Evaluation of a Practical Approach to Diagnosis of Sjögren Disease in Clinical Practice

The 2016 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria (AECC) borrow from oral pathology, ophthalmology, pathology, and serology to define Sjögren disease (SjD). The objective of this study was to analyze the utility of incorporating the 2016 AECC tools into clinical practice.

A cross-sectional database with 374 patients evaluated on protocol between 1993 and 2019 at the University Health Network Multidisciplinary Sjogren's Clinic was used for the purpose of this data analysis. All patients used for this analysis had a complete evaluation, including serology, ocular surface staining, and minor salivary gland (MSG) biopsy.

Of the 374 patients, 263 (70.3%) were diagnosed with SjD in clinic on the basis of the Schirmer test (ST), unstimulated salivary flow (USSF), and serology results alone (group A). An additional 14% were diagnosed after further assessment with ocular surface staining (ophthalmology) and MSG biopsy (ENT; group B). Group C patients did not have SjD. Groups B and C together were frequently seronegative (for antinuclear antibody and/or anti-Ro) or antimitochondrial antibody positive. Seronegative patients with abnormal ST and USSF had a positive MSG biopsy in 70% of cases.

SjD could be diagnosed according to 2016 AECC in most patients on the basis of ST, USSF, and serology results where there is concern for the disease on clinical evaluation. Patients who required further testing for diagnosis had some distinctive features. This analysis provides the practicing physician with some guidelines for establishing a diagnosis of SjD in clinic.