diagnostic criteria

sjogren's syndrome diagnostic criteria 

 

Y/N

 

I. Ocular symptoms: a positive response to at least one of the following questions:

'

 

1. Have you had daily, persistent, troublesome dry eyes for more than 3/12?

 

2. Do you have a recurrent sensation of sand or gravel in the eyes?

 

3. 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:

 

 

 

ii

1. Have you had a daily feeling of dry mouth for more than 3 months?

 

2. Have you had recurrent swollen salivary glands as an adult?

 

3. Do you frequently drink liquids to aid in swallowing dry food?

 

III. Ocular signs: that is, objective evidence for at least one of the following two tests:

 

 

iii

1. Schirmer's I test, performed without anaesthesia (<5 mm in 5 minutes)

 

2. Rose Bengal score or other ocular dye score

 

IV. Histopathology:

 

IV

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:

 

V

1. Unstimulated whole salivary flow (<1.5 ml in 15 minutes)

 

2. Parotid sialography showing the presence of diffuse sialectasias (punctate, cavitary or destructive pattern), without evidence of obstruction in the major ducts.

 

3. Salivary scintigraphy showing delayed uptake, reduced concentration and/or delayed excretion of tracer.

 

VI. Autoantibodies: presence in the serum of the following autoantibodies:

 

vi

1 . Antibodies to Ro(SSA) or La(SSB) antigens, or both                                             |

 

For primary SS

Primary SS may be defined as follows:

a.  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

b.  The presence of any 3 of the 4 objective criteria items (items III, IV, V, VI)

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 & neck radiotherapy

 

Hepatitis C infection

 

AIDs

 

Pre-existing iymphoma

 

Sarcoidosis

 

Graft versus host disease

 

Use of anticholinergic drugs

 

X = excluded


 

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