Background: Sjögren’s disease (SjD) is a systemic autoimmune disorder characterized by inflammation of the exocrine glands, mainly the salivary and lacrimal glands. However, it can affect several extraglandular organs.The diagnosis of SjD is performed according to the 2016 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria. Salivary gland ultrasonografy (SGUS) is not included in these criteria, but it should be performed in clinical practice, as studies have already shown that it increases sensitivity and specificity when added to classification criteria. Other studies evaluated the value of ultrasonografy of the salivary glands in the diagnosis and prognosis of SjD, relating the ultrasound severity scores with clinical and laboratory data, with positive results. This was a cross-sectional, observational and descriptive study, and aimed to evaluate the correlation of sonographic findings with clinical data in a patient with SjD.

Objectives: This study aimed to the correlation between clinical and ultrasound aspects of salivary glands in patients with Sjögren’s Disease (SjD) with score by OMERACT- Outcome Measures in Rheumatology-, the correlation between ultrasound findings with the EULAR -Sjogren’s syndrome disease activity index (ESSDAI), the EULAR Sjogren’s syndrome patient-reported index (ESSPRI), and the unstimulated salivary flow.

Methods: Ninety two patients that fulfilled the 2016 American-European Consensus Group diagnostic criteria for Sjögren’s disease were selected that receiving care at our institution from June 2022 to October 2024. Serology, European League Against Rheumatism Sjögren’s syndrome disease activity index (ESSDAI), Sjogren’s Syndrome Patient Reported Index (ESSPRI), salivary flow rate, serological tests including rheumatoid factor (RF), antinuclear antibodies (ANA), anti-SSA/Ro and anti-SSB/La, immunoglobulin G (IgG) levels, C3, C4 and cryoglobulins were measured were measured. Demographic data such as age, gender, ethnicity, and body mass index (BMI) were collected. Salivary gland ultrasonography (SGUS) was performed by an experienced radiologists, evaluate independently, with intra and interobserver agreement, using scores of 0–3 to classify salivary gland impairment according to the Outcome Measures in Rheumatology - OMERACT. We explored new ways to use the OMERACT points system, so as a first approach, we chose to include the sum of the OMERACT score, in addition to the ratings 0, 1, 2 and 3. Patients were grouped according to the following variables: ▪ ESSDAI: 0 - total ESSDAI < 5; 1 - total ESSDAI ≥5; ESSPRI: 0 - total ESSPRI < 5; 1: - total ESSPRI ≥ 5; Salivary flow: Positive - salivary flow ≤ 0.1 ml/min, Negative - salivary flow > 0.1 ml/min; ▪ ESSDAI Glandular Domain: 0 - Glandular domain <2; 1 - Glandular domain ≥ 2; ESSPRI Dryness Domain: 0 - Dryness domain < 5; 1- Dryness domain ≥ 5. The descriptive analysis of continuous variables was performed using measures of central tendency - mean and median - and dispersion - variance, minimum and maximum. The descriptive analysis of categorical variables was performed using absolute values and frequencies. Statistical analysis used Mann-Whitney tests, Shapiro Wilk test and, Student’s t-test and Fisher’s exact test.

Results: This study had 92 individuals, predominantly of women (96.74%), white (60.86%), with an average BMI of 26.89, diagnosed with Sjogren’s Disease around the age of 51 (mean age at diagnosis 51.4). According to ESSDAI, the group 0 (ESSDAI < 5) presented 56.52% and the group 1 (ESSDAI ≥ 5) had 43.48% of the sample. We found a higher proportion of positive RF cases in ESSDAI Group 1 (70% versus 42.31%, p<0.05) and of high Gammaglobulin in this same group (32.5% versus 19.23%, p<0.05). Evaluating the OMERACT (classification 0 - 3 and the sum), there was also a difference between the groups. Patients with OMERACT 3 in at least one salivary gland are higher in group ESSDAI 1 (55% versus 28.85%, p<0.05) as well as the mean of the sum (8.45 versus 7.0, p<0.05). In addition, patients with positive salivary flow had a higher proportion of OMERACT 3 (45.95% versus 16.67%, p<0.05), and higher sum values (mean of 8 versus 6.11, p<0.05). When evaluating the glandular domain of the ESSDAI separately, the OMERACT sum had higher values in the Glandular 1 group (mean 8.57 versus 7.32, p<0.06) and there was an absence of patients classified as OMERACT 1 in the Glandular 1 group. The ESSPRI did not relate to the ESSDAI, SGUS score, salivary flow, or serological tests.

Conclusion: The results demonstrate a relationship between systemic activity and glandular involvement observed by ultrasound. The higher the ESSDAI score, the higher the OMERACT score (both by the sum and by the maximum value in the 0-3 classification). There was also a higher positivity of RF and higher values of Gammaglobulin in group 1 of the ESSDAI (although these serological tests may have influenced this result). Patients with alterations in the glandular domain of the ESSDAI also presented a higher OMERACT score. These data confirm what has already been reported in previous studies. No correlation was observed between glandular involvement by SGUS and serum antibody levels, but we had a limitation due to the patient sample. The OMERACT score (both by the maximum value and by the sum) seems to be an adequate instrument to classify the severity of Sjogren’s disease, but we still need more studies with the final sum of the OMERACT to evaluate this correlation.

REFERENCES: [1] St. Clair EW (2017) Sjögren’s syndrome. In: Firestein GS, Gabriel SE, McInnes IB, O’ Dell JR (ed) Kelley & Firestein’s textbook of rheumatology. Elsevier, pp 1221–1244.

[2] Mariette, X., & Criswell, L. A. (2018). Primary Sjögren’s Syndrome. New England Journal of Medicine, 378(10), 931–939. doi:10.1056/nejmcp1702514

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.