I. Ocular symptoms: a
positive response to at
least one of the
following questions:
-
Have you had daily,
persistent,
troublesome dry eyes
for more than 3
months?
-
Do you have a
recurrent sensation of
sand or gravel in the
eyes?
-
Do you use tear
substitutes more than
3 times a day?
II. Oral symptoms: a
positive response to at
least one of the
following questions:
-
Have you had a daily
feeling of dry mouth
for more than 3
months?
-
Have you had
recurrently or
persistently swollen
salivary glands as an
adult?
-
Do you frequently
drink liquids to aid
in swallowing dry
food?
III. Ocular signs-that
is, objective evidence
of ocular involvement
defined as a positive
result for at least one
of the following two
tests:
-
Schirmer's I test,
performed without
anaesthesia (</=5 mm
in 5 minutes)
-
Rose bengal score or
other ocular dye score
(>/=4 according to van
Bijsterveld's scoring
system)
IV. Histopathology: In
minor salivary glands
(obtained through
normal-appearing mucosa)
focal lymphocytic
sialoadenitis, evaluated
by an expert
histopathologist, with a
focus score >/=1,
defined as a number of
lymphocytic foci (which
are adjacent to
normal-appearing mucous
acini and contain more
than 50 lymphocytes) per
4 mm2 of
glandular tissue
V. Salivary gland
involvement: objective
evidence of salivary
gland involvement
defined by a positive
result for at least one
of the following
diagnostic tests:
-
Unstimulated whole
salivary flow (</=1.5
ml in 15 minutes)
-
Parotid sialography
showing the presence
of diffuse
sialectasias (punctate,
cavitary or
destructive pattern),
without evidence of
obstruction in the
major ducts
-
Salivary scintigraphy
showing delayed
uptake, reduced
concentration and/or
delayed excretion of
tracer
VI. Autoantibodies:
presence in the serum of
the following
autoantibodies:
-
Antibodies to Ro(SSA)
or La(SSB) antigens,
or both
Revised Rules for
Classification
For
primary SS
In patients without any
potentially associated
disease, primary SS may
be defined as follows:
-
The presence of any 4
of the 6 items is
indicative of primary
SS, as long as either
item IV
(Histopathology) or VI
(Serology) is positive
-
The presence of any 3
of the 4 objective
criteria items (that
is, items III, IV, V,
VI)
-
The classification
tree procedure
represents a valid
alternative method for
classification,
although it should be
more properly used in
clinical-epidemiological
survey
For
secondary SS
In patients with a
potentially associated
disease (for instance,
another well defined
connective tissue
disease), the presence
of item I or item II
plus any 2 from among
items III, IV, and V may
be considered as
indicative of secondary
SS
Exclusion criteria:
-
Past head and neck
radiation treatment
-
Hepatitis C infection
-
Acquired
immunodeficiency
disease (AIDS)
-
Pre-existing lymphoma
-
Sarcoidosis
-
Graft versus host
disease
-
Use of anticholinergic
drugs (since a time
shorter than 4-fold
the half life of the
drug)
Related
Criteria
Revised ARA Criteria for the Classification of Rheumatoid Arthritis (RA)
Classification Criteria for the Diagnosis of Systemic Lupus Erythematosus (SLE)
Criteria for
the
Classification
of Systemic
Sclerosis (Scleroderma)
ACR Criteria for the Classification of Polyarteritis Nodosa (PAN)
ACR Criteria for the Classification of Churg-Strauss Syndrome (CSS)
ACR Criteria for the Classification of Giant-Cell Arteritis
ACR Criteria for the Classification of Hypersensitivity Vasculitis
1990 Criteria of
American College of Rheumatology for
the Classification of Takayasu
Arteritis
Classification Criteria for
Osteoarthritis
Diagnostic Criteria for Relapsing Polychondritis
Criteria for the Classification of Wegener's Granulomatosis (WG)
Diagnostic Criteria for
Autoimmune Hepatitis (AIH)
Diagnostic Criteria for Kawasaki Disease
Names and definitions of vasculitis adopted by the Chapel Hill Consensus Conference
Diagnostic
Criteria for
Mixed
Connective
Tissue
Disease (MCTD)
Criteria for the
Classification of the
Antiphospholipid Syndrome (APS)
More...
References:
-
Vitali C, Bombardieri
S, Jonsson R,
Moutsopoulos HM,
Alexander EL, Carsons
SE, Daniels TE, Fox
PC, Fox RI, Kassan SS,
Pillemer SR, Talal N,
Weisman MH; European
Study Group on
Classification
Criteria for Sjogren's
Syndrome.
Classification
criteria for Sjogren's
syndrome: a revised
version of the
European criteria
proposed by the
American-European
Consensus Group.
Ann Rheum Dis. 2002
Jun;61(6):554-8.
[Medline]
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