What are the Classification Criteria for Sjögren’s and how does it apply to individual patient care?

To conduct effective research and ensure consistency across studies, experts have developed classification criteria for Sjögren's Disease. One such set of criteria is the 2016 American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) classification criteria. Here's what the criteria entail:

1. Being Anti-Ro/SSA Positive (3 points)

2. Having a Lip Biopsy with Focus Score > 1 foci/4mm² (3 points)

3. Achieving an Ocular Staining Score ≥ 5 or a Van Bijsterveld Score ≥ 4 (1 point)

4. A Schirmer’s Test result ≤ 5mm/5min (1 point)

5. An Unstimulated Salivary Flow Rate ≤ 0.1 mL/min (1 point)

To meet the criteria, an individual must score a total of 4 or more points.

While these classification criteria are crucial for research purposes, it is important to understand their limitations in a clinical setting. When applied rigidly to an individual patient, these criteria may not capture the full spectrum of the disease. This is because Sjögren's Disease can present in many different ways and each patient’s experience can be unique.

In clinical practice, it is essential to consider the patient's overall clinical presentation, history, and symptoms as classification criteria are not diagnostic criteria. The 2016 ACR/EULAR classification criteria are a useful reference, but personalized patient care requires a more nuanced and individualized approach.

For healthcare providers and patients alike, understanding the distinction between classification criteria and the diagnostic process in clinical practice is crucial.

Reference: Shiboski, Caroline H., et al. “2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren’s syndrome: a consensus and data‐driven methodology involving three international patient cohorts.” Arthritis & Rheumatology 69.1 (2017): 35-45.