Sjogren’s Syndrome is a difficult illness to diagnose. As a result, the diagnostic criteria have changed several times. Under the current American-European Consensus Sjögren’s Classification Criteria, a patient is considered to have SS if they have ocular symptoms and oral symptoms, along with either SS-A/SS-B or a positive salivary gland biopsy. While I have significant ocular symptoms and mild oral symptoms, I do not have either a positive biopsy or antibodies, so I do not meet the current criteria for diagnosis. Though it should be noted that these criteria are designed for clinical trials, where millions of dollars can ride on having trial participants with the correct diagnosis. Rheumatologists are allowed considerably more leeway, as noted by the Sjogren’s Syndrome Foundation.
However, it seems that new criteria are on the way. I missed this article last fall, but the new criteria seem to be ready for ratification:
They add two simpler diagnostic options: the Schirmer tear test and the 5-minute salivary flow test. They also weight the various diagnostic tests, assigning 2 points each to the focus score for focal lymphocytic sialadenitis and the presence of anti–Sjögren’s syndrome antibody A; and 1 point each for a Schirmer test of 5 mm in less than 5 min, an ocular staining score of greater than 5, and salivary flow rate of less than 0.1 mL/min.
Patients need a total of 4 points for a confirmed diagnosis of Sjögren’s syndrome. Because diagnosis no longer requires mucosal dryness, the new criteria “are more flexible, and allow us to select patients in the earlier stages of Sjögren’s syndrome who are more likely to show improvement with treatment,” said Dr. Raphaèle Seror, a clinical rheumatologist at Hôpitaux universitaires Paris-Sud in France and a member of the EULAR Steering Committee for the criteria.
This isn’t a major change, as patients will still need a positive SS-A antibody or salivary gland biopsy. However, it does streamline the criteria, and adds salivary flow as a diagnostic tool. Unfortunately, it does not take some newer diagnostic tools into account. Personally, I’m less concerned with the diagnostic criteria and more with rheumatologists who aren’t willing to see past it.