| Summary: | <p><strong>Objectives</strong></p>
<p>While salivary gland ultrasound (SGU ) has gained prominence for evaluating Sjögren's syndrome, little information exists on SGU appearance of sarcoidosis and amyloidosis, potential mimics of Sjögren's syndrome. Our goal is to estimate diagnostic accuracy of major SGU features in differentiating Sjögren's syndrome from sarcoidosis, amyloidosis, and controls.</p>
<p><strong>Methods</strong></p>
<p>We enrolled consecutive adult ambulatory patients with clinical diagnosis of Sjögren's syndrome fulfilling 2016 American College of Rheumatology classification criteria; clinical diagnosis of sarcoidosis or AL amyloidosis, with histological confirmation from any tissue, and rheumatology outpatients without diagnoses affecting salivary glands. Subjects underwent major SGU using the Hočevar protocol, with resulting video clips reviewed blind to clinical diagnosis.</p>
<p><strong>Results</strong></p>
<p>Sjögren's syndrome SGU score were greater than in the other groups, but there were no distinguishing salivary glands features from AL amyloid or sarcoidosis. None of the patients in the control group scored higher than 17, a cutoff previously suggested for Sjögren's syndrome, but 27% of AL amyloidosis and 19% of sarcoidosis patients scored higher than 17. Adding Hočevar SGUS of ≥17 to the 2016 ACR /EULAR criteria in parallel scheme increased the sensitivity for Sjogren's from 87 to 98%, while combining the two criteria in series increased specificity from 81 to 98%.</p>
<p><strong>Conclusion</strong></p>
<p>Sjögren's syndrome, sarcoidosis and AL amyloidosis share common SGU features that can help distinguish these conditions from patients without systemic rheumatologic disease. Clinicians should carefully consider these potential mimics when interpreting salivary gland ultrasound results.</p>
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