LAUSR

We read with great interest the results of Couderc and colleagues concerning ultrasonographic (US) involvement of major salivary glands (SGs) in systemic sclerosis (SSc).1 We fully agree with their comment concerning the high prevalence of sicca syndrome in SSc and its underestimated impact on quality of life. US evaluation of major SGs is a non-irradiating, easy-to-use and largely available tool. Its diagnostic performances have been properly evaluated in primary Sjogren syndrome (SS)2 and can be extended to secondary SS. In their study, Couderc and colleagues highlight the high prevalence of overlap syndrome SSc/primary SS according to US evaluation. Nonetheless, this overlap syndrome may not be the only mechanism underlying sicca syndrome in SSc. As initially suggested by Couderc and colleagues, a specific SSc-associated fibrosis of major SGs could also explain sicca syndrome in SSc.1 3 This hypothesis is all the more relevant as such glandular fibrosis has already been described in minor SGs of SSc patients.3 Although the US Cornec’s score used by Couderc and colleagues …