New Classification Criteria for Sjogren's syndrome

The American College of Rheumatology and the European League Against Rheumatism have published an international set of classification criteria for primary Sjögren's syndrome.

There are currently 11 classification/diagnostic criteria sets for Sjögren's syndrome that have been published between 1965 and 2002, but none had been endorsed by the American College of Rheumatology (ACR) or European League Against Rheumatism (EULAR).

Up until now, the most commonly used classification criteria in research and clinical practice has been the American-European Consensus Group (AECG) criteria. In 2012, the ACR provisionally approved new classification criteria developed by the Sjögren's International Collaborative Clinical Alliance (SICCA). Both sets of criteria differed slightly. The AECG criteria allowed substitutions of some alternative items and the use of symptoms of dry eyes and mouth in classifying patients.

The treatment of Sjögren's syndrome has changed in recent years. There are now newly approved treatments and disease activity indices have been updated. But what’s been sorely lacking, has been a single set of data-driven consensus classification criteria.

“The provisional ACR criteria are based solely on objective tests and with symptoms considered as inclusion criteria for the target population to whom the criteria should apply,” wrote the authors of the newly published classification criteria in the Oct. 26 issue of the Annals of the Rheumatic Diseases.

The work group that penned the new classification criteria included 36 rheumatologists, 10 oral medicine/pathology specialists and nine ophthalmologists, as well as two patient advocates (from the U.S. and Europe).

The criteria applies to patients with at least one symptom of ocular or oral dryness (based on AECG questions) or suspicion of primary Sjögren's syndrome due to systemic features derived from the ESSDAI measure with at least one positive domain item.

Improvements from the 2012 ACR criteria include the addition of Schirmer's test and the UWS, the use of a higher threshold for the OSS (≥5) and the optional use of the VBS as an alternative to the OSS (in cases when an ophthalmologist trained in the OSS is not available).

For more specifics on the new criteria, please visit the Annals of the Rheumatic Diseases.

References:

Caroline H Shiboski, Stephen C Shiboski, et al. "2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren's syndrome A consensus and data-driven methodology involving three international patient cohorts," Annals of the Rheumatic Diseases. Oct. 26, 2016. DOI:10.1136/annrheumdis-2016-210571