Reassessing Diagnostic Standards in Primary Sjögren’s Disease: The Role of Salivary Gland Ultrasonography

Primary Sjögren’s disease (pSjD) is a complex autoimmune disorder with a broad spectrum of presentations, often requiring invasive procedures such as lip biopsy for diagnosis. Recent advances in salivary gland ultrasonography (SGUS) have highlighted its value as a noninvasive, real-time imaging modality capable of detecting glandular abnormalities in patients with suspected pSjD. This review evaluates the diagnostic utility of SGUS, with a focus on the standardised Outcome Measures in Rheumatology Clinical Trials (OMERACT) scoring system, and its correlation with histological and serological findings. SGUS demonstrates high specificity and reproducibility, and when integrated with clinical and laboratory features, it may reduce reliance on invasive procedures. Furthermore, the article explores comparative advantages over traditional tests, challenges in operator variability and future directions including the integration of artificial intelligence to enhance diagnostic accuracy and clinical decision-making. With increasing evidence and improved standardisation, SGUS is positioned to play a central role in the diagnostic pathway for pSjD, particularly in early, seronegative, or equivocal cases.