Sjögren's criteria embrace multispecialty approach

Diagnosis and management of Sjögren's syndrome require participation by rheumatologists, ophthalmologists and oral medicine specialties, according to the first classification criteria endorsed by the American College of Rheumatology.

The criteria appeared on the organization's website and in the April Arthritis Care & Research.

Patients must meet at least two out of three criteria to be classified as having Sjögren's syndrome:

• positive serum anti-SSA/Ro and/or anti-SSB/La or positive rheumatoid factor and ANA titer ≥1:320;
• labial salivary gland biopsy exhibiting focal lymphocytic sialadenitis with a focus score ≥1 focus/4 mm²;
• keratoconjunctivitis sicca with ocular staining score ≥3 (assuming that individual is not currently using daily eye drops for glaucoma and has not had corneal surgery or cosmetic eyelid surgery in the last 5 years).

The criteria authors wrote, “The development of new biologic immunomodulating agents that are being considered in the treatment of SS [Sjögren's syndrome] increases the need and importance of developing stringent classification criteria that can be used in the context of clinical trials. The consequence of misclassifying someone without SS as a case would be serious given the potentially toxic side effects of these agents.”

Furthermore, the distinction between primary and secondary forms of Sjögren's may now be obsolete, the authors continued. Because autoimmune conditions of the thyroid, liver, kidneys, and lungs can occur in Sjögren's patients, and many diseases have autoimmune mechanisms, “It seems of little use and risks potential confusion to distinguish in a given patient one autoimmune disease as secondary to another. Accordingly, the diagnosis of SS should be given to all who fulfill these criteria while also diagnosing any concurrent organ-specific or multiorgan autoimmune diseases, without distinguishing as primary or secondary.”