{"id":2504,"date":"2009-03-08T12:46:41","date_gmt":"2009-03-08T12:46:41","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/reusjs\/"},"modified":"2025-05-14T19:10:21","modified_gmt":"2025-05-14T19:10:21","slug":"reusjs","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/reusjs\/","title":{"rendered":"Revised International Classification Criteria for Sj\u00f6gren&#8217;s Syndrome (SS)"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> I. Ocular symptoms: a positive response to at least one of the following questions:<\/span><\/strong><\/p>\n<ol>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Have you had daily, persistent, troublesome dry eyes for more than 3 months?<\/span><\/strong><\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Do you have a recurrent sensation of sand or gravel in the eyes?<\/span><\/strong><\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Do you use tear substitutes more than 3 times a day?<\/span><\/strong><\/p>\n<p><!--more--><\/li>\n<\/ol>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> II. Oral symptoms: a positive response to at least one of the following questions:<\/span><\/strong><\/p>\n<ol>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Have you had a daily feeling of dry mouth for more than 3 months?<\/span><\/strong><\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Have you had recurrently or persistently swollen salivary glands as an adult?<\/span><\/strong><\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Do you frequently drink liquids to aid in swallowing dry food?<\/span><\/strong><\/p>\n<\/li>\n<\/ol>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> III. Ocular signs-that is, objective evidence of ocular involvement defined as a positive result for at least one of the following two tests:<\/span><\/strong><\/p>\n<ol>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Schirmer&#8217;s I test, performed without anaesthesia (&lt;\/=5 mm in 5 minutes)<\/span><\/strong><\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Rose bengal score or other ocular dye score (&gt;\/=4 according to van Bijsterveld&#8217;s scoring system)<\/span><\/strong><\/p>\n<\/li>\n<\/ol>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> IV. Histopathology: In minor salivary glands (obtained through normal-appearing mucosa) focal lymphocytic sialoadenitis, evaluated by an expert histopathologist, with a focus score &gt;\/=1, defined as a number of lymphocytic foci (which are adjacent to normal-appearing mucous acini and contain more than 50 lymphocytes) per 4 mm<sup>2<\/sup> of glandular tissue<\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong><span style=\"font-weight: normal;\">V. Salivary gland involvement: objective evidence of salivary gland involvement defined by a positive result for at least one of the following diagnostic tests:<\/span><\/strong><\/p>\n<ol>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Unstimulated whole salivary flow (&lt;\/=1.5 ml in 15 minutes)<\/span><\/strong><\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Parotid sialography showing the presence of diffuse sialectasias (punctate, cavitary or destructive pattern), without evidence of obstruction in the major ducts<\/span><\/strong><\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Salivary scintigraphy showing delayed uptake, reduced concentration and\/or delayed excretion of tracer<\/span><\/strong><\/p>\n<\/li>\n<\/ol>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> VI. Autoantibodies: presence in the serum of the following autoantibodies:<\/span><\/strong><\/p>\n<ol>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Antibodies to Ro(SSA) or La(SSB) antigens, or both<\/span><\/strong><\/p>\n<\/li>\n<\/ol>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> Revised Rules for Classification <\/strong><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> For primary SS<\/strong><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> In patients without any potentially associated disease, primary SS may be defined as follows:<\/span><\/strong><\/p>\n<ol>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> 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<\/span><\/strong><\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> The presence of any 3 of the 4 objective criteria items (that is, items III, IV, V, VI)<\/span><\/strong><\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> The classification tree procedure represents a valid alternative method for classification, although it should be more properly used in clinical-epidemiological survey<\/span><\/strong><\/p>\n<\/li>\n<\/ol>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> For secondary SS<\/strong><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> 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 <\/span><\/strong><\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong><br \/>\nExclusion criteria:<\/strong><\/p>\n<ul>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Past head and neck radiation treatment<\/span><\/strong><\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Hepatitis C infection<\/span><\/strong><\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Acquired immunodeficiency disease (AIDS)<\/span><\/strong><\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Pre-existing lymphoma<\/span><\/strong><\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Sarcoidosis<\/span><\/strong><\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Graft versus host disease<\/span><\/strong><\/p>\n<\/li>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> Use of anticholinergic drugs (since a time shorter than 4-fold the half life of the drug)<\/span><\/strong><\/p>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong>References:<\/strong><\/p>\n<ol>\n<li>\n<p class=\"MsoNormal\" style=\"margin-top: 0pt; margin-bottom: 0pt;\"><strong> <span style=\"font-weight: normal;\"> 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&#8217;s Syndrome. Classification criteria for Sjogren&#8217;s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. <\/span> <span style=\"font-weight: normal;\"> Ann Rheum Dis. 2002 Jun;61(6):554-8. <\/span><\/strong> <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/12006334\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/p>\n<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created: Dic 08, 2005<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[45],"tags":[166,167,16,15,1304,1065,8,7,1070,5,421,842,4],"class_list":["post-2504","post","type-post","status-publish","format-standard","hentry","category-rheumatology","tag-clasificacion","tag-classification","tag-criteria","tag-criterios","tag-internacional","tag-international","tag-revisados","tag-revised","tag-rheumatology","tag-sindrome","tag-sjogren","tag-ss","tag-syndrome"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2504","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2504"}],"version-history":[{"count":4,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2504\/revisions"}],"predecessor-version":[{"id":9390,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2504\/revisions\/9390"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2504"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2504"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2504"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}