Fox et al described criteria for diagnosing a patient with Sjogren's syndrome. The authors are from Scripps Clinic in La Jolla, California.
Exclusions:
(1) pre-existent malignant lymphoma
(2) graft vs host disease
(3) acquired immune deficiency disease (AIDS)
(4) sarcoidosis
Criteria for diagnosis - all of the following:
(1) keratoconjunctivitis sicca
(2) xerostomia
(3) positive histologic findings on minor salivary gland biopsy
(4) serologic evidence of systemic autoimmune disease
Criteria for keratoconjunctivitis sicca - both of the following:
(1) decreased tear flow rate on Schirmer's test (< 9 mm in 5 minutes)
(2) increased staining on Rose Bengal and/or fluorescein dye testing
Criteria for xerostomia - all of the following:
(1) symptomatic dry mouth
(2) decreased basal salivary flow rate
(3) decreased stimulated salivary flow rate
Criteria for positive histologic findings on minor salivary gland biopsy:
(1) biopsy from normal buccal mucosa
(2) focus score 2, 3 or 4 using Greenspan (Chisholm-Mason) scale (from 0 to 4)
Criteria for serologic evidence of systemic autoimmune disease - one of the following:
(1) positive rheumatoid factor (RF) with titer >= 1:160
(2) positive antinuclear antibody (ANA) with titer >= 1:160
(3) positive SS-A (anti-Ro)
(4) positive SS-B (anti-La)
