Ultrasound salivary gland involvement in Sjogren’s syndrome vs. other connective tissue diseases: is it autoantibody and gland dependent?

  • Giuliana Maria Concetta La Paglia
  • Olga Sanchez-Pernaute
  • Alessia Alunno
  • Maria José Martínez-Becerra
  • Fredeswinda Romero-Bueno
  • Sheila Recuero
  • Pablo Eder Borges
  • Ignacio Mahillo-Fernández
  • Jesús Garrido
  • Roberto Gerli
  • Gabriel Herrero-Beaumont
  • Esperanza NaredoEmail author
Brief Report



This study aims to investigate ultrasound (US) findings on salivary glands (SG) in patients with Sjögren syndrome (SS) vs. other connective tissue diseases (CTDs) and to assess the relationship of SGUS abnormalities with autoantibody profile in both groups. We enrolled 81 patients, 45 diagnosed with SS (39 with primary SS, 6 with secondary SS) and 36 diagnosed with other CTDs. All patients underwent a prospective evaluation of sicca symptoms, a Schirmer’s test, and a B-mode US assessment of the parotid and submandibular glands, all blinded to the diagnosis. Each SG was semi-quantitatively scored 0–3; a grade ≥ 2 was considered pathological. SGUS involvement was classified as normal or pathological at the patient level and for each pair at the gland level. In addition, a total SGUS score of 0–12 and a parotid/submandibular score of 0–6 were calculated for each patient. Autoimmunity laboratory data were also obtained. All SGUS scores were higher in SS patients than in those with CTD (p < 0.001) and significantly more SS patients showed a pathological global (p < 0.001), parotid (p < 0.001), or submandibular (p = 0.001) US score compared with CTD patients. In SS patients, the presence of autoantibodies was significantly associated with pathological SGUS and higher scores, particularly at the parotid level, while in CTD patients, xerostomia and a pathological Schirmer’s test were associated with pathological US and higher scores at the submandibular level (p < 0.05). SGUS showed a different grade of abnormality, site involvement, and associated autoantibody profile in SS patients as compared with other CTD.

Key Points

Patients with SS and other CTDs showed different grades of SGUS abnormality.

Patients with SS and other CTDs showed different gland involvement and associated autoantibody profiles.

Anti-Ro60 and anti-Ro52 Ro60 positivity were associated with the severity of parotid involvement in SS patients.


Autoantibodies Connective tissue diseases Mixed connective tissue disease Salivary glands Sjögren syndrome Systemic lupus erythematosus Systemic sclerosis Ultrasound Undifferentiated connective tissue disease 



The authors would like to thank the Spanish Society of Rheumatology for their help in the English language editing throughout the manuscript preparation process.

Authors contribution

Study design: E.N.; GMC. LP. Acquisition of data: GMC. LP; E.N; O.SP.; MJ. MB.; F. RB.; S. R.; PE. B. Analysis and interpretation of data: GMC. LP; E.N.; O.SP.; A.A.; MJ. MB.; F. RB.; S. R.; PE. B.; I. MF.; J.G.; R.G.; G. H-B. Manuscript preparation: E.N.; GMC. LP; J.G. Manuscript critical revision: GMC. LP; E.N; O.SP.; A.A.; MJ. MB.; F. RB.; S. R.; PE. B.; I. MF.; J.G.; R.G.; G. H-B. Final approval: GMC. LP; E.N.; O.SP.; A.A.; MJ. MB.; F. RB.; S. R.; PE. B.; I. MF.; J.G.; R.G.; G. H-B.

Funding information

This study has no financial support.

Compliance with ethical standards



Supplementary material

10067_2019_4780_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 20 kb)


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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  • Giuliana Maria Concetta La Paglia
    • 1
    • 2
  • Olga Sanchez-Pernaute
    • 1
  • Alessia Alunno
    • 3
  • Maria José Martínez-Becerra
    • 4
  • Fredeswinda Romero-Bueno
    • 1
  • Sheila Recuero
    • 1
  • Pablo Eder Borges
    • 1
  • Ignacio Mahillo-Fernández
    • 5
  • Jesús Garrido
    • 6
  • Roberto Gerli
    • 3
  • Gabriel Herrero-Beaumont
    • 1
  • Esperanza Naredo
    • 1
    Email author
  1. 1.Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez DíazUniversidad Autónoma de MadridMadridSpain
  2. 2.Division of Rheumatology and Clinical ImmunologyHumanitas Clinical and Research CenterRozzanoItaly
  3. 3.Rheumatology Unit, Department of MedicineUniversity of PerugiaPerugiaItaly
  4. 4.Department of ImmunologyHospital Universitario Fundación Jiménez DíazMadridSpain
  5. 5.Biostatistics UnitHospital Universitario Fundación Jiménez DíazMadridSpain
  6. 6.Department of Social Psychology and Methodology, Facultad de PsicologíaUniversidad Autónoma de MadridMadridSpain

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