Diagnostic performance of the lacrimal and salivary gland ultrasound in patients with primary Sjogren's disease.

Abstract

Background: Sjögren's disease (SjS) is a chronic systemic autoimmune disease that primarily affects the exocrine glands. The use of salivary gland ultrasound in SjS is increasing due to its good diagnostic yield and its noninvasive, radiation-free, low-cost, and reproducible nature. However, there is limited information on lacrimal gland ultrasound.

Objectives: To determine the usefulness of lacrimal and salivary gland ultrasound in the diagnosis of patients with recent-onset primary SjS compared with idiopathic sicca syndrome (SICCA).

Methods: Patients with recent-onset primary SSc (≤5 years) who met the 2016 ACR/EULAR criteria and were presenting to a tertiary referral center with a disease duration of ±5 years were included. SICCA controls, matched for age (±5 years) and sex, were also included. An ophthalmologist evaluated sicca keratoconjunctivitis, including the Schirmer test, the OSS score, and the Van Bijsterveld scale. The ESSPRI and Ocular Surface Disease Index [OSDI] questionnaires were evaluated. Patients and controls with diabetes mellitus or a body mass index ≥30 were excluded. Ultrasound evaluation of the lacrimal and salivary glands (parotid and submandibular) was performed using a GE LOGIQe device with an 8-18 MHz linear probe. The OMERACT and Hocevar ultrasound scales were used for the salivary glands, and the scale described by Kim et al. for the lacrimal glands.

Results: Fifteen patients with primary SjS and 15 controls with SICCA were included. Patients and controls had similar ESSPRI scores (6 points and 5 points). Patients with SjS had a higher degree of tear duct dysfunction than controls (46.7% and 53.3% vs. 0% and 80% with moderate and mild damage, respectively; p = 0.005). However, both groups had similar OSDI scores.

The OMERACT score had good diagnostic performance, with an AUC of 0.97 (95% CI: 0.89-1; p < 0.0001). The Hocevar score, with two cutoff points of 14 and 17 points, had good and adequate diagnostic performance, with AUCs of 0.93 (95% CI: 0.82-1; p < 0.0001) and 0.9 (95% CI: 0.77-1; p < 0.0001), respectively.

Regarding the lacrimal gland, the presence of an intraglandular arterial branch, loss of homogeneity, hypoechoic areas, hyperechoic bands, and loss of glandular demarcation were characteristics observed primarily in patients with SjS compared to controls (p < 0.0001 for each). Finally, we observed a strong correlation between the lacrimal gland and Hocevar scores (rho = 0.83, p < 0.001).

Conclusion: Ultrasonography of the lacrimal and salivary glands is a valuable diagnostic tool for identifying patients with recent-onset primary SjS and differentiating them from patients with SICCA.