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Rheumatol Int. 2017 May;37(5):675-684. doi: 10.1007/s00296-017-3691-8. Epub 2017 Mar 13.

Criteria sets for primary Sjogren's syndrome are not adequate for those presenting with extraglandular organ involvements as their dominant clinical features.

Author information

1
Department of Internal Medicine-Rheumatology, Faculty of Medicine, Ege University, 35040, Izmir, Turkey. yasemin.kabasakal@gmail.com.
2
Biostatistics and Medical Informatics, Ege Üniversitesi Tıp Fakültesi, İzmir, Turkey.
3
Department of Internal Medicine-Rheumatology, Faculty of Medicine, Ege University, 35040, Izmir, Turkey.
4
Rheumatology, Gazi Universitesi Tıp Fakültesi, Ankara, Turkey.
5
Rheumatology, Pamukkale Universitesi Tıp Fakültesi, Denizli, Turkey.
6
Rheumatology, Dokuz Eylül Üniversitesi Tıp Fakültesi, İzmir, Turkey.
7
Rheumatology, Marmara Üniversitesi Tıp Fakültesi, İstanbul, Turkey.
8
Rheumatology, Selçuk Üniversitesi Tıp Fakültesi, Konya, Turkey.
9
Rheumatology, Eskişehir Osmangazi Üniversitesi Tıp Fakültesi, Eskişehir, Turkey.
10
Rheumatology, Hacettepe Üniversitesi Tıp Fakültesi, Ankara, Turkey.
11
Rheumatology, Uludağ Üniversitesi Tıp Fakültesi, Bursa, Turkey.
12
Rheumatology, Çukurova Üniversitesi Tıp Fakültesi, Adana, Turkey.
13
Rheumatology, Adnan Menderes Üniversitesi Tıp Fakültesi, Aydın, Turkey.
14
Rheumatology, Abant İzzet Baysal Üniversitesi Tıp Fakültesi, Bolu, Turkey.
15
Rheumatology, Süleyman Demirel Üniversitesi Tıp Fakültesi, Isparta, Turkey.
16
Rheumatology, İstanbul Üniversitesi İstanbul Tıp Fakültesi, İstanbul, Turkey.
17
Rheumatology, İzmir Katip Çelebi Üniversitesi Tıp Fakültesi, İzmir, Turkey.
18
Rheumatology, Kocaeli Üniversitesi Tıp Fakültesi, İzmit, Turkey.
19
Rheumatology, Ankara Üniversitesi Tıp Fakültesi, Ankara, Turkey.
20
Rheumatology, Yeditepe Üniversitesi Tıp Fakültesi, İstanbul, Turkey.
21
Rheumatology, Gülhane Askeri Tıp Akademisi, Ankara, Turkey.
22
Rheumatology, İzmir Atatürk Eğitim Araştırma Hastanesi, İzmir, Turkey.
23
Rheumatology, GATA Haydarpaşa Eğitim Hastanesi, İstanbul, Turkey.
24
Rheumatology, Maltepe Üniversitesi Tıp Fakültesi, İstanbul, Turkey.
25
Rheumatology, Başkent Üniversitesi Tıp Fakültesi, Ankara, Turkey.

Abstract

Patients with primary Sjogren's syndrome (pSS) may go undiagnosed or be misclassified due to the insidious nature and wide spectrum of the disease. The available several classification criteria emphasize glandular findings. We aimed to analyze the efficiency of various classification criteria sets in patients diagnosed on the clinical basis by expert opinion and to compare those pSS patients who fulfilled these criteria with those who did not. This is a multicenter study in which 834 patients from 22 university-based rheumatology clinics are included. Diagnosis of pSS was made on the clinical basis by the expert opinion. In this study, we only interviewed patients once and collected available data from the medical records. The European criteria, American-European Consensus Group (AECG) and American College of Rheumatology (ACR) Sjogren's criteria were applied. Majority of the patients were women (F/M was 20/1). The median duration from the first pSS-related symptom to diagnosis was significantly shorter in men (2.5 ± 2.3 vs 4.3 ± 5.9 years) (p = 0 < 0.016). When the European, AECG and ACR Sjogren's criteria were applied, 666 patients (79.9%) satisfied at least one of them. In total, 539 patients (64.4%) satisfied the European, 439 (52.6%) satisfied the AECG, and 359 (43%) satisfied the ACR criteria. Among the entire group, 250 patients (29.9%) satisfied all and 168 (20.1%) met none of the criteria. The rates of extraglandular organ involvements were not different between patients who met at least one of the criteria sets and those who met none. There is an urgent need for the modification of the pSS criteria sets to prevent exclusion of patients with extraglandular involvements as the dominant clinical features.

KEYWORDS:

Classification criteria; Epidemiology; Extraglandular involvement; Sjogren’s syndrome

PMID:
28289872
DOI:
10.1007/s00296-017-3691-8
[Indexed for MEDLINE]

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