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Research ArticleArticle

Are Salivary Gland Ultrasonography Scores Associated with Salivary Flow Rates and Oral Health-related Quality of Life in Sjögren Syndrome?

Yasemin Yalcinkaya, Gonca Mumcu, Filiz Türe Özdemir, Ramazan Esad Kuruş, Ali Uğur Ünal, Haner Direskeneli, George A. Bruyn and Nevsun Inanc
The Journal of Rheumatology May 2020, jrheum.190849; DOI: https://doi.org/10.3899/jrheum.190849
Yasemin Yalcinkaya
Y. Yalcinkaya, Associate Professor, A. U. Ünal, MD, H. Direskeneli, Professor, N. Inanc, Professor, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; G. Mumcu, Dentist, Professor, Department of Health Management, Marmara University School of Health Sciences, Istanbul, Turkey; F. Türe Özdemir, PhD, Division of Immunology, Marmara University, School of Medicine, Istanbul, Turkey; R. Esad Kuruş, MD, Marmara University, School of Medicine, Istanbul, Turkey; G.A. Bruyn, Professor, Department of Rheumatology, MC Groep Hospitals, Leystad, the Netherlands. Address correspondence to Dr. N. Inanc, Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey. Email: inanc.nevsun@gmail.com. Accepted for publication March 26, 2020.
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Gonca Mumcu
Y. Yalcinkaya, Associate Professor, A. U. Ünal, MD, H. Direskeneli, Professor, N. Inanc, Professor, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; G. Mumcu, Dentist, Professor, Department of Health Management, Marmara University School of Health Sciences, Istanbul, Turkey; F. Türe Özdemir, PhD, Division of Immunology, Marmara University, School of Medicine, Istanbul, Turkey; R. Esad Kuruş, MD, Marmara University, School of Medicine, Istanbul, Turkey; G.A. Bruyn, Professor, Department of Rheumatology, MC Groep Hospitals, Leystad, the Netherlands. Address correspondence to Dr. N. Inanc, Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey. Email: inanc.nevsun@gmail.com. Accepted for publication March 26, 2020.
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Filiz Türe Özdemir
Y. Yalcinkaya, Associate Professor, A. U. Ünal, MD, H. Direskeneli, Professor, N. Inanc, Professor, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; G. Mumcu, Dentist, Professor, Department of Health Management, Marmara University School of Health Sciences, Istanbul, Turkey; F. Türe Özdemir, PhD, Division of Immunology, Marmara University, School of Medicine, Istanbul, Turkey; R. Esad Kuruş, MD, Marmara University, School of Medicine, Istanbul, Turkey; G.A. Bruyn, Professor, Department of Rheumatology, MC Groep Hospitals, Leystad, the Netherlands. Address correspondence to Dr. N. Inanc, Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey. Email: inanc.nevsun@gmail.com. Accepted for publication March 26, 2020.
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Ramazan Esad Kuruş
Y. Yalcinkaya, Associate Professor, A. U. Ünal, MD, H. Direskeneli, Professor, N. Inanc, Professor, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; G. Mumcu, Dentist, Professor, Department of Health Management, Marmara University School of Health Sciences, Istanbul, Turkey; F. Türe Özdemir, PhD, Division of Immunology, Marmara University, School of Medicine, Istanbul, Turkey; R. Esad Kuruş, MD, Marmara University, School of Medicine, Istanbul, Turkey; G.A. Bruyn, Professor, Department of Rheumatology, MC Groep Hospitals, Leystad, the Netherlands. Address correspondence to Dr. N. Inanc, Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey. Email: inanc.nevsun@gmail.com. Accepted for publication March 26, 2020.
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Ali Uğur Ünal
Y. Yalcinkaya, Associate Professor, A. U. Ünal, MD, H. Direskeneli, Professor, N. Inanc, Professor, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; G. Mumcu, Dentist, Professor, Department of Health Management, Marmara University School of Health Sciences, Istanbul, Turkey; F. Türe Özdemir, PhD, Division of Immunology, Marmara University, School of Medicine, Istanbul, Turkey; R. Esad Kuruş, MD, Marmara University, School of Medicine, Istanbul, Turkey; G.A. Bruyn, Professor, Department of Rheumatology, MC Groep Hospitals, Leystad, the Netherlands. Address correspondence to Dr. N. Inanc, Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey. Email: inanc.nevsun@gmail.com. Accepted for publication March 26, 2020.
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Haner Direskeneli
Y. Yalcinkaya, Associate Professor, A. U. Ünal, MD, H. Direskeneli, Professor, N. Inanc, Professor, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; G. Mumcu, Dentist, Professor, Department of Health Management, Marmara University School of Health Sciences, Istanbul, Turkey; F. Türe Özdemir, PhD, Division of Immunology, Marmara University, School of Medicine, Istanbul, Turkey; R. Esad Kuruş, MD, Marmara University, School of Medicine, Istanbul, Turkey; G.A. Bruyn, Professor, Department of Rheumatology, MC Groep Hospitals, Leystad, the Netherlands. Address correspondence to Dr. N. Inanc, Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey. Email: inanc.nevsun@gmail.com. Accepted for publication March 26, 2020.
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George A. Bruyn
Y. Yalcinkaya, Associate Professor, A. U. Ünal, MD, H. Direskeneli, Professor, N. Inanc, Professor, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; G. Mumcu, Dentist, Professor, Department of Health Management, Marmara University School of Health Sciences, Istanbul, Turkey; F. Türe Özdemir, PhD, Division of Immunology, Marmara University, School of Medicine, Istanbul, Turkey; R. Esad Kuruş, MD, Marmara University, School of Medicine, Istanbul, Turkey; G.A. Bruyn, Professor, Department of Rheumatology, MC Groep Hospitals, Leystad, the Netherlands. Address correspondence to Dr. N. Inanc, Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey. Email: inanc.nevsun@gmail.com. Accepted for publication March 26, 2020.
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Nevsun Inanc
Y. Yalcinkaya, Associate Professor, A. U. Ünal, MD, H. Direskeneli, Professor, N. Inanc, Professor, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey; G. Mumcu, Dentist, Professor, Department of Health Management, Marmara University School of Health Sciences, Istanbul, Turkey; F. Türe Özdemir, PhD, Division of Immunology, Marmara University, School of Medicine, Istanbul, Turkey; R. Esad Kuruş, MD, Marmara University, School of Medicine, Istanbul, Turkey; G.A. Bruyn, Professor, Department of Rheumatology, MC Groep Hospitals, Leystad, the Netherlands. Address correspondence to Dr. N. Inanc, Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey. Email: inanc.nevsun@gmail.com. Accepted for publication March 26, 2020.
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Abstract

Objective Major salivary gland ultrasonography (SGUS) is a widely used imaging technique to evaluate salivary gland involvement in primary Sjögren syndrome (pSS). The aim of this study was to evaluate the relationship between SGUS, salivary flow rate (SFR) as an objective measure of the gland function, and oral health-related quality of life (OHRQOL) as a patient-reported outcome measure (PROM) in a pSS cohort.

Methods Sixty-six patients with pSS were examined by SGUS according to Hocevar and Milic scoring systems. Patients with inhomogeneity/hypoechoic areas with scores ≥ 2 in parotid and submandibular glands were classified separately as “severe glandular involvement.” Further, oral health, SFR, and Oral Health Impact Profile-14 (OHIP-14) for OHRQOL were assessed.

Results Both total Hocevar and Milic scores were higher in 21 pSS patients with low unstimulated whole salivary flow rate (U-WSFR) than 45 pSS patients without low U-WSFR (P = 0.001 and P < 0.0001, respectively). Increased scores of homogeneity, hypoechoic areas and glandular border visibility were observed in patients with low U-WSFR (P < 0.05). Among these variables, homogeneity score was found to be an independent risk factor for low U-WSFR in pSS according to logistic regression analysis (OR 1.586, P = 0.001). Moreover, a higher OHIP-14 score was observed in severe parotid involvement compared to nonsevere cases (23.26 ± 21.19 vs 8.32 ± 13.82, P = 0.004).

Conclusion High Milic and Hocevar SGUS scores are associated with reduced SFR and poor OHRQOL as a PROM. The inhomogeneity component of the SGUS score is associated with low U-WSFR and is an indicator of severely affected gland function.

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1 Jan 2021
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Are Salivary Gland Ultrasonography Scores Associated with Salivary Flow Rates and Oral Health-related Quality of Life in Sjögren Syndrome?
Yasemin Yalcinkaya, Gonca Mumcu, Filiz Türe Özdemir, Ramazan Esad Kuruş, Ali Uğur Ünal, Haner Direskeneli, George A. Bruyn, Nevsun Inanc
The Journal of Rheumatology May 2020, jrheum.190849; DOI: 10.3899/jrheum.190849

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Are Salivary Gland Ultrasonography Scores Associated with Salivary Flow Rates and Oral Health-related Quality of Life in Sjögren Syndrome?
Yasemin Yalcinkaya, Gonca Mumcu, Filiz Türe Özdemir, Ramazan Esad Kuruş, Ali Uğur Ünal, Haner Direskeneli, George A. Bruyn, Nevsun Inanc
The Journal of Rheumatology May 2020, jrheum.190849; DOI: 10.3899/jrheum.190849
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