Classification criteria for Sjogren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group

Vitali, Claudio

doi:10.1136/ard.61.6.554

Cited by 4,696 publications

(3,868 citation statements)

References 17 publications

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“…(SS-I) (62 subjects), diagnosed according to the American-European Consensus Group; 4 Non-SS autoimmune diseases (non-SS AD) patients (56 subjects), patients with other autoimmune diseases (such as rheumatoid arthritis, systemic lupus erythematosus, sclerodermia, connective tissue disorders) but who did not satisfy the classification criteria for secondary Sjogren's Syndrome; Sicca syndrome (Sicca) patients (59 subjects) reporting subjective symptoms of xeroftalmia and xerostomia, without serological positivity for any autoimmune disease, and non contact lens wearers.…”

Section: Patientsmentioning

confidence: 99%

“…There are several published criteria for the diagnosis of SS but none has still reached a general consensus. The American-European Community criteria 4 appear to be the one of the most practical because it takes into consideration the multisystem nature of the disease; the criteria require that patients meet four out of six proposed items for the diagnosis of SS-I.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic performance of tear function tests in Sjogren's syndrome patients

Versura

Frigato

Cellini

et al. 2006

Eye

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Objective To evaluate the diagnostic performance of the tests included in primary Sjogren's syndrome (SS-I) diagnostic criteria (Schirmer I, break-up time, vital dye staining) and to compare them with other examinations related to the ocular surface status. Methods Clinical and cytological data were collected from 177 patients (62 SS-1, 56 non-SS autoimmune diseases, 59 Sicca syndrome). Tear tests included: a validated questionnaire on symptoms, Schirmer I, Jones test, Ferning test, BUT, corneal aesthesiometry, tear clearance test, lissamine green staining, impression conjunctival cytology. Data were statistically evaluated and sensitivity, specificity, likelihood ratio (LR þ ), receiveroperating characteristics (ROC) curves were calculated for each test. Results Data showed a poor diagnostic performance of Schirmer test I (sensitivity 0.42; specificity 0.76; LR þ 1.75) and BUT (sensitivity 0.92; specificity 0.17; LR þ 1.11) (area under the curve in ROC analysis o0.58). Validated subjective symptoms questionnaire (sensitivity 0.89; specificity 0.72; LR þ 3.18), Jones test (sensitivity 0.60; specificity 0.88; LR þ 5), corneal aesthesiometry (sensitivity 0.80; specificity 0.67; LR þ 2.42), and tear clearance test (sensitivity 0.63; specificity 0.84; LR þ 3.93), all exhibited a high diagnostic performance (area under the curve in the ROC analysis always 40.70). Lissamine green staining exhibited the best performance (sensitivity 0.63; specificity 0.89; LR þ 5.72) but the result could be distorted by an incorporation bias. Conclusions Our data suggest to implement the items for ocular signs and symptoms contained in many SS-I diagnostic criteria with the use of a validated questionnaire, performance of Jones test, corneal aesthesiometry measurement, and tear clearance rate evaluation.

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Section: Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic performance of tear function tests in Sjogren's syndrome patients

Versura

Frigato

Cellini

et al. 2006

Eye

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“…The presence of FLS, i.e . at least one inflammatory focus within 4 mm 2 of MSG tissue, allowed the diagnosis of pSS 2, 19 in 12 patients. Of the remaining 16 patients, eight displayed normal MSGs and eight displayed a certain degree of MSG inflammation, i.e .…”

Section: Methodsmentioning

confidence: 99%

“…NSCS, but no evidence of FLS. None of these 16 patients had serological features of pSS; hence, pSS diagnosis was ruled out according to the American‐European criteria 2. Focus score and Tarpley biopsy score (0–4 scale) 20 were performed on hematoxylin‐ and eosin‐stained sections.…”

Section: Methodsmentioning

confidence: 99%

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Mobilization of lymphatic endothelial precursor cells and lymphatic neovascularization in primary Sjögren's syndrome

Alunno

Ibba‐Manneschi

Bistoni

et al. 2016

J Cellular Molecular Medi

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Although lymphatic neovascularization may be a key feature of chronic inflammation, it is almost unexplored in primary Sjögren's syndrome (pSS). A recent study revealed a pro‐lymphangiogenic function of interleukin (IL)‐17, a leading player in pSS pathogenesis. The aims of the study were to investigate lymphangiogenic mediators and lymphatic vasculature in pSS, as well as their possible association with IL‐17. Circulating lymphatic endothelial precursor cells (LEPCs) and Th17 cells were enumerated in pSS patients and healthy donors. VEGF‐C and IL‐17 levels were assessed in paired serum samples. Lymphatic vasculature, VEGF‐C/VEGF receptor (VEGFR)‐3 and IL‐17 were evaluated in pSS minor salivary glands (MSGs) and compared with normal and non‐specific chronic sialadenitis (NSCS) MSGs. Circulating LEPCs were expanded in pSS and correlated with circulating Th17 cells, IL‐17 and VEGF‐C. In pSS MSGs, a newly formed lymphatic capillary network was found within periductal inflammatory infiltrates and the number of interlobular lymphatic vessels was significantly increased compared with normal and NSCS MSGs. Strong VEGF‐C expression was detected in pSS ductal epithelial cells and periductal inflammatory cells. Numerous VEGFR‐3+ infiltrating mononuclear cells were exclusively observed in pSS MSGs. VEGFR‐3 expression was strongly increased in lymphatic capillaries of pSS MSGs. IL‐17+ inflammatory cells were preferentially observed around lymphatic vessels in pSS MSGs. This study supports the notion that lymphvasculogenesis and lymphangiogenesis are active in pSS, thereby unmasking a novel aspect of disease pathogenesis. In addition, our results suggest another possible pathogenic role of IL‐17 in pSS, further supporting its therapeutic targeting in this disease.

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