E. Mossel, MD, J.F van Nimwegen, MD, A.J. Stel, PhD, R.F. Wijnsma, MD, G.S. van Zuiden, MSc, F.G. Kroese, PhD, S. Arends, PhD, H. Bootsma, MD, PhD, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen.
K. Delli, PhD, A. Vissink, PhD, Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen.
J Rheumatol. 2021 May;48(5):717-727. doi: 10.3899/jrheum.200482. Epub 2020 Oct 1.
To investigate salivary gland ultrasound (SGUS) abnormalities in relation to clinical phenotype and patient characteristics, disease activity, and disease damage in patients with primary Sjögren syndrome (pSS).
Consecutive outpatients included in our REgistry of Sjögren Syndrome LongiTudinal (RESULT) cohort were selected. Patients with pSS who were included were classified according to the American College of Rheumatology/European League Against Rheumatism (EULAR) criteria and underwent full ultrasonographic examination (Hocevar score 0-48) at baseline. Total SGUS scores of ≥ 15 were considered positive. Patient characteristics, disease activity, and disease damage were compared between the different SGUS groups.
In total, 172 of 186 patients with pSS were eligible, of whom 136 (79%) were SGUS positive. Compared with patients who were SGUS negative, SGUS-positive patients had significantly longer disease duration, higher EULAR Sjögren Syndrome Disease Activity Index, higher Sjögren Syndrome Disease Damage Index, and were more likely to have a positive parotid gland biopsy, anti-SSA/SSB antibodies, and abnormal unstimulated whole saliva (UWS) and ocular staining score (OSS), and higher levels of IgG and rheumatoid factor. Regarding patient-reported outcome measurements (PROM), patients who were SGUS positive scored significantly lower on the EULAR Sjögren Syndrome Patient-Reported Index for fatigue and pain, and more often found their disease state acceptable compared with patients who were SGUS negative. SGUS total score showed significant associations with various clinical and serological variables, and with PROM. Highest associations were found for UWS (ρ = -0.551) and OSS (ρ = 0.532).
Patients who were SGUS positive show a distinct clinical phenotype in all aspects of the disease compared with patients who were SGUS negative: clinical, functional, serological, and PROM. SGUS could be a helpful tool in selecting patients for clinical trials and estimating treatment need.
研究原发性干燥综合征（pSS）患者唾液腺超声（SGUS）异常与临床表型和患者特征、疾病活动度和疾病损害的关系。
从我们的干燥综合征纵向注册研究（RESULT）队列中选择连续的门诊患者。纳入的 pSS 患者根据美国风湿病学会/欧洲抗风湿病联盟（EULAR）标准进行分类，并在基线时进行全面超声检查（Hocevar 评分 0-48）。总 SGUS 评分≥15 被认为是阳性。比较不同 SGUS 组之间的患者特征、疾病活动度和疾病损害。
共有 186 例 pSS 患者中 172 例符合条件，其中 136 例（79%）SGUS 阳性。与 SGUS 阴性患者相比，SGUS 阳性患者的疾病病程明显更长，EULAR 干燥综合征疾病活动指数更高，干燥综合征疾病损害指数更高，且更有可能出现腮腺活检阳性、抗 SSA/SSB 抗体阳性、未刺激全唾液（UWS）和眼染色评分（OSS）异常以及 IgG 和类风湿因子水平升高。在患者报告的结局测量（PROM）方面，与 SGUS 阴性患者相比，SGUS 阳性患者的 EULAR 干燥综合征患者报告疲劳和疼痛指数明显较低，且更多患者认为自己的疾病状态可以接受。SGUS 总评分与各种临床和血清学变量以及 PROM 均有显著相关性。与 UWS（ρ=-0.551）和 OSS（ρ=-0.532）的相关性最高。
与 SGUS 阴性患者相比，SGUS 阳性患者在疾病的各个方面均表现出明显不同的临床表型：临床、功能、血清学和 PROM。SGUS 可能是选择患者进行临床试验和评估治疗需求的有用工具。
