OMERACT score for ultrasound assessment of submandibular glands in patients with SSc

(A) Grade 0, normal parenchyma. (B) Grade 1, minimal change mild inhomogeneity without anechoic/hypoechoic areas. (C) Grade 2, moderate change: moderate inhomogeneity with focal anechoic/hypoechoic areas but with preserved surrounding normal tissue. (D) Grade 3, severe change: diffuse inhomogeneity with anechoic/hypoechoic areas occupying the entire gland surface but without surrounding normal tissue or only fibrotic aspect with a submandibular parenchyma indistinguishable from the adjacent tissue. (E) Ultrasound view of the parotid glands (OMERACT grade 3). Grade 3 is characterized by the absence of healthy parenchyma. Hyperechoic fibrotic bands (blue dashed lines) are key features of OMERACT grade 3 in SSc patients.