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To assess the clinical, laboratory, and salivary gland ultrasound (SGUS) characteristics of elderly-onset of primary Sjögren's syndrome (EopSS). We included pSS patient from two referral hospitals over a 4-year period. The SGUS scores (0-48) and SG volumes were assessed. Clinical, laboratory, and SGUS data were compared according to age at onset EopSS (≥65 years), adult-onset (AopSS) (≥40 and 65 years), and young-onset (YopSS) (40 years). This cross-sectional study included a total of 221 patients, 43 (19.5%) of which had EopSS.