In response to the urgent unmet needs of heterogeneity, unpredictability, and diagnostic delay in systemic lupus erythematosus (SLE), we aimed to identify and validate new immunoglobulin (Ig)G and IgA autoantibody specificities.

Using a KoRectly EXpressed technology-based microarrays (i-Ome Discovery; Sengenics), we screened for circulating IgG and IgA autoantibodies against 1609 proteins in 2 independent cohorts (discovery: NTC02890121; validation: NCT02890134) comprising patients with SLE (n = 199 and n = 30), primary Sjögren's disease (n = 115 and n = 31), and systemic sclerosis (n = 115 and n = 24), and healthy controls (HCs; n = 111 and n = 84), respectively.

We identified and validated 5 IgG (anti-Lin-28 homolog A [LIN28A], anti-HNRNPA2B1, anti-HMG20B, anti-HMGB2, and anti-alpha-globin transcription factor CP2 [TFCP2]) and 4 IgA (anti-LIN28A, anti-HMG20B, anti-SUB1, and anti-TFCP2) autoantibodies that demonstrated high specificity for SLE (0.91-0.94), along with consistent and robust positivity (0.22-0.69) in differentially abundant autoantibody (daAAb) analysis between SLE and comparator groups. IgG and IgA anti-LIN28A levels varied over a 14-month follow-up in the validation cohort of newly diagnosed patients with SLE and exhibited metrics that outperformed those of traditional autoantibody markers such as anti-double-stranded DNA. Clustering of patients with SLE based on autoantibody positivity (levels above the HC median plus 2 IQRs in the discovery cohort) status revealed 1 subgroup demonstrating seroreactivity against multiple antigens, 3 exhibiting varying reactivity, and 1 showing no reactivity. In pathway analysis, daAAb targets pointed to DNA-binding and RNA-binding and transcription functions.

Novel autoantibodies validated in this study may enhance diagnostics and molecular characterisation in SLE. The prominent IgA seroreactivity implicates important roles of mucosal tissues in SLE autoimmunity, warranting further investigation.

Activation of the type I interferon (IFN) pathway and autoreactive B cells are key immunopathogenic features of systemic lupus erythematosus (SLE), primary Sjögren's disease (pSjD) and systemic sclerosis (SSc). TANK-binding kinase 1 (TBK1) is a mediator of type I IFN and essential during B cell development in mice. We investigated the properties of the TBK1 inhibitor amlexanox in systemic autoimmune diseases.

The effects of amlexanox on peripheral blood mononuclear cells (PBMCs) stimulated with Imiquimod, CpG-A, Poly:IC, G3-YsD and 3p-hpRNA were assessed. B cells from healthy controls and patients with SLE, pSjD and SSc were cultured with CD40L, IL-21, IFN, B cell activating factor (BAFF) and amlexanox. Differentiation into CD38highCD27highCD138+/- cells, proliferation, and IgM and IgG production were measured.

Amlexanox inhibited production of type I IFN induced through endosomal and cytosolic routes in PBMCs. Likewise, supernatants from amlexanox-treated cells did not induce expression of BAFF and MX1. Amlexanox inhibited spontaneous MX1 expression in PBMCs from SLE, pSjD and SSc patients. Immunohistochemical staining confirmed expression of the TBK1 protein in pSjD salivary glands. Using a B cell differentiation assay, addition of amlexanox decreased B cell proliferation and differentiation into CD27highCD38highCD138+/- plasmablasts and plasma cells. Correspondingly, production of IgM and IgG was suppressed. The observations were corroborated in B cells from patients with SLE, pSjD and SSc.

Our findings demonstrate inhibitory effects of amlexanox on type I IFN production and B cell differentiation in primary human cells. Inhibition of TBK1 could potentially be a therapeutic option for the treatment of type I IFN-driven systemic inflammatory diseases.

The etiology of primary Sjogren's syndrome (pSS) is complex and not completely clear. This study was to identify key genes in pSS based on Gene Expression Omnibus (GEO).

We downloaded the GSE40568, GSE80805, GSE127952, and GSE164885 mRNA expression profiles from GEO. Differentially expressed genes (DEGs) analyses were carried out by using the online analysis tool GEO2R and R. Gene Ontology (GO) annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed to elucidate the biological processes, molecular function, cellular component, and KEGG signaling pathways for the DEGs in salivary glands (SGs) and peripheral blood mononuclear cells (PBMCs). Genes co-expressed were found in PBMCs and SGs of pSS patients. RT-qPCR was performed for validation. Finally, clinical correlation analysis and receiver operator characteristic (ROC) curve analysis were performed.

A total of thirty-nine up-regulated and one down-regulated genes were identified in pSS SGs. GO and KEGG pathway revealed that these DEGs were related to response to virus, and type I interferon signaling pathway. It was verified that fourteen genes were up-regulated in the SGs of pSS by RT-qPCR. Twenty up-regulated genes were identified in pSS patients PBMCs. Two genes were up-regulated in SGs and PBMCs of pSS patients, including IFI27 and IFI44L. The mRNA level of IFI27 was positively correlated with the disease activity of pSS patients. Furthermore, ROC analyses proved IFI27 may have diagnostic value for pSS.

IFI27 might serve as a potential biomarker for the early diagnosis and therapy of pSS. Key Points • IFI27 expression was significantly increased in PBMCs and SGs of pSS patients. • IFI27 was positively correlated with disease activity in pSS patients. • IFI27 might have a good diagnostic value for pSS.

Pulmonary fibrosis (PF) is a fatal fibrotic lung disease without any options to halt disease progression. Feasible evidence suggests that aberrant metabolism of amino acids may play a role in the pathoetiology of PF. However, the exact impact of kynurenine (Kyn), a metabolite derived from tryptophan (Trp) on PF is yet to be addressed.

This study aims to elucidate the role of kynurenine in both the onset and advancement of PF.

Liquid chromatography-tandem mass spectrometry was employed to assess Kyn levels in patients with idiopathic PF and PF associated with Sjögren's syndrome. Additionally, a mouse model of PF induced by bleomycin was utilized to study the impact of Kyn administration. Furthermore, cell models treated with TGF-β1 were used to explore the mechanism by which Kyn inhibits fibroblast functions.

We demonstrated that high levels of Kyn are a clinical feature in both idiopathic PF patients and primary Sjögren syndrome associated PF patients. Further studies illustrated that Kyn served as a braking molecule to suppress fibroblast functionality, thereby protecting mice from bleomycin-induced lung fibrosis. The protective effects depend on AHR, in which Kyn induces AHR nuclear translocation, where it upregulates PTEN expression to blunt TGF-β mediated AKT/mTOR signaling in fibroblasts. However, in fibrotic microenviroment, the expression of AHR is repressed by methyl-CpG-binding domain 2 (MBD2), a reader interpreting the effect of DNA methylation, which results in a significantly reduced sensitivity of Kyn to fibroblasts. Therefore, exogenous administration of Kyn substantially reversed established PF.

Our studies not only highlighted a critical role of Trp metabolism in PF pathogenesis, but also provided compelling evidence suggesting that Kyn could serve as a promising metabolite against PF.

Autoimmune diseases are highly prevalent and affect people at all ages, women more often than men. The most prominent immunological manifestation is the production of antibodies directed against self-antigens. In many cases, these antibodies (Abs) drive the pathogenesis by attacking the body's own healthy cells, causing serious health problems that may be life threatening. Most autoantibodies are of the immunoglobulin G (IgG) isotype, which has a long plasma half-life and potent effector functions. Thus, there is a need for specific treatment options that rapidly eliminate these pathogenic IgG auto-Abs. In this review, we discuss how the neonatal Fc receptor (FcRn) acts as a regulator of the high levels of not only IgG Abs, but also albumin, by rescuing both these soluble proteins from cellular catabolism, and how a molecular and cellular understanding of this complex biology has spurred an intense interest in the development of FcRn-targeting strategies for the treatment of IgG-driven autoimmune diseases. We find that this emerging therapeutic class demonstrates efficacy within several autoimmune diseases with distinct pathophysiology. This offers hope for both new therapeutic avenues for highly prevalent diseases currently treated by other means, and rare diseases with no approved therapies to date. In addition, we elaborate on studies that have led to approval of the first FcRn antagonists, the clinical progress and structural design of molecules in the pipeline, their position in the overall therapeutic landscape of autoimmunity, the design of next-generation antagonists as well as the use of this receptor-targeting principle for other therapeutic applications.

The objective of this study was to report 52-week safety and efficacy of ianalumab from phase 2b dose-finding study in patients with Sjögren's disease (SjD).

Patients randomly received (1:1:1:1) ianalumab (5, 50, or 300 mg) or placebo subcutaneously every 4 weeks until week 24 (treatment period [TP]1). At week 24, patients on 300 mg were rerandomized to continue 300 mg or receive placebo until week 52 (TP2), patients on placebo were switched to ianalumab 150 mg, and patients on 5 and 50 mg directly entered posttreatment safety follow-up. Patients who discontinued treatment early or completed treatment entered safety follow-up (≥20 weeks).

During TP1, 190 patients were randomized (placebo = 49, 5 mg = 47, 50 mg = 47, 300 mg = 47). Of these 190 patients, 90 (47.4 %; 43 continued 300 mg and 47 received placebo) entered TP2, and 81 of 90 (90.0%) completed the study treatment. By week 52, efficacy was sustained in patients who continued 300 mg in TP2 (EULAR Sjögren's Syndrome Disease Activity Index, EULAR Sjögren's Syndrome Patient Reported Index, patient global assessment, and physician global assessment change from week 24: -1.45, -0.46, -4.69, and -6.86, respectively). Stimulated salivary flow rates and autoantibody levels numerically improved in the 300 mg group. Treatment-emergent adverse events were not dose-dependent, except for injection-site reactions. Cases of decreased neutrophil counts (Common Terminology Criteria for Adverse Events v4.03 grade 3 according to laboratory listings) were observed in three patients during the posttreatment follow-up, occurring at 3.5, 5.5, and 3 months, after the last ianalumab administration. None were associated with infection except one incidental finding of asymptomatic cytomegalovirus infection (IgM-positive).

In patients with SjD, ianalumab 300 mg demonstrated sustained efficacy through week 52 and a favorable safety profile up to two years of follow-up.

This study evaluates the effectiveness of lacrimal gland ultrasonography (LGUS) and shear wave elastography (SWE) in distinguishing primary Sjögren's syndrome (PSS) patients from healthy controls and examines their role in assessing disease activity and prognosis.

A total of 35 PSS patients and 23 age- and gender-matched healthy controls were included. LGUS was used to grade lacrimal gland structure, while SWE assessed gland elasticity. Disease activity and prognosis were evaluated using european league against rheumatism sjögren's syndrome disease activity index (ESSDAI) and serologic markers.

Compared with healthy controls, LGUS, Emean, and shear wave velocity (SWV) were significantly higher in PSS patients. The optimal cut-off value of LGUS for diagnosis of PSS was 2 (area under the curve [AUC]: 0.832, sensitivity: 80.0%, specificity: 69.6%), the optimal thresholds for diagnosis of PSS using Emean and SWV values are 9.4 kPa (AUC: 0.768, sensitivity: 65.7%, specificity: 82.6%) and 1.7 m/s (AUC: 0.823, sensitivity: 71.4%, specificity: 91.3%), respectively. There are statistical differences in Emean and SWV between subgroups based on european league against rheumatism sjögren's syndrome disease activity index (ESSDAI); there are statistical differences in LGUS, Emean, and SWV between subgroups based on IgG levels and complement titers.

LGUS and SWE are accurate, noninvasive diagnostic tools for PSS and may serve as indicators of disease activity and prognosis.

This study aimed to perform a detailed stratification analysis of B lymphocyte subsets in patients with primary Sjögren's syndrome (pSS) and to investigate their associations with lymphoma risk, clinical phenotypes, and disease activity.

In this retrospective study, we analyzed data from 137 patients with pSS. We employed machine learning approaches, specifically principal component analysis (PCA) and k-means clustering, to examine B lymphocyte subset distributions from flow cytometry data and immunoglobulin IgG and complement (C3, C4) levels. The optimal cluster number was determined using the Elbow Method in R software. Based on these 10 variables, patients were categorized into distinct subgroups. We then comprehensively compared clinical characteristics, laboratory parameters, and disease activity indices among these identified subgroups.

Four distinct subgroups were identified. Cluster A exhibited a significantly higher lymphoma incidence rate of 20%, compared to 3.39% in Cluster B and 0% in Clusters C and D (p = 0.007). Cluster A also had the highest percentage of double-negative B cells (32.26 ± 17.96%) and plasma cells (2.02 ± 1.92%). ESSDAI scores indicated that disease activity was highest in Cluster A (9.00, 6.00-20.00), followed by Clusters B (7.00, 3.50-14.00), C (6.00, 1.25-17.50), and D (5.00, 1.50-9.00), respectively.

This innovative stratification method revealed the critical role of B cell subset imbalance in the pathogenesis of pSS and provided new evidence for predicting lymphoma risk and guiding personalized treatment. Key Points • Identifying a distinct patient subgroup with elevated lymphoma risk and increased disease activity could aid in risk prediction. • Applying machine learning techniques to stratify B cell populations provides insights into pSS pathogenesis. • A proposed framework for personalized treatment approaches based on B cell subset imbalances in pSS.

This study aims to investigate the feasibility and clinical value of single-photon-emission computed tomography/computed tomography (SPECT/CT) in the quantitative assessment of salivary gland function in patients with Sjögren's syndrome (SS).

Data were collected from 84 patients diagnosed with SS who underwent dynamic salivary gland scintigraphy at the First Affiliated Hospital of Anhui University of Science and Technology between October 2020 and October 2023. Additionally, a control group of 25 thyroid cancer patients who underwent thyroidectomy was selected. Imaging data from dynamic salivary gland scintigraphy were obtained and analyzed to calculate salivary gland functional parameters, including maximum accumulation rate (MAR), uptake ratio (UR), maximum secretion rate (MSR), Tmin (time from peak to lowest point on the time-activity curve), and average secretion rate (Vmin) following acidic stimulation.

Significant differences in MAR, UR, MSR, Vmin, and Tmin of the parotid and submandibular glands were observed between the SS group and the control group (P < 0.05). In the mild impairment group, significant differences were found in MSR, Tmin, and Vmin of the submandibular gland compared to the control group (P < 0.05). Moderate and severe impairment groups exhibited significant differences in MAR, MSR, Tmin, UR, and Vmin of the parotid gland compared to the control group (P < 0.05).

In SS patients, MAR, UR, MSR, Vmin, and Tmin are important indicators for evaluating salivary gland damage. The qualitative analysis of SPECT/CT salivary gland dynamic imaging and time-activity curves effectively assesses salivary gland function in SS patients, providing vital information for the development of clinical treatment strategies.

In recent years, autoimmune diseases are becoming more and more prevalent worldwide, with this rapid rise being influenced by environmental factors linked to lifestyle changes in modern societies. In this context, the role of diet has been the topic of extensive research as evidence has mounted that particular dietary patterns may contribute to or modulate autoimmunity. The present review specifically focuses on the Mediterranean diet (MD) as a whole dietary pattern, and on its peculiar components, such as n-3 polyunsaturated fatty acids (PUFAs), polyphenols and fiber. We explored their potential benefits in a spectrum of both systemic and organ-specific autoimmune disorders, including rheumatic diseases (like rheumatic arthritis and systemic lupus erythematosus), and thyroid diseases (like Hashimoto's thyroiditis), since they often occur in the same individuals. Here, we offer a comprehensive review about the influence of dietary factors on these autoimmune diseases and potential translation into therapeutic interventions, as an adjuvant therapeutic approach to improve autoimmunity-related outcomes.

Antimelanoma differentiation-associated gene 5-positive dermatomyositis (anti-MDA5+ DM) is a rare subtype of myositis with a poor prognosis and insufficient genetic understanding. Our study aimed to identify risk variants associated with anti-MDA5+ DM and to assess their correlation with clinical outcomes.

We enrolled 231 anti-MDA5+ DM patients, 127 anti-MDA5⁻ DM patients, 1468 patients with non-DM rheumatic disease, and 1027 healthy controls, with an additional 51 anti-MDA5+ DM patients for validation. Whole-exome sequencing was used to identify human leukocyte antigen (HLA) alleles, amino acids, and single nucleotide polymorphisms (SNPs) in major histocompatibility complex (MHC) and non-MHC regions. Association studies were performed to identify genetic variants associated with anti-MDA5+ DM by comparing different sets of control groups. A clinical association study was conducted to further explore the influence of genetic factors on clinical manifestations.

Two novel genetic risks, HLA-DQA1*06:01 and HLA-DQB1*06:09, were significantly associated with anti-MDA5+ DM in both the discovery and validation cohorts. HLA-DQA1*06:01 was particularly prevalent in anti-MDA5+ DM (20.4%) compared with anti-MDA5⁻ DM (6.69%) and non-DM rheumatic disease (5.93%). Besides, the strongest associated amino acid was HLA-DQα1:69 (P = 3.27 × 10-11), and 1 SNP in the ARHGAP22 gene (rs76208937) showed suggestive significance (P = 7.99 × 10-6). In addition, HLA-DQA1*06:01 was linked to acute rapidly progressive interstitial lung disease (P < .001), elevated levels of lactate dehydrogenase (P = .026), and death (P = .049) in patients with anti-MDA5+ DM.

HLA-DQA1*06:01 is a new genetic and prognostic factor for anti-MDA5+ DM, potentially serving as a biomarker for early diagnosis and intervention.

A case series of five patients (mean age, 77.0 years) with complaints of nocturnal xerostomia were subjected to occlusal appliance treatment with a reservoir of moisturizing gel during the night. An occlusal appliance covers the dental arch and hard palate, providing space in the midline of the hard palate to hold the moisturizing gel. Sleepiness was assessed using the Epworth Sleepiness Scale (ESS), and sleep quality was assessed using the Japanese version of the Pittsburgh Sleep Questionnaire (PSQI-J) before and after treatment. The total PSQI-J scores decreased in all patients after treatment. The ESS score, sleep time, and sleep efficiency improved or remained unchanged and none of the patients' symptoms worsened.

This study demonstrated the efficacy of occlusal appliance treatment in patients with dry mouth in improving self-reported sleep quality. Patients included those with nocturnal xerostomia and poor sleep quality on the PSQI-J. Treatment with xerostomia resulted in improved sleep quality, as assessed by the decrease in PSQI-J scores.

This case series suggests that sleep quality may be worse in patients with xerostomia, and that treatment for nocturnal xerostomia using occlusal appliances may improve sleep quality.

Anti-Ro60 and anti-Ro52 autoantibodies are frequently used as diagnostic biomarkers for Sjögren's disease, but their clinical significance in systemic lupus erythematosus (SLE) is not well characterized.

Patients fulfilling SLE classification criteria were studied according to their anti-Ro status. We defined Ro positivity (Ro+) as those who have either anti-Ro60 or anti-Ro52 positivity. Patient characteristics and disease outcomes, including High Disease Activity Status (HDAS) defined as an ever attainment of SLEDAI2K ≥10, adjusted mean SLEDAI (AMS), and time-adjusted mean clinical SLEDAI (excluding serologic activities) were compared using linear or logistic regressions. Furthermore, isolated or dual positivity of anti-Ro60 and anti-Ro52 were studied.

Out of 409 patients, 47.2% were Ro+. Ro+ patients were predominantly Asian, had positive dsDNA and hypocomplementemia. They showed a higher likelihood of HDAS (OR 1.65, 95% CI 1.10-2.48, P = 0.015), AMS >4 (OR 1.84, 1.18-2.88, P = 0.007) and more frequent use of glucocorticoids (OR 1.87, 1.16-3.03, P = 0.011) and immunosuppressants (OR 2.0, 1.26-3.17, P = 0.003). Additionally, 24.4% of Ro+ patients experienced sicca symptoms, and hypergammaglobulinemia was significantly more common. Multivariate analysis confirmed that Asian ethnicity, severe flares, AMS, hypocomplementemia, rheumatoid factor, proteinuria, leucopenia and sicca symptoms were significantly linked to Ro positivity.

Anti-Ro positivity is associated with higher disease activity and increased treatment needs. Ro positivity correlates with laboratory abnormalities such as hypocomplementemia and leucopenia. These findings highlight the importance of anti-Ro60/Ro52 testing in the clinical evaluation of SLE.

Primary Sjögren's syndrome (pSS) is typically associated with dryness of the eyes and mouth, but it can also involve other organs, including the lungs, kidneys, nervous system, and joints. Among its less common manifestations is distal renal tubular acidosis (dRTA), which can lead to metabolic acidosis, hypokalemia, and bone-related complications due to chronic acid-base imbalance. We report the case of a 42-year-old woman with a four-year history of recurrent hypokalemic quadriparesis, who recently developed progressive difficulty walking over the past two months, severely limiting her mobility. Laboratory investigations revealed a normal anion gap metabolic acidosis and elevated urine pH, consistent with dRTA. Further evaluation confirmed a diagnosis of pSS with objective evidence of glandular involvement. Imaging and biochemical findings supported the presence of osteomalacia secondary to dRTA. This case highlights a rare and often overlooked complication of pSS. Timely diagnosis and appropriate management are crucial to preventing long-term disability and improving patient outcomes.

Sjögren's syndrome (SS) is a chronic, systemic, and autoimmune disease characterized by lymphocytic infiltration of all exocrine glands, primarily the lacrimal and salivary glands. Chemokines play a key role in many inflammatory diseases. They play a fundamental role in recruitment, transport, and activation of immune cells. This study aimed to investigate the role of CXCL9, CXCL10, and CXCL13 chemokines in primary SS patients.

The study included 62 SS patients and 68 individuals without known systemic or rheumatological disease. CXCL9, CXCL10, and CXCL13 levels were analyzed in both groups using ELISA test kits and compared. The mean age of SS and healthy controls (HC) were similar. White blood cell neutrophil and lymphocyte values were found significantly lower in the SS compared to the HC; ESR value was higher in SS. Other hemogram parameters such as hemoglobin, platelets, monocytes, and CRP did not show a significant difference. CXCL10 levels were found to be significantly higher in SS compared to HC. CXCL13 level was significantly lower in SS. However, there was no statistically significant difference in CXCL9 serum between SS and HC. There was a negative correlation between serum CXCL9 level and lymphocyte and there was also a positive correlation between CXCL13 serum level and leukocyte.

CXCL10 chemokine may serve as a potential biomarker for primary SS and it may also be a new therapeutic target. Key Points • Chemokines play a key role in Sjögren's syndrome. • CXCL10 may serve as a potential biomarker for primary SS.

Objectives: We aimed to evaluate the quality of life (QoL), oral health-related quality of life (OHRQoL), and mental health well-being in female patients diagnosed with Sjögren's Disease compared with healthy controls. Methods: An ethically approved cross-sectional study was carried out on 65 female patients with a confirmed diagnosis of Sjögren's Disease according to the American European Association Consensus Group Criteria and 61 sex-matched healthy volunteers. The World Health Organization Quality of Life-BREF, Oral Health Impact Profile-14, and Hospital Anxiety and Depression Scale were used to evaluate the general and oral health-related QoL (OHRQoL) and the mental health well-being of the participants. Results: The general QoL was lower in the patients' group (p < 0.05) compared with the control group in all four domains (physical, psychological, social, and environment). The OHRQoL was significantly reduced in the patients' group, who were more anxious (58.5%, n = 38/65) and four times more depressed (32.3%, n = 21/65) compared with healthy volunteers (anxiety = 21%, n = 13/61; depression = 8.2%, n = 5/61). Conclusions: This study concludes that Sjögren's Disease negatively affects QoL and mental well-being. Therefore, addressing these aspects in patients' management is crucial to helping individuals cope with the disease's burden and ultimately enhancing their overall life experience.

Patients with autoimmune rheumatic diseases (ARDs) are at an increased risk for herpes zoster (HZ). Vaccination is recommended for this population.

The aim of this study was to evaluate the safety of vaccination with the recombinant zoster vaccine (Shingrix) in ARD patients, humoral immunogenicity (HI), cellular immunogenicity (CI), and the incidence of HZ.

This randomized, double-blind, placebo-controlled phase 4 study involves 1180 ARD patients and a control group (CG) of 393 balanced healthy individuals, aged ≥50 years. ARD patients will be randomly assigned in a blinded manner (1:1 ratio) to 2 groups: vaccine or placebo (on days 0 and 42), administered intramuscularly. Outcomes will be assessed at baseline, 6 weeks, and 12 weeks after vaccination, including disease activity (using specific disease activity scores), HI, and CI. Adverse events will be assessed using a standardized questionnaire after each vaccine dose. Incident HZ cases will be monitored throughout the study. One year following the second dose, the persistence of HI and CI will be evaluated in both ARD patients and CG. HI and CI will be assessed using serum concentrations of anti-gE antibodies and the frequencies of gE-specific CD4+ T cells, respectively. Comparisons of anti-gE titers between ARD patients and CG at different time points will be analyzed using 2-way repeated-measures analysis of variance. Multiple regression analysis will be conducted, with a positive immune response as the dependent variable, and variables with p < 0.2 from univariate analysis as independent variables.

This large trial addresses a critical gap by examining disease safety, efficacy, adverse effects, and immunogenicity, considering the impact of diverse therapies following recombinant zoster vaccine administration in ARD patients.

We aimed to quantify the mortality risk in a large, well-characterized cohort of patients with Sjögren disease (SjD) and to identify independent predictors of mortality in this population.

We included 314 patients diagnosed with SjD according to the 2002 American-European Consensus Group criteria from a prospective, multicenter SjögrenSER Prospective cohort. Detailed data on systemic manifestations, serological markers, disease activity, and mortality were collected after a median of 9.5 (IQR 9.2-9.9) years of follow-up. The primary outcome was overall mortality, and secondary analyses aimed to identify independent predictors of mortality using Cox proportional hazards models. Standardized mortality ratios were calculated by comparing the observed deaths in the SjD cohort to the expected deaths in an age- and sex-matched general population.

The study identified a 70% increased mortality risk in the SjD cohort compared to the general population, with a standard mortality ratio of 1.7. Infections (35.7%), malignancies (23.8%), and cardiovascular disease (CVD; 7.1%) were the most common causes of death. Multivariate analysis revealed that older age (HR 1.11/year, 95% CI 1.07-1.15), C4 hypocomplementemia (HR 3.75, 95% CI 1.55-9.06), elevated erythrocyte sedimentation rate (ESR; HR 1.01, 95% CI 1.00-1.03), history of heart failure (HR 4.24, 95% CI 1.02-17.58), and pulmonary involvement (HR 3.31, 95% CI 1.39-7.88) were independent predictors of mortality.

This study found a significantly increased mortality risk in SjD, with infections, malignancies, and CVD as leading causes of death. Independent predictors of mortality include advanced age, C4 hypocomplementemia, elevated ESR, heart failure, and pulmonary involvement, underscoring the need for proactive, individualized management.

The aim of this study was to determine serum I-309 levels in primary Sjögren's syndrome (pSS) patients, as well as the association with disease phenotype, systemic activity, and T helper cell-related cytokines. A total of 58 pSS patients and 30 healthy controls (HC) were enrolled in this study. The concentrations of serum I-309, interleukin-4 (IL-4), IL-6, IL-9, IL-13, IL-17, IL-22, IL-23, tumor-necrosis factor-α (TNF-α), interferon-γ (IFN-γ), IFN-α, and IFN-β were measured with multiplex immunoassay. The relationships between I-309 and various clinical and laboratory variables were analyzed. The serum concentrations of I-309 were significantly increased (median, IQR, 14.24, 10.99--20.35, pg/ml) in pSS patients compared with HC (median, IQR, 8.27, 6.74--9.62, pg/ml) (P < 0.001). Serum I-309 is increased in pSS, and may be associated with systemic inflammation, Th1-, Th17,- and Th9 cells, type Key Points • Serum I-309 levels are increased in pSS patients. • Increased I-309 may be associated with systemic rather than local manifestations in pSS. • Increased I-309 may be associated with Th1, Th17 and Th9 other than Th2 in pSS. • There may be close relationships between I-309 and type land type II IFNs in pSS.

To determine prevalence and clinical associations of anti-Four-and-a-half-LIM-domain 1 (FHL1) autoantibodies in patients with idiopathic inflammatory myopathies (IIM) and to evaluate autoantibody levels over time.

Sera at the time of diagnosis from patients with IIM (n = 449), autoimmune disease controls (DC, n = 130), neuromuscular diseases (NMDs, n = 16) and healthy controls (HC, n = 100) were analysed for anti-FHL1 autoantibodies by enzyme-linked immunosorbent assay (ELISA). Patients with IIM FHL1+ and FHL1- were included in a longitudinal analysis. Serum levels were correlated to disease activity.

Autoantibodies to FHL1 were more frequent in patients with IIM (122/449, 27%) compared with DC (autoimmune DC and NMD, 13/146, 9%, P < 0.001) and HC (3/100.3%, P < 0.001). Anti-FHL1 levels were higher in IIM [median (IQR)=0.62 (0.15-1.04)] in comparison with DC [0.22 (0.08-0.58)], HC [0.35 (0.23-0.47)] and NMD [0.48 (0.36-0.80)] P < 0.001. Anti-FHL1+ patients with IIM were younger at the time of diagnosis compared with the anti-FHL1- group (P = 0.05) and were seronegative for other autoantibodies in 25%.In the first follow-up, anti-FHL1+ sample 20/33 (60%) positive at baseline had turned negative for anti-FHL1 autoantibodies. Anti-FHL1 autoantibodies rarely appeared after initiating treatment. Anti-FHL1 autoantibody levels correlated with CK (r = 0.62, P= 0.01), disease activity measured using the Myositis Disease Activity Assessment Tool (MYOACT) (n = 14, P = 0.004) and inversely with Manual Muscle Test-8 (r = -0.59, P = 0.02) at baseline.

Anti-FHL1 autoantibodies were present in 27% of patients with IIM; of these, 25% were negative for other autoantibodies. Other autoimmune diseases had lower frequencies and levels. Anti-FHL1 levels often decreased with immunosuppressive treatment, correlated with disease activity measures at diagnosis and rarely appeared after start of treatment.

This nationwide cohort study aimed to evaluate (1) whether primary Sjogren's syndrome (pSS) can contribute to the development of dementia and (2) whether the use of hydroxychloroquine (HCQ) can decrease the incidence of dementia in patients with pSS using the Health Insurance Review and Assessment database.

We established a cohort between 2008 and 2020 of 20,160 patients with pSS without a history of dementia. The control group comprised sex- and age-matched individuals with no history of autoimmune disease or dementia. Cox proportional hazard analyses were performed to identify the association between pSS and dementia development. We also assessed the hazard ratio (HR) of dementia in early users of HCQ (within 180 days of the diagnosis of pSS) compared to non-users, adjusted for age, sex, and comorbidities.

The incidence of dementia was 0.68 (95% CI 0.64-0.72) cases per 100 person-years in pSS, and it was 0.58 (0.56-0.60) in the controls. The adjusted HR (aHR) of developing dementia was 1.16 (1.09-1.25) times greater in the pSS group than in the controls. The risk of dementia did not increase in HCQ users (aHR 1.07 [0.94-1.21]), but HCQ non-users had a 1.22 (1.12-1.33) higher risk of developing dementia than the matched controls. The use of HCQ lowered the risk of dementia in comparison with non-users in patients with pSS (aHR 0.82 [0.71-0.94]).

Our results suggest that pSS is associated with an increased risk of dementia. HCQ may prevent dementia in patients with pSS.

Oral hypofunction comprises seven aspects of oral condition, including oral hygiene, oral dryness, bite strength, tongue-lip motor function, tongue pressure, masticatory function, and swallowing function. Each of these seven has a single diagnostic criterion; however, the use of a single indicator without consideration of sex, age, or other factors is controversial. The purpose of this study was to evaluate the association between the oral hypofunction test and sex, age, and number of remaining teeth.

The study was conducted at 12 facilities by the members of the Japanese Society of Geriatric Dentistry during April to December 2019. The participants comprised 181 healthy older adults aged 65 years and over (56.9% female; age range 65-95 years) who regularly visited these facilities. All tests of oral function and oral status available in Japan were performed on the participants, and the association between these tests and sex, age, and number of remaining teeth was examined.

Sex differences were observed in masticatory function, bite force, lip closure force, jaw-opening force, oral diadochokinesis "ka," and tongue coating index (p < .05). In men, age was weakly (r = 0.20-0.40) associated with masticatory function, jaw-opening force, maximum tongue pressure, oral diadochokinesis, and swallowing function. In women, the number of remaining teeth, masticatory function, jaw-opening force, and oral diadochokinesis "ta" and "ka" was also weakly associated with age.

Performance on the oral hypofunction test differs by sex, age, and number of remaining teeth. This means that the current single criterion for evaluation requires caution in its interpretation.

Primary Sjogren's Syndrome (pSS) is a systemic autoimmune disorder characterized by lymphocyte infiltration of the exocrine glands. Disease duration plays a pivotal role in evaluating the development of SS. In this study, we aimed to clarify the clinical manifestations of pSS across various stages of its progression, thereby offering critical insights for early diagnosis and targeted management strategies for Sjogren's Syndrome.

We conducted a retrospective analysis involving 3,978 patients with primary Sjogren's Syndrome (mean [SD] age: 53.1[24] years) from Peking University People's Hospital between January 2015 and December 2022. We classified patients into five distinct groups based on the duration of the syndrome: T0 (≤ 1 year), T1 (> 1 year, ≤ 5 years), T2 (> 5 years, ≤ 10 years), T3 (> 10 years, ≤ 20 years), and T4 (> 20 years).

We observed a statistically significant increase in the percentage of pSS patients with white blood cell (WBC) decrease, specifically: T0 (9.23%), T1 (15.40%), T2 (22.62%), T3 (20.22%), T4 (26.45%). The decreases in hemoglobin (HGB) and platelet (PLT) were also robustly associated with extended disease duration (p < 0.0001). Simultaneously, systemic involvements aggravated with disease progression as incidence rates of skin, joint, lung, and nervous system were strikingly increased in each group. The findings also indicated that patients with long-term pSS exhibit a higher likelihood of developing comorbid conditions, such as diabetes and tumors. In summary, disease duration serves as a crucial determinant for the prognosis of patients with pSS.

Therefore, early identification of symptoms and initiation of therapies are imperative for mitigating the risk of significant complications in pSS patients.

To elucidate the effectiveness of dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, on renal function in patients with rheumatic musculoskeletal diseases complicated by chronic kidney disease (CKD).

We conducted a retrospective analysis of patients with rheumatic musculoskeletal disease and chronic kidney disease who were treated with dapagliflozin for more than a year. The good response was defined as an improvement in the estimated glomerular filtration rate slope per year after dapagliflozin treatment compared to that before treatment. Additionally, we investigated the response rate and its predictive factors.

In this analysis, 43 patients were included. The average estimated glomerular filtration rate slope demonstrated a significant improvement after dapagliflozin treatment compared to that before the treatment (0.04 vs -0.55 ml/min/1.73 m2/year, P = .001). A good response rate was 69.8% and was associated with low average levels of C-reactive protein, a high frequency of angiotensin II receptor blocker (ARB) use, and a low frequency of tacrolimus use compared to nonresponse (0.08 ± 0.18 vs 0.25 ± 0.29 mg/dl, P = .03; 80.0 vs 38.4%, P = .01; 10.0 vs 76.9%, P < .01).

Dapagliflozin is effective for rheumatic musculoskeletal disease patients with CKD for preventing deterioration of renal function. Antihypertensive treatment with ARB and inflammation control without tacrolimus was associated with a high likelihood of favourable response to dapagliflozin.

The aim of this study is to evaluate the superb microvascular imaging (SMI) findings of the lacrimal glands for the sonographic diagnosis of primary Sjögren's syndrome (pSS).

Twenty-one patients with pSS and 20 healthy groups were evaluated. Dry eye symptoms and their effects on vision-related functions were evaluated with McMonnies and Ocular Surface Disease Index (OSDI) questionnaires. Lacrimal glands were evaluated by power Doppler ultrasonography (PDUS), colour Doppler ultrasonography (CDUS), and SMI.

Dry eye symptoms, as determined by McMonnies and OSDI, were significantly more severe in patients with pSS than in the control group (P = .001 and P = .021, respectively). Lacrimal gland vascular activity rates and hypoechoic areas were significantly higher in pSS patients compared to the control group (P < .05). The detection rates of the degree of vascularity in the lacrimal glands of patients with pSS were higher with SMI compared to CDUS and PDUS. In addition, SMI positively correlated with CDUS, PDUS, OSDI, and McMonnies.

Evaluation of the lacrimal gland by the SMI was found to be excellent in predicting the likelihood of individuals having pSS compared to CDUS and PDUS. This technique may serve as a reliable and noninvasive adjunctive tool for assessing the degree of lacrimal vascularity in pSS.

To investigate the prevalence and recurrence rates of spontaneous pneumothorax (SP) in patients with diffuse cystic lung diseases (DCLDs).

We retrospectively identified and analyzed medical records of patients with DCLDs encountered at the First Affiliated Hospital of University of Science and Technology of China from Jan 1, 2017 to December 31, 2023.

A total of 289 patients were identified with DCLDs; 212 females and 77 males, with a median age of 48 years (range, 18-81 years). Among them, 89 (31%) patients had experienced SP; 59% among 115 patients with Birt-Hogg-Dubé (BHD), 34% of 41 patients with lymphangioleiomyomatosis (LAM, all women), 36% of 11 patients with pulmonary Langerhans cell histiocytosis (PLCH), none of 57 patients with Sjögren's syndrome-associated diffuse cystic lung disease (SS-DCLD), and 5% of 65 patients with no identifiable underlying disease (χ² = 90.585, P < 0.001). The overall recurrence rate of SP was higher with observation or chest tube placement strategy compared to surgical intervention, 59% vs. 11% (P < 0.001, 95% CI [0.1, -0.4]), respectively. The recurrence rate after surgical management was significantly lower compared to conservative management in patients with BHD (10% vs. 69%, P < 0.001, 95% CI [0.1, 0.3]) and LAM (20% vs. 57%, P = 0.322, 95% CI [0.1, 2.1]). Among patients with BHD, LAM, and PLCH, those who had pneumothorax as the initial presentation were diagnosed of their underlying disease at a significantly younger age (42.2 ± 13.0 years) compared to those without pneumothorax (48.1 ± 11.8 years) (P = 0.032, 95% CI [-8.24, -0.36]). Notably, eight of LAM patients who were treated with sirolimus after the initial SP did not experience recurrence of SP.

The risk of SP secondary to DCLDs was highest in patients with BHD, followed by those with PLCH and LAM. It was extremely low in SS-DCLD. Pneumothorax as the initial presentation often facilitated diagnosis of the underlying disease. Surgical treatment was associated with a lower recurrence rate of SP compared to nonsurgical management. In addition, sirolimus therapy may reduce the risk of pneumothorax recurrence in patients with LAM.

This multicenter, retrospective longitudinal study identified primary Sjögren's syndrome (pSS) patients with clinically significant renal involvement, and analyzed factors associated with predisposition. To investigate clinical features and long-term prognosis of renal involvement, we compared the clinical outcomes for the entire cohort based on the presence or absence of renal involvement. Among 1306 pSS patients (mean age, 51 ± 12 years; 98% female), 36 (2.8%) had renal involvement; 17 patients had tubular involvement, 15 had glomerular involvement, one had both, and 3 were unclassified. The presence of anti-La antibodies was associated with renal involvement. Over the median 5-year follow-up period, the renal function did not change significantly; however, 44% of patients with renal involvement showed impaired renal function at the last visit. Impaired renal function at the last visit was inversely associated with baseline renal function and hemoglobin levels. Among the entire cohort, the prevalence of lymphoproliferative disease (LPD) was significantly higher in pSS patients with renal involvement than those without. Renal involvement is a rare manifestation of pSS; however, it is associated with impaired renal function and LPD. Therefore, screening for renal involvement is important for preserving renal function and early detection of LPD.

Anti-SS-B antibodies are often associated with anti-SS-A in Sjögren's disease. Compared to anti-SS-A antibody positivity, the significance of the immunological profile anti-SS-B positive/anti-SS-A negative remains controversial. We aimed to evaluate the prevalence and diagnostic significance of isolated anti-SS-B antibodies.

We conducted a retrospective study across three hospitals of the Assistance Publique-Hôpitaux de Paris. Patients with anti-SS-B positivity were identified using ELISA, addressable laser beam immunoassay (ALBIA) and immunodot assays. They were retained if anti-SS-B was positive in two techniques and anti-SS-A was absent. Clinical, biological and immunological data were extracted and presented in a descriptive analysis.

A total of 80 540 requests for anti-SS-B antibody testing were carried out over a period of 7.9 years. Anti-SS-B positivity was found in 1693 patients. Among them, 335 (19.8%) patients had isolated anti-SS-B in ELISA/ALBIA. Immunodot was performed in 186 of them and confirmed anti-SS-B positivity in 61 patients (3.6% of anti-SS-B positivity). 24 patients (39.3%) presented with a history of various autoimmune or autoinflammatory diseases and only 6 were diagnosed with a new connective tissue disease. After a median follow-up of 26 months, only two new diagnoses were made.

Anti-SS-B without anti-SS-A is exceedingly rare when accurately identified by a rigorous immunological approach. The initial anti-SS-B positivity does not correlate with a specific condition, both at the time of initial identification and after a 26-month follow-up period. This supports the fact that isolated anti-SS-B has no diagnostic or prognostic value.

To develop a novel ultrasound scoring system for the major salivary glands in patients with immunoglobulin G4-related sialadenitis (IgG4-RS) and assess its diagnostic value in a multicentre cohort of Chinese patients.

Twenty clinicians (rheumatologists, stomatologists and radiologists) participated. The study was conducted in four steps: (i) defining the ultrasonography (US) elements, (ii) developing a novel ultrasound scoring system for US of the salivary glands, (iii) evaluation of inter- and intra-reader reliabilities using the new ultrasound scoring system, and (iv) assessing the diagnostic value of this novel ultrasound scoring system in IgG4-RS patients in a Chinese multicentre cohort.

A novel ultrasound scoring system for the salivary glands was developed, with total scores ranging from 0 to 34. The inter- and intra-reader reliabilities of the ultrasound scoring system were excellent (0.972 and 0.940, respectively). A total of 470 people were recruited in this study; 187 patients were diagnosed with IgG4-RS, and the remaining 283 people were diagnosed with non-IgG4-RS. Patients with IgG4-RS group had significantly higher US scores than the non-IgG4-RS group (mean US score = 16 vs 4, P < 0.001). The calculated area under the curve for the total US score was 0.852 (95% CI: 0.814, 0.891). The total US scores ≥9 showed a sensitivity of 75.4% and a specificity of 91.9%. Association analysis showed a positive correlation between total US scores and serum IgG4 levels and hypocomplementaemia (r = 0.221 and r = 0.349, respectively; P = 0.002 and P < 0.001, respectively) and a negative correlation between total US scores and serum C3 and C4 levels (r = -0.210 and r = -0.303, respectively; P = 0.005 and P < 0.001, respectively).

A novel semiquantitative ultrasound scoring system for patients with IgG4-RS was developed, with good diagnostic performance. The inter- and intra-reader reliabilities were excellent. US scores were correlated with IgG4, C3 and C4 levels and hypocomplementaemia.

A 78-year-old woman experienced systemic edema and was diagnosed with nephrotic syndrome and Hashimoto's thyroiditis (HT). A renal biopsy revealed minimal change disease (MCD) and tubulointerstitial nephritis, which resulted in the diagnosis of primary Sjögren's syndrome (PSS). PSS and HT can be complicated with MCD; however, there are no published case reports of MCD presenting with both conditions simultaneously. We aimed to inform nephrologists and rheumatologists about this rare condition through a literature review of renal outcomes in patients with MCD associated with PSS and HT.

Sjogren's disease (SjD) in children is a rare chronic autoimmune disease not fully recognized due to clinical manifestations different from adults. As such, new objective indicators are needed to supplement existing markers and assist in diagnosis. This review summarizes pathogenesis of SjD in children, current diagnostic criteria and research progress in laboratory diagnosis including serologic testing, saliva and tear analysis, histopathological examination as well as emerging markers of interest.

This study analyzed the association between anti-Ro/SSA and anti-La/SSB antibody levels with quantitative and visual sialoscintigraphy patterns in patients suspected of having Sjögren or sicca syndrome.

Medical records of patients who underwent sialoscintigraphy between April 2020 and May 2022 were reviewed. Associations between antibody levels and sialoscintigraphy parameters were evaluated using linear regression. Receiver operating characteristic curve analysis was used to identify antibody cutoff values for predicting flat-type patterns and the risk of Sjögren or sicca syndrome.

Of the 170 patients (mean age, 56.6 years; 78.8% female), 95.3% had dry mouth and eyes, 30% experienced polyarthralgia, and 66.5% were prescribed hydroxychloroquine. The most common sialoscintigraphy finding was the median-type time-activity curve (TAC) pattern. Anti-Ro/SSA and anti-La/SSB levels were significantly correlated with maximum accumulation or maximum secretion in the salivary glands. Receiver operating characteristic analysis for anti-Ro/SSA predicting a flat-type TAC pattern showed an area under the curve (AUC) of 0.659 to 0.780, with specificity between 82.1% and 86.3% for antibody levels greater than 85.2 units. Anti-Ro/SSA levels greater than 49.75 units predicted a higher risk of Sjögren or sicca syndrome, with an AUC of 0.622 and 83.9% specificity. Anti-La/SSB levels had no significant predictive value, with an AUC of 0.554.

Anti-Ro/SSA levels greater than 85.2 units were strong predictors of flat-type TAC patterns, indicating near-total salivary gland dysfunction and supporting their diagnostic utility in Sjögren or sicca syndrome.

Rheumatoid arthritis (RA) is an immune-mediated disease characterized by polyarthritis that affects the small joints of the bilateral upper and lower extremities. RA shares several common clinical symptoms with Sjögren's syndrome (SS), another rheumatic disease caused by the lymphocytic infiltration of exocrine glands, with dry eye and dry mouth being the two most common symptoms. Anti-Ro/SS-A antibodies, a diagnostic biomarker of SS, are positive in patients with RA at a certain rate. The coexistence of SS and/or positivity for anti-Ro/SS-A antibodies in patients with RA influences disease activity and the effectiveness of several classes of disease-modifying antirheumatic drugs (DMARDs). Furthermore, RA, SS, and certain DMARDs, including methotrexate, are associated with the onset of lymphoproliferative disorders (LPD). In contrast, several biological DMARDs, such as tocilizumab and rituximab, are plausible options without the risk of LPD relapse. Considering the results of the studies introduced in this article, RA with SS and/or positivity for anti-Ro/SS-A antibodies could be considered a phenotype different from isolated RA from the perspective of refractoriness to DMARD therapy and LPD risk. Hence, rheumatologists should observe caution when choosing DMARDs. Further studies are needed to establish the appropriate treatment for patients with RA, SS, and/or the presence of anti-Ro/SS-A antibodies.

Primary Sjogren's syndrome (pSS) and autoimmune thyroiditis (AIT) share overlapping genetic and immunological profiles. This retrospective study evaluates the efficacy of machine learning algorithms, with a focus on the Random Forest Classifier, to predict the presence of thyroid-specific autoantibodies (TPOAb and TgAb) in pSS patients.

A total of 96 patients with pSS were included in the retrospective study. All participants underwent a complete clinical and laboratory evaluation. All participants underwent thyroid function tests, including TPOAb and TgAb, and were accordingly divided into positive and negative thyroid autoantibody groups. Four machine learning algorithms were then used to analyze the risk factors affecting patients with pSS with positive and negative for thyroid autoantibodies.

The results indicated that the Random Forest Classifier algorithm (AUC = 0.755) outperformed the other three machine learning algorithms. The random forest classifier indicated Age, IgG, C4 and dry mouth were the main factors influencing the prediction of positive thyroid autoantibodies in pSS patients. It is feasible to predict AIT in pSS using machine learning algorithms.

Analyzing clinical and laboratory data from 96 pSS patients, the Random Forest model demonstrated superior performance (AUC = 0.755), identifying age, IgG levels, complement component 4 (C4), and absence of dry mouth as primary predictors. This approach offers a promising tool for early identification and management of AIT in pSS patients.

This retrospective study was approved and monitored by the Ethics Committee of The Third Affiliated Hospital of Sun Yat-sen University (No.II2023-254-02).

To use shear wave elastography (SWE) in the evaluation of salivary glands in patients with ankylosing spondylitis (AS) who present with sicca symptoms.

This was a prospective controlled study of patients diagnosed with AS and exhibiting sicca symptoms (study group) and of healthy volunteers (control group). The levels of antinuclear, anti-Ro, and anti-La antibodies were determined in blood samples. In both groups, parotid and submandibular glands were evaluated by ultrasound and tissue stiffness was determined by SWE. Intraclass correlation coefficients were used in order to assess reliability. The differences between the two groups were assessed by statistical methods, and a ROC curve analysis was performed to determine the predictive values.

A total of 66 patients with AS and 71 healthy volunteers were included in the study. There were no significant differences between the groups in terms of age or sex (p > 0.05). The intraand inter-rater reliability of SWE were good for the parotid gland (0.81-0.85 and 0.80, respectively) and for the submandibular gland (0.85-0.88 and 0.80, respectively). Statistically significant differences were found. Tissue stiffness in the parotid and submandibular glands, as determined by SWE, was significantly greater in the study group than in the control group (p < 0.05).

Although there was no histopathological correlation in the parotid and submandibular salivary glands of patients with AS and sicca symptoms compared with the healthy volunteers, quantitative measurements showed greater tissue stiffness in the former group. In patients with AS, SWE guides salivary gland biopsy, which is the gold standard for diagnosing Sjögren's syndrome.