Although we have had a useful and internationally agreed-upon definition of Sjogren's syndrome (SS) for more than 30 years, we have not yet agreed upon criteria for diagnosing it. Understanding the clinical spectrum of SS and the various tests used to diagnose its components provides a basis for discussing controversies about diagnostic criteria. A review of the clinical features of SS and their diagnostic tests is followed by assessments of seven sets of diagnostic criteria and a proposal for future criteria. The various existing criteria use different combinations of clinical features and tests, which results in populations of different sizes and homogeneities being given the diagnosis of SS. Some criteria propose alternative tests in diagnosing components of SS, while others do not. Internationally accepted diagnostic criteria for SS that are as disease-specific as possible are needed for us to learn the epidemiology, pathogenesis, treatment, and prognosis of this clinically and scientifically important disease.
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. (1988). The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum31 :315-324.
2.
Bartley AG (1868). Suppression of saliva. Medical Times and Gazette, Nov 21.
3.
Bloch KJ, Buchanan WW, Wohl MJBunim JJ (1965). Sjogren's syndrome: A clinical, pathological and serological study of sixty-two cases. Medicine44 :187-231.
4.
Caruso AJ, Sonies BC, Atkinson JCFox PC (1989). Objective measures of swallowing in patients with primary Sjogren's syndrome. Dysphagia4:101-105.
Chudwin DS, Daniels TE, Wara DW, Ammann AJBarrett DJ, Whitcher JP, et al. (1981). Spectrum of Sjogren's syndrome in children . J Pediatr98:213-217.
7.
Daniels TE (1984). Labial salivary gland biopsy in Sjogren's syndrome: assessment as a diagnostic criterion in 362 suspected cases. Arthritis Rheum27:147-156.
8.
Daniels TE, Benn DK ( 1996). Is sialography effective in diagnosing the salivary component of Sjogren's syndrome? Adv Dent Res10:25-28.
9.
Daniels TE, Fox PC (1992). The salivary and oral components of Sjogren's syndrome. Rheum Dis Clin North Am18:571-589.
10.
Daniels TE, Whitcher JP (1994). Association of patterns of labial salivary gland inflammation with keratoconjunctivitis sicca. Analysis of 618 patients with suspected Sjogren's syndrome. Arthritis Rheum37 :869-877.
11.
Daniels TE, Silverman S., Michalski JP, Greenspan JS, Sylvester RA, Talal N. (1975). The oral component of Sjogren's syndrome. Oral Surg Oral Med Oral Pathol39:875-885.
12.
Daniels TE, Powell MR, Sylvester RA, Talal N. (1979). An evaluation of salivary scintigraphy in Sjogren's syndrome. Arthritis Rheum22:809-814.
13.
Forstot JZ, Forstot SL, Greer RO, Tan EM (1982). The incidence of Sjogren's sicca complex in a population of patients with keratoconjunctivitis sicca. Arthritis Rheum25:156-160.
14.
Fox RI, Saito I. (1994). Criteria for diagnosis of Sjogren's syndrome. Rheum Dis Clin North Am20:391-407.
15.
Fox RI, Robinson CA, Curd JG, Kozin F., Howell FV (1986). Sjogren's syndrome: proposed criteria for classification . Arthritis Rheum29:577-585.
16.
Friedlaender MH (1992). Ocular manifestations of Sjogren's syndrome: keratoconjunctivitis sicca. Rheum Dis Clin North Am18:591-608.
17.
Gleeson MJ, Cawson RA, Bennett MH (1986). Benign lymphoepithelial lesion: a less than benign disease. Clin Otolaryngol11:47-51.
18.
Greenspan JS, Daniels TE, Talal N., Sylvester RA (1974). The histopathology of Sjogren's syndrome in labial salivary gland biopsies. Oral Surg Oral Med Oral Pathol37:217-229.
19.
Hernandez YL, Daniels TE (1989). Oral candidiasis in Sjogren's syndrome: prevalence, clinical correlations and treatment. Oral Surg Oral Med Oral Pathol68:324-329.
20.
Homma M., Tojo T., Akizuki M., Yamagata H. (1986). Criteria for Sjogren's syndrome in Japan. Scand J Rheumatol Suppl61:26-27.
21.
Hutchinson J. (1889). A second report on "xerostomia". Trans Clin Soc London22:25-27.
22.
Manthorpe R., Frost-Larsen K., Isager H., Prause JU (1981). Sjogren's syndrome. A review with emphasis on immunological features. Allergy36:139-153.
23.
Manthorpe R., Oxholm P., Prause JU, Schiødt M. (1986). The Copenhagen criteria for Sjogren's syndrome . Scand J Rheumatol Suppl61:19-21.
24.
Moutsopoulos HM (1993). Sjogren's syndrome. In: Primer on the rheumatic diseases. 10th ed. Schumacher HR, editor. Atlanta: Arthritis Foundation, pp. 131-135.
25.
Newbrun E. (1996). Current treatment modalities for oral problems of patients with Sjogren's syndrome: Caries prevention. Adv Dent Res10:.
26.
Ohfuji T. (1977). Review on research reports. Annual report of the Ministry of Health and Welfare: Sjogren's Disease Research Committee, Japan, 3-6 (in Japanese).
27.
Reveille JD, Arnett FC (1992). The immunogenetics of Sjogren's syndrome. Rheum Dis Clin North Am18:539-550.
28.
Schall GL, Anderson LG, Wolf RO, Herdt JR, Tarpley TM, Cummings NA (1971). Xerostomia in Sjogren's syndrome: evaluation by sequential salivary scintigraphy. J Am Med Assoc216:2109-2116.
29.
Shearn MA (1971). Sjogren's syndrome. Philadelphia : W.B. Saunders, p. 11.
30.
Ship JA, Fox PC, Baum BJ ( 1991). How much saliva is enough? Normal function defined. J Am Dent Assoc122:63-69.
31.
Sjogren H. (1933). Zur kenntnis der keratoconjunctivitis sicca (Keratitis filiformis bei Hypofunktion der Tränendrüsen). Acta Ophthalmol (Copenh)11(Suppl 2):1-151.
Sox HC, Blatt MA, Higgins MC, Marton KI (1988). Medical decision making. Boston: Butterworth-Heinemann , p. 107. Talal N. (1992). Sjogren's syndrome. In: Cecil textbook of medicine. 19th ed. Wyngaarden JB, Smith LH, Bennett JC, editors. Philadelphia: W.B. Saunders, pp. 1535-1537.
34.
Tarpley TM, Anderson LG, White CL (1974). Minor salivary gland involvement in Sjogren's syndrome. Oral Surg Oral Med Oral Pathol37:64-74.
35.
van Bijsterveld OP (1969). Diagnostic tests in the sicca syndrome. Arch Ophthalmol82:10-14.
36.
Vitali C., Bombardieri S., Moutsopoulos HM, Balestrieri G., Bencivelli W., Bernstein RM, et al. (1993). Preliminary criteria for the classification of Sjogren's syndrome. Results of a prospective concerted action supported by theEuropean Community. Arthritis Rheum36:340-347.
37.
Vitali C., Moutsopoulos HM, Bombardieri S. (1994). The European Community Study Group on diagnostic criteria for Sjogren's syndrome. Sensitivity and specificity of tests for ocular and oral involvement in Sjogren's syndrome. Ann Rheum Dis53:637-647.
38.
Whitcher JP (1987). Clinical diagnosis of the dry eye. Int Ophthalmol Clin27:7-24.
39.
Wulff HR (1981). Rational diagnosis and treatment. An introduction to clinical decision-making. Oxford: Blackwell Scientific Publications, pp. 46-75.
40.
Zulman J., Jaffe R., Talal N. (1975). Evidence that the malignant lymphoma of Sjogren's syndrome is a monoclonal B-cell neoplasm. N Engl J Med299:1215-1220.
