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Introduction Salivary gland ultrasonography (SGUS) is a well-validated diagnostic tool in Sjögren’s disease (SD) and has been shown to correlate with clinical and serological features in systemic sclerosis (SSc). Despite symptomatic overlap such as oral dryness, direct comparisons of SGUS findings between SD and SSc remain limited. This study aimed to compare ultrasonographic, clinical, and immunological characteristics in patients with SD and SSc.Material and Methods Cross-sectional study including 22 SD and 18 SSc patients. All SD patients met 2016 ACR/EULAR criteria; SSc patients met 2013 ACR/EULAR criteria and were selected based on anti-SSA and/or anti-Ro52 positivity. Clinical, serological, and SGUS data were collected. SGUS was scored using the OMERACT system. Associations between categorical variables were analyzed using chi-square or Fisher’s exact test.Results Sicca symptoms were more frequent in patients with SD: xerostomia (100% vs. 61.1%, p = 0.004) and xerophthalmia (95.5% vs. 33.3%, p < 0.001). Reactive lymph nodes were also more common (45.5% vs. 16.7%, p = 0.028).No significant differences were observed regarding gland size, edge definition, hyperechogenic bands, or OMERACT scores. Overall, 62.5% of patients had OMERACT >=2 ( table 1), with similar prevalence in SD (59.1%) and SSc (62.2%, p = 0.753). In the full cohort, OMERACT >=2 was associated with ANA patterns (p = 0.010): centromere (32.0% vs. 14.3%) and homogeneous (8.0% vs. 0%) were more frequent in OMERACT >=2, while nucleolar predominated in OMERACT <2 (35.7% vs. 0%). The speckled pattern was similarly distributed (~56%). Anti-Ro52 positivity was also linked to OMERACT >=2 (80.0% vs. 57.1%, p = 0.036). No other associations were found (table 2).Conclusions SGUS abnormalities were observed in both SD and SSc, despite distinct clinical profiles. The similarity in SGUS severity suggests that salivary gland damage also occurs in SSc, particularly in anti-Ro52/SSA-positive patients. The association between OMERACT >=2 and centromere and homogeneous ANA patterns may indicate immunologically driven glandular changes. The speckled ANA pattern, usually linked to anti-SSA/Ro and more common in SD, was similarly distributed across OMERACT groups. Although a higher prevalence in OMERACT >=2 might be expected, this was not observed, possibly due to sample size limitations or the immunological selection of SSc patients. Alternatively, SGUS abnormalities in SSc may result from distinct mechanisms such as fibrosis or vascular damage, despite overlapping antibody profiles. These findings support SGUS as a useful tool in SSc, capable of identifying glandular involvement that may reflect broader autoimmune activity beyond classic SD.Abstract P.390 Table 1Soclodemographic, clinical, immunological, and ultrasonographic characteristcs of patients with primary Sjogren’s disease (SD) and systemic sclerosis (SSc)Abstract P.390 Table 2Association between OMERACT salivary gland ultrasound score (22 vs <2) and clinical, serological, and histopathological features