Skip to main content

Classification Criteria

  • Chapter
  • First Online:

Abstract

Over the past 25 years, several classification criteria sets have been proposed for primary Sjögren’s syndrome (pSS). In this chapter, we describe the different features of these criteria and summarize the debate that has arisen in the scientific community over this period. We devote particular attention to a critical analysis of the American and European consensus group criteria (AECG), which have achieved important consensus in the literature. Proposals for the future are also outlined.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Nikolov NP, Illei GG. Pathogenesis of Sjögren’s syndrome. Curr Opin Rheumatol. 2009;21(5):465–70.

    Article  PubMed  Google Scholar 

  2. Fietta P, Delsante G, Quaini F. Hematologic manifestations of connective autoimmune diseases. Clin Exp Rheumatol. 2009;27(1):140–54.

    PubMed  CAS  Google Scholar 

  3. Voulgarelis M, Tzioufas AG, Moutsopoulos HM. Mortality in Sjögren’s syndrome. Clin Exp Rheumatol. 2008;26(5 Suppl 51):S66–71.

    PubMed  CAS  Google Scholar 

  4. Theander E, Jacobsson LT. Relationship of Sjögren’s syndrome to other connective tissue and autoimmune disorders. Rheum Dis Clin North Am. 2008;34(4):935–47, viii–ix.

    Article  PubMed  Google Scholar 

  5. Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carson SE, et al. Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61:554–8.

    Article  PubMed  CAS  Google Scholar 

  6. Iorgulescu G. Saliva between normal and pathological. Important factors in determining systemic and oral health. J Med Life. 2009;2(3):303–7.

    PubMed  Google Scholar 

  7. Kikuchi M, Inagaki T, Ogawa K, Banno S, Matsumoto Y, Ueda R, et al. Histopathological investigation of salivary glands in the asymptomatic elderly. Arch Gerontol Geriatr. 2004;38(2):131–8.

    Article  PubMed  Google Scholar 

  8. Manthorpe R, Oxholm P, Prause JU, Schiodt M. The Copenhagen criteria for Sjögren’s syndrome. Scand J Rheumatol. 1986;61:19–21.

    CAS  Google Scholar 

  9. Homma M, Tojo T, Akizuki M, Yamagata H. Criteria for Sjögren’s syndrome in Japan. Scand J Rheumatol. 1986;61:26–7.

    CAS  Google Scholar 

  10. Skopouli FN, Drosos AA, Papaioannou T, Moutsopoulos HM. Preliminary diagnostic criteria for Sjögren’s syndrome. Scand J Rheumatol. 1986;61:22–5.

    CAS  Google Scholar 

  11. Fox RI, Robinson CA, Curd JG, Kozin F, Howell FV. Sjögren’s syndrome. Proposed criteria for classification. Arthritis Rheum. 1986;29(5):577–85.

    Article  PubMed  CAS  Google Scholar 

  12. Daniels TE, Silverman S, Michalski JP, Greenspan JS, Sylvester RA, Talal N. The oral component of Sjögren’s syndrome. Oral Surg Oral Med Oral Pathol. 1975;39:875–85.

    Article  PubMed  CAS  Google Scholar 

  13. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The 1987 revised American association criteria for classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315–24.

    Article  PubMed  CAS  Google Scholar 

  14. Daniels TE. Labial salivary gland biopsy in Sjögren’s syndrome: assessment as a diagnostic criterion in 362 suspected cases. Arthritis Rheum. 1984;27:147–56.

    Article  PubMed  CAS  Google Scholar 

  15. Fox RI, Saito I. Criteria for diagnosis of Sjögren’s syndrome. Rheumatol Dis North Am. 1994;20(2):391–407.

    CAS  Google Scholar 

  16. Shah F, Rapini RP, Arnett FC, Warner NB, Smith CA. Association of labial salivary gland histopathology with clinical and serologic features of connective tissue diseases. Arthritis Rheum. 1990;33:1682–7.

    Article  PubMed  CAS  Google Scholar 

  17. Atkinson JC, Travis WD, Slocum L, Ebbs WL, Fox PC. Serum anti-SS-B/La and IgA rheumatoid factor are markers of salivary gland disease activity in primary Sjögren’s syndrome. Arthritis Rheum. 1992;35:1368–72.

    PubMed  CAS  Google Scholar 

  18. Daniels TE, Witcher JP. Association of patterns of labial salivary gland inflammation with keratoconjunctivitis sicca. Analysis of 618 patients with suspected Sjögren’s syndrome. Arthritis Rheum. 1994;6:869–77.

    Article  Google Scholar 

  19. Prause JU, Manthorpe R, Oxholm P, Schiødt M. Definition and criteria for Sjögren’s syndrome used by the contributors to the First International Seminar on Sjögren’s syndrome – 1986. Scand J Rheumatol Suppl. 1986;61:17–8.

    PubMed  CAS  Google Scholar 

  20. Workshop on diagnostic criteria for Sjögren’s syndrome: I. Questionnaires for dry eye and dry mouth. II Manual of methods and procedures. Clin Exp Rheumatol. 1989;7:212–19.

    Google Scholar 

  21. Vitali C, Bombardieri S, Moutsopoulos HM, Balestrieri G, Bencivelli W, Bernstein RM, et al. Preliminary criteria for the classification of Sjögren’s syndrome. Results of a prospective concerted action supported by the European Community. Arthritis Rheum. 1993;36(3):340–7.

    Article  PubMed  CAS  Google Scholar 

  22. Vitali C, Bombardieri S, Moutsopoulos HM, Coll J, Gerli R, Hatron PY, et al. Assessment of the European classification criteria for Sjögren’s syndrome in a series of clinically defined cases: results of a prospective multicentre study. The European Study Group on Diagnostic Criteria for Sjögren’s Syndrome. Ann Rheum Dis. 1996;55(2):116–21.

    Article  PubMed  CAS  Google Scholar 

  23. Fox RI. Fifth international symposium on Sjögren’s syndrome. Arthritis Rheum. 1996;39(2):195–6.

    Article  PubMed  CAS  Google Scholar 

  24. Ramos-Casals M, Garcia Carrasco M, Cervera R, Rosas J, Trejo O, de la Red G, et al. Hepatitis C virus infection mimicking primary Sjögren’s syndrome. A clinical and immunologic description of 35 cases. Medicine (Baltimore). 2001;80:1–8.

    Article  CAS  Google Scholar 

  25. Novljan MP, Rozman B, Jerse M, Rotar Z, Kveder T, Tomsic M. Comparison of the different classification criteria sets for primary Sjögren’s syndrome. Scand J Rheumatol. 2006;35:463–7.

    Article  PubMed  CAS  Google Scholar 

  26. Langegger C, Wenger M, Duftner C, Dejaco C, Baldissera I, Moncayo R, et al. Use of the European preliminary criteria, the Breiman classification tree and the American–European criteria for diagnosis of primary Sjögren’s Syndrome in daily practice: a retrospective analysis. Rheumatol Int. 2007;27(8):699–702.

    Article  PubMed  CAS  Google Scholar 

  27. Binard A, Devauchelle-Pensec V, Fautrel B, Jousse S, Youinou P, Saraux A. Epidemiology of Sjögren’s syndrome: where are we now? Clin Exp Rheumatol. 2007;25(1):1–4.

    PubMed  CAS  Google Scholar 

  28. Birlik M, Akar S, Gurler O, Sari I, Birlik B, Sarioglu S, et al. Prevalence of primary Sjögren’s syndrome in Turkey: a population-based epidemiological study. Int J Clin Pract. 2009;63(6):954–61.

    Article  PubMed  CAS  Google Scholar 

  29. Haugen AJ, Peen E, Hultén B, Johannessen AC, Brun JG, Halse AK, et al. Estimation of the prevalence of primary Sjögren’s syndrome in two age-different community-based populations using two sets of classification criteria: the Hordaland Health Study. Scand J Rheumatol. 2008;37(1):30–4.

    Article  PubMed  CAS  Google Scholar 

  30. Kabasakal Y, Kitapcioglu G, Turk T, Oder G, Durusoy R, Mete N, et al. The prevalence of Sjögren’s syndrome in adult women. Scand J Rheumatol. 2006;35(5):379–83.

    Article  PubMed  CAS  Google Scholar 

  31. Bjerrum KB. Keratoconjunctivitis sicca and primary Sjögren’s syndrome in a Danish population aged 30–60 years. Acta Ophthalmol Scand. 1997;75:281–6.

    Article  PubMed  CAS  Google Scholar 

  32. Zhang NZ, Shi CS, Yao QP, Pan GX, Wang LL, Wen ZX, et al. Prevalence of primary Sjögren’s syndrome in China. J Rheumatol. 1995;22(4):659–61.

    PubMed  CAS  Google Scholar 

  33. Alamanos Y, Tsifetaki N, Voulgari PV, Venetsanopoulo AI, Siozos C, Drosos AA. Epidemiology of primary Sjögren’s syndrome in north-west Greece, 1982–2003. Rheumatology. 2006;45:187–91.

    Article  PubMed  CAS  Google Scholar 

  34. Trontzas PI, Andrianakos AA. Sjögren’s syndrome: a population-based study of prevalence in Greece: The ESORDIG study. Ann Rheum Dis. 2005;64:1240–1.

    Article  PubMed  CAS  Google Scholar 

  35. Bowman SJ, Ibrahim GH, Holmes G, Hamburger J, Ainsworth JR. Estimating the prevalence among Caucasian women of primary Sjögren’s syndrome in two general practices in Birmingham, UK. Scand J Rheumatol. 2004;33:39–43.

    Article  PubMed  CAS  Google Scholar 

  36. Tomsic M, Logar D, Grmek M, Perkovic T, Kveder T. Prevalence of Sjögren’s syndrome in Slovenia. Rheumatology. 1999;38:164–70.

    Article  PubMed  CAS  Google Scholar 

  37. Thomas E, Hay EM, Hajeer A, Silman AJ. Sjögren’s syndrome: a community-based study of prevalence and impact. Br J Rheumatol. 1998;37:1069–76.

    Article  PubMed  CAS  Google Scholar 

  38. Dafni UG, Tzioufas AG, Staikos P, Skopouli FN, Moutsopoulos MH. Prevalence of primary Sjögren’s syndrome in a closed rural community. Ann Rheum Dis. 1997;56:521–5.

    Article  PubMed  CAS  Google Scholar 

  39. Jacobsson LT, Axell TE, Hansen BU, Henricsson VJ, Larsson A, Lieberkind K, et al. Dry eyes or mouth – an epidemiological study in Swedish adults, with special reference to primary Sjögren’s syndrome. J Autoimmun. 1989;2(4):521–7.

    Article  PubMed  CAS  Google Scholar 

  40. Brun JG, Madland TM, Gjesdal CB, Bertelsen LT. Sjögren’s syndrome in an out-patient clinic: classification of patients according to the preliminary European criteria and the proposed modified European criteria. Rheumatology. 2002;41(3):301–4.

    Article  PubMed  CAS  Google Scholar 

  41. Sánchez-Guerrero J, Pérez-Dosal MR, Cárdenas-Velázquez F, Pérez-Reguera A, Celis-Aguilar E, Soto-Rojas AE, et al. Prevalence of Sjögren’s syndrome in ambulatory patients according to the American-European Consensus Group criteria. Rheumatology. 2005;44(2):235–40.

    Article  PubMed  Google Scholar 

  42. Kassan SS, Mutsopoulos HM. Clinical manifestations and early diagnosis of Sjögren syndrome. Arch Intern Med. 2004;164:1275–84.

    Article  PubMed  Google Scholar 

  43. Ramos Casals M, Tzioufas AG, Font J. Primary Sjögren’s syndrome: new clinical and therapeutic concepts. Ann Rheum Dis. 2005;64:347–54.

    Article  PubMed  CAS  Google Scholar 

  44. Morbini P, Manzo A, Caporali R, Epis O, Villa C, Tinelli C, et al. Multilevel examination of minor salivary gland biopsy for Sjögren’s syndrome significantly improves diagnostic performance of AECG classification criteria. Arthritis Res Ther. 2005;7(2):R343–8.

    Article  PubMed  Google Scholar 

  45. Whitcher JP, Shiboski CH, Shiboski SC, Heidenreich AM, Kitagawa K, Zhang S, et al. A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjögren’s Syndrome International Registry. Am J Ophthalmol. 2010;149(3):405–15.

    Article  PubMed  Google Scholar 

  46. Daniels TE, Criswell LA, Shiboski C, Shiboski S, Lanfranchi H, Dong Y, et al. An early view of the international Sjögren’s syndrome registry. Arthritis Rheum. 2009;61(5):711–4.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Miss Wendy Doherty and Miss Luisa Marconcini for their valuable contribution in reviewing the text.

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag London Limited

About this chapter

Cite this chapter

Baldini, C., Talarico, R., Bombardieri, S. (2011). Classification Criteria. In: Ramos-Casals, M., Stone, J., Moutsopoulos, H. (eds) Sjögren’s Syndrome. Springer, London. https://doi.org/10.1007/978-0-85729-947-5_29

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-947-5_29

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-946-8

  • Online ISBN: 978-0-85729-947-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics