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| ==Overview== | | ==Overview== |
| ==Classification== | | ==Classification== |
| Revised Classification Criteria for Sjogren's Syndrome<ref>Ann Rheum Dis 2002; 61: 54-558</ref>
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| A. '''Ocular symptoms''': a positive response to at least one of the following questions:
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| :1. Have you had daily, persistent, troublesome dry eyes for more than 3 months?
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| :2. Do you have a recurrent sensation of sand or gravel in the eyes?
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| :3. Do you use tear substitutes more than 3 times a day?
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| B. '''Oral symptoms''': a positive response to at least one of the following questions:
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| :1. Have you had a daily feeling of dry mouth for more than 3 months?
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| :2. Have you had recurrently or persistently swollen salivary glands as an adult?
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| :3. Do you frequently drink liquids to aid in swallowing dry food?
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| C. '''Ocular signs'''- that is, objective evidence of ocular involvement defined as a positive result for at least one of the following two tests:
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| :1. Schirmer's test, performed without anaesthesia ( ≦5 mm in 5 minutes )
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| :2. Rose bengal score or other ocular dye score ( ≧4 according to van Bijsterveld's scoring system )
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| D. '''Histopathology''': In minor salivary glands (obtained through normal-appearing mucosa) focal lymphocytic sialoadenitis, evaluated by an expert histopathologist, with a focus score ≧1, defined as a number of lymphocytic foci (which are adjacent to normal-appearing mucous acini and contain more than 50 lymphocytes) per 4 mm2 of glandular tissue.
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| E. '''Salivary gland involvement''': objective evidence of salivary gland involvement defined by a positive result for at least one of the following diagnostic tests:
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| :1. Unstimulated whole salivary flow ( ≦ 1.5 ml in 15 minutes )
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| :2. Parotid sialography showing the presence of diffuse sialectasias (punctate, cavitary,or destructive pattern ), without evidence of obstruction in the major ducts.
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| :3. Salivary scintigraphy showing delayed uptake, reduced concentration and/or delayed excretion of tracer
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| F. '''Autoantibodies''': presence in the serum of the following autoantibodies:
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| :1. antibodies to Ro(SSA) or La(SSB) antigens, or both
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| ===Revised rules for classification===
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| ====For primary SS====
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| In patients without any potentially associated disease, primary SS may be defined as follows:
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| :a. The presence of any 4 of the 6 items is indicative of primary SS, as long as either item 4 (Histopathology) or 6 (Serology) is positive.
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| :b. The presence of any 3 of the 4 objective criteria items (that is, items 3, 4, 5, 6)
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| :c. The classification tree procedure represents a valid alternative method for classification, although it should be more properly used in clinical-epidemiological survey.
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| ====For secondary SS====
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| In patients with a potentially associated disease (for instance, another well defined connective tissue disease), the presence of item 1 or item 2 plus any two from among items 3, 4, and 5 may be considered as indicative of secondary SS.
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| ===Exclusive criteria===
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| :Past head and neck [[radiation therapy]]
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| :[[Hepatitis C]] infection
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| :[[Acquired immunodeficiency syndrome]] ([[AIDS]])
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| :Pre-existing [[lymphoma]]
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| :[[Sarcoidosis]]
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| :[[Graft-versus-host disease]]
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| :Use of [[anticholinergic]] drugs (since a time shorter than 4-fold life of the drug)
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| ==References== | | ==References== |