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. 2022 Oct:56:152075.
doi: 10.1016/j.semarthrit.2022.152075. Epub 2022 Jul 22.

Discriminative power of salivary gland ultrasound in relation to symptom-based endotypes in suspected and definite primary Sjögren's Syndrome

Liselotte Deroo  1 , Helena Achten  1 , Kristel De Boeck  2 , Eva Genbrugge  3 , Wouter Bauters  3 , Dimitri Roels  4 , Frederick Dochy  5 , David Creytens  6 , Ann-Sophie De Craemer  1 , Filip Van den Bosch  1 , Dirk Elewaut  1 , Isabelle Peene  7
Affiliations

Discriminative power of salivary gland ultrasound in relation to symptom-based endotypes in suspected and definite primary Sjögren's Syndrome

Liselotte Deroo et al. Semin Arthritis Rheum. 2022 Oct.

Abstract

Objectives: Salivary gland ultrasound (SGUS) is emerging as essential tool in primary Sjögren's Syndrome (pSS), but its link to symptom-based endotypes is unknown. Therefore, we explored SGUS outcomes in relation to endotypes in patients with definite and suspected pSS.

Methods: Definite pSS patients (n = 171) fulfilling the 2016 ACR/EULAR classification criteria, and suspected pSS patients (n = 119), positive for at least one criterion, were included in the Belgian Sjögren's Syndrome Transition Trial (BeSSTT). Stratification into endotypes according to the Newcastle Sjögren's Stratification Tool resulted in low symptom burden (LSB), pain dominant with fatigue (PDF), dryness dominant with fatigue (DDF) and high symptom burden (HSB). SGUS was assessed with Hocevar score (0-48). The dataset was randomly divided into a discovery (n = 203) and replication (n = 87) cohort.

Results: SGUS had strong discriminative power for pSS classification (AUC=0.74), especially in DDF (AUC=0.89). In definite pSS, Hocevar scores in DDF were high compared to other endotypes (38 (20-44) versus 18 (9-33); p < 0.001). Patients with highest SGUS-scores showed more sicca and laboratory abnormalities. Moreover, a subset of young, anti-SSA/Ro positive patients not fulfilling classification criteria showed clear SGUS abnormalities. Replication showed similar results.

Conclusions: SGUS-scores were significantly higher in definite pSS with DDF endotype, providing the first evidence of imaging abnormalities in salivary glands matching distinct biological profiles ascribed to pSS endotypes. Additionally, a subset of patients with potential early disease was detected based on presence of anti-SSA antibodies and high SGUS-scores. These results underscore the role of SGUS as powerful tool both in pSS classification and stratification.

Keywords: Biomarkers; Diagnostic imaging; Primary Sjögren's Syndrome; Ultrasonography.

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Conflict of interest statement

Declaration of Competing Interest Competing interests: L.D., H.A., K.D.B., E.G., W.B., D.R., F.D., D.C. and A.S.D.C. report no competing interests. F.Vd.B. has received consultancy fee honoraria from Abbvie, Amgen, Eli Lilly, Galapagos, Gilead, Janssen, Merck, Moonlake, Novartis, Pfizer and UCB. D.E. has received consultancy fee honoraria from Abbvie, Amgen, Eli Lilly, Galapagos, Gilead, Janssen, Merck, Novartis, Pfizer and UCB. I.P. has received consultancy and/or speaker fee honoraria from Amgen, Argenx, Galapagos and Novartis; and participated in advisory boards for Astra-Zeneca, Amgen, GSK, Argenx, BMS, Galapagos, UCB and Novartis.

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