Level of agreement between 2002 American–European Consensus Group and 2012 American College of Rheumatology classification criteria for Sjögren’s syndrome and reasons for discrepancies

Table 1 Pragmatic AECG[1] and ACR[2] classification criteria for Sjögren’s syndrome

	Pragmatic 2002 AECG criteria	2012 ACR criteria
Items	1. Ocular dryness symptoms	1. Positive anti-SSA or anti-SSB antibodies or positive rheumatoid factor plus ANA ≥1:320
	2. Oral dryness symptoms	2. Focus score ≥1 focus/4 mm² on minor salivary gland biopsy
	3. Ocular signs: Schirmer’s test ≤5 mm/5 minutes	3. Keratoconjunctivitis sicca with ocular staining score ≥3
	4. Focus score ≥1 focus/4 mm² on minor salivary gland biopsy
	5. Salivary gland involvement: unstimulated whole salivary flow ≤0.1 ml/minute
	6. Positive anti-SSA or anti-SSB antibodies
Rules for classification	Presence of any four of the six items with at least item 4 or 6, or presence of any three of the four objective items (items 3, 4, 5 and 6)	In a patient with suspected Sjögren’s syndrome, any two of the three items

Exclusion criteria for both criteria sets are head-and-neck radiation, graft-versus-host disease, hepatitis C infection, acquired immunodeficiency syndrome or sarcoidosis. Pre-existing lymphoma and use of anticholinergic drugs are exclusion criteria only in the AECG criteria, whereas amyloidosis and IgG4-related disease are exclusion criteria only in the ACR criteria.
We did not use in this study the whole set of AECG criteria, but only the tests we use in clinical practice (pragmatic AECG criteria); that is, only the unstimulated whole salivary flow to assess salivary gland involvement (and not salivary scintigraphy or parotid sialography which are considered obsolete by most physicians), and only the Schirmer’s test to assess ocular signs (and not vital dye staining graded according to van Bijsterveld method). ACR, American College of Rheumatology; AECG, American–European Consensus Group.

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