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Salivary gland ultrasound predictive in more severe Sjögren's cases
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FORT WORTH, Texas — Although salivary gland ultrasonography is not a reliable diagnostic predictor of Sjögren’s syndrome in all cases, it is more predictive among advanced or severe cases of the disease, according to a poster presentation at the Rheumatology Nurses Society Annual Conference.
“This is important because it affects patient care,” Lauren M. Long, RN, BSN, of the NIH National Institute of Dental and Craniofacial Research, told Healio Rheumatology. “We are hoping to help patients using procedures that are less invasive and provide more patient-centered care.”
According to Long and colleagues, although minor salivary gland biopsy is well-established as a diagnostic tool for Sjögren’s syndrome, the procedure is invasive and may not be available in all clinical settings. However, most clinical settings do have access to ultrasound capabilities, which carries negligible risks for patients. To analyze the correlation of salivary gland ultrasound findings with surgical pathology scores, and to determine the clinical implications of ultrasound findings as a diagnostic tool, the researchers studied data from 50 consecutive, previously-undiagnosed patients at the National Institute of Dental and Craniofacial Research Sjögren’s syndrome clinic.
All participants received minor salivary gland biopsy and salivary gland ultrasonography. The researchers then evaluated the findings for correlation between ultrasound results consistent with changes seen in Sjögren’s syndrome, and participants whose biopsies demonstrated a focus score of at least one lymphocytic focus per 4 mm2 of salivary gland tissue. The participants were then split into three groups: Those with normal ultrasound findings and no focus score; those with a focus score of at least 1 and normal, or indeterminant, ultrasound results; and those with a focus score of at least 1 and ultrasound results consistent with Sjögren’s syndrome. The researchers compared salivary function across the three groups, and calculated the correlation between focus score and ultrasound findings.
According to the researchers, 22 of the 50 participants satisfied the diagnostic criteria for Sjögren’s syndrome. Among those 22 patients, 13 demonstrated anti-Ro-antibody (SSA) positivity, whereas 16 had a focus score of at least 1. In addition, six of the 22 patients demonstrated positive salivary gland ultrasonography results consistent with Sjögren’s syndrome, and more than 90% of all patients reported subjective oral dryness. The researchers further noted that, in general, salivary gland ultrasonography scoring was consistent across all four glands. Although there was moderate correlation between focus score and salivary gland ultrasonography, no correlation was reported between salivary flow rates and ultrasound category. There was also no correlation between focus score or salivary gland ultrasonography and the age of diagnosis.
“For patients who are more adversely affected, or those who are more symptomatic, or have a higher focus score, the ultrasound findings were more correlative,” Long said. “So, the higher focus scores correlated with the higher salivary gland ultrasonography scores. However, salivary gland ultrasonography is a fairly new procedure in our clinic, and we recognize that evolving technique and expertise may impact correlative data.” – by Jason Laday
Reference:
Long LM. Identifying Sjögren’s syndrome: Nursing implications and comparison of salivary gland ultrasound to minor salivary gland biopsy. Presented at: Rheumatology Nurses Society Annual Conference; Aug. 8-11, 2018; Fort Worth, Texas.
Disclosure: Long reports support from the NIH National Institute of Dental and Craniofacial Research.