2016 American College of Rheumatology (ACR)/EULAR classification criteria. Thirty-one (91%) patients with pSS had a focus score > 1 in the biopsy of minor salivary gland. Twenty-one (62%) of patients with pSS had a positive SSA antibody.Of the 73 patients, 26 (35%) patients had at least one gland with an ultrasound score of 2 among them, 21 patients were diagnosed with pSS. More patients with pSS compared with non-pSS had score ≥2 in at least one gland (21 pSS vs 5 non pSS) in at least one gland. Among the 26 patients with an ultrasonographic score ≥ 2, 14 patients had positive SSA antibody (p= 0.001). When using ROC analysis, we found that an ultrasound score cutoff ≥2 in at least one gland was associated with a sensitivity at 67 % and specificity at 88%, air under the curve (AUC) was 0.83 [IC95% 0.732-0.93].ConclusionMore patients with pSS compared with non-pSS had score ≥2 in at least one gland (21 pSS vs 5 non pSS) in at least one gland. An ultrasound cutoff > 1 is associated with a sensitivity at 67 % and Specificity at 88%. Our data supports what have been previously reported in several studies. Fana et al [3] reported in a cohort of 143 patients with suspected pSS that the best ultrasound cutoff value was ≥ 1 gland with a score ≥2 was associated to sensitivity at 72 % and specificity of 91%.Our data supports the importance of use of ultrasound as tool for diagnosing pSS. SGUS should be integrated as a criterion in ACR/EULAR score.