Sjögren Syndrome: New Classification Criteria

New criteria for classification of Sjögren syndrome (SS) released by the American College of Rheumatology (ACR) call for collaboration among the medical specialties that regularly provide treatment for the condition—rheumatology, ophthalmology, and oral medicine. Classification criteria for Sjögren syndrome have been published previously, but the current criteria are the first to be endorsed by the ACR, and they acknowledge the emergence of biologic agents as potential treatments for patients with Sjögren syndrome and associated comorbidities.

Rheumatologists are specially trained to recognize and manage rheumatologic diseases and often partner with primary care physicians and medical specialists to control the diseases with medications and nonpharmacological therapies, it was noted. The inclusion of objective tests related to oral, ocular, and systemic manifestations of Sjögren syndrome is a key feature of the current classification criteria, which reinforce the multidisciplinary nature of the disease and underscore the importance of collaboration in disease assessment and management.

At least 2 of the 3 medical specialties are required to determine a patient's disease status, according to the new criteria. For classification as Sjögren syndrome, patients' symptoms must meet at least 2 of 3 the following criteria:

 • Blood tests positive for specific antibodies related to autoimmunity (anti-SS-A AND/OR anti-SS-B), OR blood tests positive for rheumatoid factor AND an antinuclear antibody titer 1:320 or higher.
 • Keratoconjunctivitis sicca with an ocular staining score of 3 or higher (assuming that the patient is not currently using daily eye drops for glaucoma and has not had corneal surgery or cosmetic eyelid surgery in the previous 5 years).
• Pathological examination of a biopsy specimen of the minor salivary glands found in the lip (involving detection of lymphocytic foci) indicating the presence of autoimmune impairment of salivary function.

The article "American College of Rheumatology Classification Criteria for Sjogren's Syndrome: A Data-Driven, Expert Consensus Approach in the Sjögren 's International Collaborative Clinical Alliance Cohort" appears in the April issue of Arthritis Care & Research. The classification criteria—created to provide guidance and not for diagnostic purposes—were developed from registry data collected using standardized measures and are based on objective tests. Validation indicates improved classification performance relative to existing alternatives, making the criteria more suitable for application in situations in which incorrect classification may present health risks.

For more information, visit the ACR Web site. Or, contact the organization at American College of Rheumatology, 2200 Lake Boulevard NE, Atlanta, GA 30319; telephone: (404) 633-3777; fax (404) 633-1870.