OMERACT scoring atlas for Sjögren's disease

Ultrasonography of the parotid and submandibular glands in Sjögren's disease. The images of each gland are scored according to a four-grade semiquantitative system and two-item qualitative system (fatty and fibrous glands) devised by the Outcomes Measures in Rheumatology Clinical Trials (OMERACT) working group^[1]. For the parotid and submandibular glands, grade 0 (panels A and B) is characterized by normal parenchyma (uniform echoic texture comparable to normal thyroid parenchyma with clear demarcation between the gland and the overlying tissue); grade 1 (panels C and D) is characterized by minimal change (mild inhomogeneity without anechoic/hypoechoic areas); grade 2 (panels E and F) is characterized by moderate change (moderate inhomogeneity with focal anechoic/hypoechoic areas surrounded by normal tissue); grade 3 (panels G and H) is characterized by severe changes (diffuse inhomogeneity with anechoic/hypoechoic areas occupying the entire gland surface and not surrounded by normal tissue); and grade 3 fibrous (panels I and J) is characterized by hyperechoic bands covering the entire surface of the gland, resulting in the gland having a similar appearance compared with the adjacent tissue.