BSR Guideline for the Management of Primary Sjögren's Syndrome

Salient Points

• Patients commonly present with a dryness of the eyes and mouth. In the early stages, they may complain of grittiness rather than dryness of the eyes, and the mouth symptoms may require prompting.


• Fatigue and arthralgia are almost universal.


• There is often a considerable delay between symptom onset and diagnosis.


• The most widely accepted current classification criteria for pSS and those referred to in this guideline are the American-European Consensus Group (AECG) criteria. The 2016 ACR–EULAR criteria have just been published derived from criteria proposed by the Sjögren’s International Collaborative Clinical Alliance (SICCA). The populations described by both criteria are very similar.


• For a definite diagnosis the AECG criteria require four out of six of dry eye symptoms, dry mouth symptoms, objective ocular dryness (Schirmer’s test ⩽5 mm in 5 min or van Bijsterveld score ⩾4), objective oral dryness (unstimulated salivary flow rate ⩽0.1 ml/min or positive salivary scintigraphy and sialography), positive anti-Ro/La antibodies, labial gland focus score ⩾1 including at least one of the last two objective features.


• The 2016 ACR–EULAR classification criteria are based on the weighted sum of five items and require a total score ⩾4 to meet the criteria for diagnosis where the presence of anti-Ro antibodies or focal lymphocytic sialadenitis with a focus score of ⩾1 score 3 each and where abnormal ocular staining score ⩾5, Schirmer’s test result of ⩽5 mm/5 min and unstimulated salivary flow rate of <0.1 ml/min score 1 each.

Read the full article click on the following link: https://doi.org/10.1093/rheumatology/kex375