Background Primary Sjögren’s syndrome (pSS) is a systemic autoimmune epithelitis characterized by lymphocytic infiltration of exocrine glands, leading to sicca symptoms. The 2016 ACR/EULAR classification criteria emphasize objective diagnostic markers, notably minor salivary gland biopsy and anti-SSA/Ro antibodies. However, minor salivary gland biopsy is invasive and not always feasible. Salivary gland ultrasonography (SGUS), particularly with the OMERACT scoring system, has emerged as a non-invasive tool to evaluate glandular abnormalities. This study aimed to assess the diagnostic performance of SGUS using the OMERACT score in patients with suspected pSS. Methods We conducted a cross-sectional study from June 2022 to January 2024, including 94 patients referred for sicca symptoms. All patients underwent clinical evaluation, serological testing ophthalmologic assessment, minor salivary gland biopsy, and SGUS. SGUS was performed using a standardized protocol and scored according to the OMERACT semi-quantitative system (grades 0–3 per gland). Results Among the 94 patients, 50 fulfilled the criteria for pSS. The mean age was 57 ± 12.5 years, and 83% were women. SGUS abnormalities particularly heterogeneous echotexture and hypoechogenicity were significantly more prevalent in the pSS group. An OMERACT score > 1 was observed in 44% of pSS patients versus 7% of controls (p < 0.001). ROC analysis revealed an AUC of 0.727 (95% CI: 0.645–0.809). Using an OMERACT score > 1 as the threshold, SGUS had a sensitivity of 40%, specificity of 93%, positive predictive value of 87%, and negative predictive value of 57%. Conclusion SGUS, which uses the OMERACT scoring system, is a specific, noninvasive imaging modality that can aid in the diagnosis of pSS. Although it is not a substitute for histology or serology, SGUS may be a valuable complementary tool, especially when biopsies are unavailable or declined.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry nameend="c2" namest="c1"> Key Points • SGUS using the OMERACT score shows high specificity (93%) for diagnosing primary Sjögren’s syndrome. • An OMERACT score >1 strongly supports the diagnosis, though sensitivity remains modest. • SGUS is a valuable complementary, non-invasive alternative when biopsy is not feasible. </entry> </row> </tbody> </tgroup> </Table>

Usefulness of salivary gland ultrasonography in Sjögren’s syndrome: The Tunisian Experience

期刊论文
发表日期：

2025年12月27日

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Rim Bourguiba,
Syrine Bellakhal,
Manel Boudokhane,
Wiem Helali,
Mehdi Charfi,
Khaled Bouzaidi

摘要

Background

Primary Sjögren’s syndrome (pSS) is a systemic autoimmune epithelitis characterized by lymphocytic infiltration of exocrine glands, leading to sicca symptoms. The 2016 ACR/EULAR classification criteria emphasize objective diagnostic markers, notably minor salivary gland biopsy and anti-SSA/Ro antibodies. However, minor salivary gland biopsy is invasive and not always feasible. Salivary gland ultrasonography (SGUS), particularly with the OMERACT scoring system, has emerged as a non-invasive tool to evaluate glandular abnormalities. This study aimed to assess the diagnostic performance of SGUS using the OMERACT score in patients with suspected pSS.

Methods

We conducted a cross-sectional study from June 2022 to January 2024, including 94 patients referred for sicca symptoms. All patients underwent clinical evaluation, serological testing ophthalmologic assessment, minor salivary gland biopsy, and SGUS. SGUS was performed using a standardized protocol and scored according to the OMERACT semi-quantitative system (grades 0–3 per gland).

Results

Among the 94 patients, 50 fulfilled the criteria for pSS. The mean age was 57 ± 12.5 years, and 83% were women. SGUS abnormalities particularly heterogeneous echotexture and hypoechogenicity were significantly more prevalent in the pSS group. An OMERACT score > 1 was observed in 44% of pSS patients versus 7% of controls (p < 0.001). ROC analysis revealed an AUC of 0.727 (95% CI: 0.645–0.809). Using an OMERACT score > 1 as the threshold, SGUS had a sensitivity of 40%, specificity of 93%, positive predictive value of 87%, and negative predictive value of 57%.

Conclusion

SGUS, which uses the OMERACT scoring system, is a specific, noninvasive imaging modality that can aid in the diagnosis of pSS. Although it is not a substitute for histology or serology, SGUS may be a valuable complementary tool, especially when biopsies are unavailable or declined.

Key Points

• SGUS using the OMERACT score shows high specificity (93%) for diagnosing primary Sjögren’s syndrome.

• An OMERACT score >1 strongly supports the diagnosis, though sensitivity remains modest.

• SGUS is a valuable complementary, non-invasive alternative when biopsy is not feasible.