This article highlights the challenges in diagnosing Sjogren's syndrome. As is pointed out in the introduction, there is no one gold standard for diagnosis and since 1965, there have been 11 sets of classification criteria for Sjogren's syndrome. The authors discuss the difficulties associated with a condition that involves three different specialties, namely rheumatology, ophthalmology and oral medicine. They detail the limitations of the various criteria that we are familiar with. These include subjective symptoms, labial gland biopsy, autoantibodies and various methods of assessing tear production. They outline the criteria required to make a diagnosis of Sjogren's syndrome for both the American-European Consensus Group (AECG) and the American College of Rheumatology (ACR) and critique both comprehensively. They also include a study based on their own patients, numbering 100 subjects, and show that although all 100 of these patients would meet the criteria for the AECG diagnosis of Sjogren's síndrome, only five met the new ACR criteria. This is an informative review article that highlights the diagnostic challenges of primary Sjogren's syndrome. It raises the question in my mind about the effectiveness of making this diagnosis in our clinics and whether we should be considering multidisciplinary clinics in tertiary referral centres.

Diagnosis of Sjogren’s syndrome – American-European and the American College of Rheumatology Classification Criteria.
Sankar V, Noll J, Brennan M.
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David Chin Shong

University of South Manchester NHS Foundation Trust, Manchester, UK

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