With great interest we have read the recent publication by Fisher et al ,1 entitled ‘Effect of rituximab on a salivary gland ultrasound score in primary Sjogren’s syndrome: results of the TRACTISS randomised double-blind multicenter substudy’ in which the authors demonstrated a significant improvement in total ultrasound score (TUS) after rituximab treatment compared with placebo at weeks 16 and 48 in 52 patients with primary Sjogren’s syndrome (pSS). We and others have shown that treatment with rituximab, a chimeric anti-CD20 monoclonal antibody, affects the histopathology of the salivary glands and results in a decrease in area of lymphocytic infiltrate in the labial and parotid glands.2–5 This reduction in infiltrated area, that is, up to 50%, is mainly caused by B cell depletion.2 Rituximab treatment also causes a significant loss of germinal centres.2 Interestingly, rituximab treatment also leads to a significant restoration of the ductal epithelium glandular tissue itself. This is illustrated by a significant decrease in number and severity of lymphoepithelial lesions (LELs) in parotid gland tissue 12 weeks after rituximab treatment.2 6 The normalisation of the epithelium appears to be a direct consequence of depletion of intraepithelial B cells.7 Significant improvement of the parotid gland ultrasound score of patients with pSS has been observed before in another randomised controlled trial (RCT) with rituximab, the Tolerance and Efficacy of Rituximab in Primary Sjogren’s Syndrome (TEARS) study.8 This is an RCT with rituximab versus placebo, performed by a French group. Together with the improvement of the histopathology of the gland, it might not be a surprise that Fisher et al 1 also observed a significant improvement in TUS. This newly …

中文翻译：

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主要唾液腺超声能否评估由利妥昔单抗治疗引起的原发性干燥综合征的组织病理学变化？

我们怀着极大的兴趣阅读了 Fisher 等人最近发表的题为“利妥昔单抗对原发性干燥综合征唾液腺超声评分的影响：TRACTISS 随机双盲多中心子研究的结果”的文章，其中作者证明了显着改善在 52 名原发性干燥综合征 (pSS) 患者中，在第 16 周和第 48 周，利妥昔单抗治疗后的总超声评分 (TUS) 与安慰剂相比。我们和其他人已经证明，使用 rituximab（一种嵌合抗 CD20 单克隆抗体）治疗会影响唾液腺的组织病理学，并导致唇和腮腺淋巴细胞浸润面积减少。 2-5 这种浸润面积减少，即高达 50%，主要是 B 细胞耗竭所致。2 利妥昔单抗治疗也会导致生发中心的显着丧失。2 有趣的是，利妥昔单抗治疗还导致导管上皮腺组织本身的显着恢复。利妥昔单抗治疗 12 周后，腮腺组织中淋巴上皮病变 (LEL) 的数量和严重程度显着降低，这说明了这一点。2 6 上皮正常化似乎是上皮内 B 细胞耗竭的直接结果。 7 显着改善之前在另一项使用利妥昔单抗的随机对照试验 (RCT) 中观察到 pSS 患者腮腺超声评分的差异，即利妥昔单抗在原发性干燥综合征 (TEARS) 研究中的耐受性和疗效。 8 这是一项使用利妥昔单抗与安慰剂的 RCT，由法国乐队演奏。随着腺体组织病理学的改善，Fisher 等人 1 也观察到 TUS 的显着改善也就不足为奇了。这个新…