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PONE-D-21-25023A Danish single-center study of patients with Sjögren’s Syndrome: Pathologic salivary gland ultrasound is associated with the presence of autoantibodiesPLOS ONE

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Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: 1- I suggest that the title is revised in the interest of clarity to:

Salivary gland ultrasound is associated with the presence of autoantibodies in patients with Sjögren’s Syndrome: A Danish single-centre study

2- Line 92: Explain “focus score” as this is the first time it is mentioned in this manuscript. A focus score of 1 or greater is diagnostic of Sjogren’s and not as stated in line 178 (…a focus score of > 1..)

3- Swap the numbering of table 2 and table 3, as table 3 is referred to in line 207 before table 3 in line 216

Reviewer #2: This is a comprehensive and well conducted study aiming to investigate whether ultrasound findings of major salivary glands in Sjögren’s syndrome are correlated with serological markers, autoantibodies, patient- or doctor-reported disease activity in a Danish cohort. One of the strengths of the study is that only one “ultrasounder” was used. The following conclusions could be drawn: Abnormal ultrasound findings are associated with autoantibodies of high specificity for Sjögren’s but not with ESSDAI, ESSPRI or inflammatory markers.

The following comments and questions can be raised:

1. Disease duration – from the time of diagnosis to the SGUS analyses. I think this should be elaborated on further and in particular if the results are related to a short disease duration as well as if younger versus older patients influenced the SGUS data.

2. The outcome measures used (and these are currently the only available) might not be the most sensitive/optimal. This certainly makes it difficult to relate the SGUS data to. Maybe discuss this further?

3. One can assume that the most severe SGUS data recorded is a result of a longstanding chronic inflammation. Are there any studies that you refer to that brings this up? Maybe also discuss this further?

4. Autoantibodies are known to occur years before symptoms onset and diagnosis in other rheumatic diseases (RA, SLE) but also in Sjögren’s. Do you dare to speculate on this in relation to your SGUS results?

5. The DISCUSSION could be made more exciting for the reader as well as shortened. Have you selected the most novel and interesting data and discussed these? Is all the repetition of results necessary?

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Reviewer #1: No

Reviewer #2: No

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Salivary gland ultrasound is associated with the presence of autoantibodies in patients with Sjögren´s Syndrome: A Danish single-centre study

PONE-D-21-25023R1

Dear Dr. Lindegaard,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Silke Appel, PhD (Dr. rer. nat.)

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: Interesting study on a relative novel method to analyze inflammation in major salivary glands. The authors have responded appropriately to my comments. I have no further comments.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No