Many patients are told that they cannot have Sjogren's because they don't meet the Classification Criteria. This is simply incorrect. While many Sjogren's patients do meet the criteria, some do not. The Sjogren's Classification Criteria are necessarily strict because they were created to standardize research populations. They do not substitute for clinical judgment in individual patients. Classification Criteria are not diagnostic criteria. There are no diagnostic criteria for Sjogren's. Sjogren's is a big picture diagnosis and ultimately depends on the clinician's expert opinion. The problem is that there are few clinicians with enough expertise to appreciate the nuances of diagnosis. For more information and self-advocacy tools, see Myths # 7A and 7B on the MYTHS ABOUT DIAGNOSIS page.
Unfortunately, some rheumatologists will not diagnose patients with Sjogren's unless they meet the classification criteria. This deprives many patients of timely disease management.
Why some Sjogren's patients do not meet the Classification Criteria: 1. Early in the disease, sicca /dryness may not be fully developed. The criteria are heavily weighted toward dryness symptoms.
2. About 20 % of patients experience systemic Sjogren's symptoms prior to the onset of sicca. This is particularly common with neurologic presentations. (2,3)
3. Inaccuracies with the tests used for diagnosis remain problematic-- see labs for diagnosis and lip biopsy/ MSGB for more information.
4. Many patients do not have access to the full range of tests used in the criteria. Providers often do not have the training or equipment to administer these tests properly. Complete testing is rarely done outside of research settings.
Sjogren's is a complex systemic disease that requires a multidisciplinary team for proper diagnosis and management. It usually takes a team of experienced specialists to put together the pieces of the puzzle that lead to a diagnosis.
