0706: Major salivary glands Ultrasound features in a group of patients with systemic sclerosis: a multicentric study

Background/Purpose: Ultrasound (US) abnormalities of major salivary glands are frequent in systemic sclerosis (SSc) patients. However, US role is not yet fully understood, and the data available on this topic is limited.
The aim of this study is to evaluate the role of major salivary gland ultrasound (SGUS) in patients with SSc

Methods: We consecutively recruited patients with SSc who were regularly followed in two Rheumatology and Internal Medicine centers in France between 2023 and 2024.

- SGUS was performed with a 4–15 MHz and 4–12.5 MHz linear ultrasound probe, by two operators.

- The parotid and submandibular glands were bilaterally studied and scored on a 0 to 4 scale using the Jousse-Joulin (JJ) score, based on progressive bands and hypoechoic areas.

- SGUS findings were considered pathological with a JJ score ≥ 2 in at least one gland.

- Hyperechoic bands indicating fibrosis were evaluated with a 0 to 3 scoring system based on the JJ reference atlas.

- A fibrosis score ≥ 2 in at least one gland was considered pathological.



US data was compared to clinical and biochemical data of our patients.

Results: A total of 123 patients were included: 13 men (10.6%) and 110 women (89.4%), with a mean age of 58.5 ± 13.2 years. Thirty-three (26.8%) had diffuse cutaneous SSc. Subjective sicca syndrome was present in 88 patients (71.5%), with objective sicca syndrome in 77% of cases. An overlap with Sjögren’s syndrome was diagnosed in 29 patients (23.6%), all of whom had pathological minor salivary gland biopsies (MSGB).

Fifty-six patients (45.5%) had a JJ score ≥ 2, while 45 (36.6%) had a fibrosis score ≥ 2.

- The group of patients presenting with a JJ score ≥ 2, compared to the group JJ < 2, presented significatively more frequently an overlap with Sjögren’s syndrome in 21 cases (72%) (p < 0.001) with a Pathological MSGB more frequent. Higher prevalence of Objective Sicca syndrome in 58% of cases (p = 0.044) along with the Presence of anti-SSA antibodies in 87.5% of cases (p = 0.014), and a Longer disease duration (p = 0.044). No association was found between a JJ score ≥ 2 and visceral disease involvement.

- On the other side, patient with a Fibrosis score ≥ 2 compared to those with a fibrosis score < 2, presented a longer disease duration (p = 0.014).

There was no association between either score and the disease-specific antibodies or visceral involvement, such as cutaneous, pulmonary, articular, or renal involvement.

Conclusion: Ultrasound abnormalities of major salivary glands are common in patients with SSc. A global JJ score ≥ 2 should raise suspicion of an overlapped Sjögren’s syndrome. However, while fibrotic lesions are common, they do not appear to be related to the severity of the SSc phenotype.