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Abstract Introduction Major salivary gland ultrasonography (SGUS) demonstrated its good metric properties as an outcome measure for diagnosing primary Sjögren’s disease (SD). The objective was to assess SGUS reliability among sonographers with different levels of experience, using web training. Methods Sonographers from expert centers participated in the reliability exercise. Before exercises, training was done by videoconferencing. Reliability of the two most experienced sonographers (MES) was assessed and then compared to other sonographers. Intra-reader and inter-reader reliability of SGUS items were assessed by computing Cohen’s κ coefficients. Results All sets were read twice by all 14 sonographers within a 4-month interval. Intra-reader reliability of MES was almost perfect for homogeneity, substantial for Outcome Measures in Rheumatology (OMERACT) scoring system (OMERACTss). Among LES (less experienced sonographers), reliability was moderate to almost perfect for homogeneity, fair to moderate for OMERACTss, and fair to almost perfect for binary OMERACTss. Inter-reader reliability between MES was almost perfect for homogeneity, substantial for diagnosis, moderate for OMERACTss, and substantial for binary OMERACTss. Compared to MES, reliabilities of LES were moderate to almost perfect for both homogeneity and diagnosis, only fair to moderate for OMERACTss, but increased in binary OMERACTss. Conclusions Videoconferencing training sessions in an international reliability exercise could be an excellent tool to train experienced and less-experienced sonographers. SGUS homogeneity items is useful to distinguish normal from abnormal salivary glands parenchyma independently of diagnosis. Structural damage evaluations by OMERACT scoring system is a new comprehensive score to diagnose patients with SD and could be easily used by sonographers in a binary method.

IntroductionIt has been hypothesized that gut and oral dysbiosis may contribute to the development of primary Sjögren’s syndrome (pSS). The aim of this systematic review was to assemble available data regarding the oral and gut microbiota in pSS and to compare them to data from healthy individuals and patients with dry symptoms without a diagnosis of Sjögren’s syndrome or lupus disease to identify dysbiosis and discuss the results.MethodologyUsing the PRISMA guidelines, we systematically reviewed studies that compared the oral and gut microbiota of Sjögren’s patients and controls. The PubMed database and Google Scholar were searched.ResultsTwo-hundred and eighty-nine studies were found, and 18 studies were included: 13 referred to the oral microbiota, 4 referred to the gut microbiota, and 1 referred to both anatomical sites. The most frequent controls were healthy volunteers and patients with sicca symptoms. The most common analysis method used was 16S-targeted metagenomics. The results were mostly heterogeneous, and the results regarding diversity were not always in accordance. Dysbiosis in pSS was not confirmed, and reduced salivary secretion seems to explain more microbial changes than the underlying disease.ConclusionThese heterogeneous results might be explained by the lack of a standardized methodology at each step of the process and highlight the need for guidelines. Our review provides evidence that sicca patients seem to be more relevant than healthy subjects as a control group.

Abstract Background The objective was to evaluate concordance between 2002 American-European Consensus Group (AECG) and 2016 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for primary Sjögren’s syndrome (pSS) and to assess how salivary gland ultrasonography (SGUS) might improve the classification of patients. Methods Patients with suspected pSS underwent a standardised evaluation, including SGUS, at inclusion into the single-centre Brittany DIApSS cohort. Agreement between the two criteria sets was assessed using Cohen’s κ coefficient. Characteristics of discordantly categorised patients were detailed. Results We prospectively included 290 patients between 2006 and 2016, among whom 125 (43%) met ACR/EULAR criteria and 114 (39%) also met AECG criteria; thus, 11 (4%) patients fulfilled only ACR/EULAR, no patients AECG only, and 165 (57%) patients neither criteria set. Concordance was excellent (κ = 0.92). Compared to patients fulfilling both criteria sets, the 11 patients fulfilling only ACR/EULAR criteria had similar age and symptom duration but lower frequencies of xerophthalmia and xerostomia (p

La biopsie des glandes salivaires accessoires est un examen simple, fréquemment réalisé par les rhumatologues dans un contexte diagnostique (syndrome de Sjögren, sarcoïdose, amylose, etc.). Les glandes salivaires accessoires représentent plusieurs centaines de glandes disséminées dans la cavité buccale et sont facilement accessibles dans la lèvre inférieure. Toutefois, un certain nombre de précautions sont nécessaires pour éviter les complications liées à cette petite chirurgie. Étant donné qu'elles ne représentent que 10 % de la production de salive, la biopsie de quatre à six glandes (selon les recommandations EULAR) sur les centaines existantes a peu d'impact sur la production de salive. La biopsie de glandes salivaires principales a été rapportée, en particulier pour les parotides qui étaient les premières glandes prélevées, et de façon plus anecdotique pour les glandes sublinguales. L'évolution des techniques, en particulier de l'échographie, remet probablement au goût du jour ces biopsies des glandes parotides en limitant considérablement les risques de complication. Minor salivary gland biopsy is routinely performed by rheumatologist owing to its simplicity and its diagnostic usefulness. Sjögren's syndrome, sarcoidosis, amyloidosis are classic indications for salivary gland biopsy. Hundreds of minor salivary glands are located into the oral cavity. Palate salivary gland are rarely taken off and labial salivary gland biopsy is the most used technique. Despite its apparent ease, few precautions are mandatory to prevent complications such as hematomas or secondary numbness of the lip. Considering that labial salivary glands produce only 10 % of the saliva, their biopsy has no functional impact. Major salivary gland biopsy has been reported. Parotid biopsy was mainly performed before labial salivary gland biopsy was described. Sublingual gland biopsy was rarely described and submandibular gland biopsy never. With new techniques and the use of ultrasonography–limiting the side effects–parotid gland biopsy might find a new lease of life. [ABSTRACT FROM AUTHOR]

Résumé La sécheresse buccale et oculaire est une plainte très fréquente, augmentant avec l’âge, et entraînant une altération profonde de la qualité de vie. Plusieurs pathologies peuvent être à l’origine d’un syndrome sec, parmi lesquelles le syndrome de Sjögren primitif (SSp). Le SSp est caractérisée par un syndrome sec oculaire et buccal, associé fréquemment à une augmentation de volume des glandes salivaires, en raison d’une infiltration lymphocytaire des glandes exocrines salivaires et lacrymales. Des manifestations systémiques sont également possibles chez la moitié des patients, et la principale complication est l’apparition d’un lymphome non hodgkinien. Le clinicien doit savoir écarter les diagnostics différentiels, pour reconnaître précocement les pathologies justifiant des traitements spécifiques. Cette revue présente certaines autres causes de syndrome sec (médicamenteux, infections virales chroniques, maladie du greffon contre l’hôte) et de gonflement des glandes salivaires (granulomatose avec polyangéite, sarcoïdose, maladie liée aux IgG4…), qu’il faut savoir évoquer chez un patient présentant un tableau de SSp atypique. Abstract Eye and/or mouth dryness (or sicca syndrome) is a very common complaint, increasing with age, and causing a profound decrease of the quality of life. Several conditions can cause a sicca syndrome, including primary Sjögren's syndrome (pSS). pSS is characterized by sicca syndrome, frequently associated with recurrent swelling of the salivary glands, due to a lymphocyte infiltration of the exocrine glands. Systemic manifestations are also possible in half of the patients, and the main complication is the development of non-Hodgkin's lymphoma. The clinician must know how to rule out several differential diagnoses, in order to recognize early the conditions that require specific treatments. This review presents some other causes of sicca syndrome (medications, chronic viral infections, graft-versus-host disease) and swelling of the salivary glands (granulomatosis with polyangiitis, sarcoidosis, IgG4-related disease…), which could be mistaken for atypical pSS. [ABSTRACT FROM AUTHOR]