Sjogren's Syndrome Diagnosis - Medical Algorithm

Are you evaluating a patient for Sjogren's syndrome?

Yes

Does the patient have ?

• decreased tear flow rate on Schirmer's test (< 9 mm in 5 minutes)?

Yes

• increased conjunctival staining on Rose Bengal and/or fluorescein dye testing?

Yes

• symptomatic dry mouth?

Yes

• a decreased basal salivary flow rate?

Yes

• a decreased stimulated salivary flow rate?

Yes

• pre-existent malignant lymphoma?

Yes

• graft vs host disease?

Yes

• acquired immune deficiency disease (AIDS)?

Yes

• sarcoidosis?

Yes

Biopsy score for minor salivary glands from normal buccal mucosa (enter from 0 to 4)

Does the serologic testing show ?

• positive rheumatoid factor (RF) with titer >= 1:160?

Yes

• positive antinuclear antibody (ANA) with titer >= 1:160?

Yes

• positive SS-A (anti-Ro)?

Yes

• positive SS-B (anti-La)?

Yes

Results

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Results Interpretation and Description References Next Steps

Data complete?

Evaluation appropriate?

Number of criteria for keratoconjunctivitis sicca present

Number of criteria for xerostomia present

Is the minor salivary gland biopsy supportive?

Is there serologic evidence of a systemic autoimmune disease?

Number of conditions that would exclude the diagnosis of Sjogren's syndrome

Does the patient have Sjogren's syndrome?

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Interpretation and Description

References

Next Steps in Evaluation

Diagnosis

Clinical Diagnosis, Including Family History For Genetics
- Classification Tree of Vitali et al for Primary Sjogren's Syndrome
Imaging Studies
Laboratory Tests
Criteria For Diagnosis
Severity, Prognosis, Stage
Differential Diagnosis And Mimics, Red Flags
- Classification Tree of Vitali et al for Primary Sjogren's Syndrome
- Exclusion Conditions in Diagnosis of Sjogren's Syndrome

Monitoring

Disease Progression
- Sjogren's Syndrome Disease Damage Index (SSDDI)
- Sjogren's Syndrome Disease Activity Index (SSDAI)
Comorbid Conditions
- Secondary Sjogren's Syndrome Associated with Hepatitis C Virus (HCV)

Evaluation

Results

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Interpretation and Description

References

Next Steps in Evaluation

Diagnosis

Monitoring

Specialty

Objective

ICD-10

Criteria of Fox et al for Sjogren's Syndrome (La Jolla or California Criteria)

Purpose: To determine if a patient has Sjogren's syndrome using the criteria proposed by Fox et al (La Jolla or California criteria).

Evaluation

Results

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Interpretation and Description

References

Next Steps in Evaluation

Diagnosis

Monitoring

Specialty

Objective

ICD-10