title: Utility of the American-European Consensus Group and American College of Rheumatology Classification Criteria for Sjögren's syndrome in patients with systemic autoimmune diseases in the clinical setting.
abstract: OBJECTIVE
  The aim of this study was to evaluate the feasibility and performance of the American-European Consensus Group (AECG) and ACR Classification Criteria for SS in patients with systemic autoimmune diseases.
  
  
  METHODS
  Three hundred and fifty patients with primary SS, SLE, RA or scleroderma were randomly selected from our patient registry. Each patient was clinically diagnosed as probable/definitive SS or non-SS following a standardized evaluation including clinical symptoms and manifestations, confirmatory tests, fluorescein staining test, autoantibodies, lip biopsy and medical chart review. Using the clinical diagnosis as the gold standard, the degree of agreement with each criteria set and between the criteria sets was estimated.
  
  
  RESULTS
  One hundred fifty-four (44%) patients were diagnosed with SS. The AECG criteria were incomplete in 36 patients (10.3%) and the ACR criteria in 96 (27.4%; P < 0.001). Nevertheless, their ability to classify patients was almost identical, with a sensitivity of 61.6 vs 62.3 and a specificity of 94.3 vs 91.3, respectively. Either set of criteria was met by 123 patients (80%); 95 (61.7%) met the AECG criteria and 96 (62.3%) met the ACR criteria, but only 68 (44.2%) patients met both sets. The concordance rate between clinical diagnosis and AECG or ACR criteria was moderate (k statistic 0.58 and 0.55, respectively). Among 99 patients with definitive SS sensitivity was 83.3 vs 77.7 and specificity was 90.8 vs 85.6, respectively. A discrepancy between clinical diagnosis and criteria was seen in 59 patients (17%).
  
  
  CONCLUSIONS
  The feasibility of the SS AECG criteria is superior to that of the ACR criteria, however, their performance was similar among patients with systemic autoimmune diseases. A subset of SS patients is still missed by both criteria sets.
authors.affiliation: Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Department of Pathology, University Health Network, Toronto General Hospital, Toronto, ON, Canada, Ophthalmology Service, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, and Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Hernández-Molina
authors.affiliation: Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Department of Pathology, University Health Network, Toronto General Hospital, Toronto, ON, Canada, Ophthalmology Service, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, and Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Carmen
authors.initials: C
authors.lastname: Avila-Casado
authors.affiliation: Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Department of Pathology, University Health Network, Toronto General Hospital, Toronto, ON, Canada, Ophthalmology Service, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, and Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Carlos
authors.initials: C
authors.lastname: Nuñez-Alvarez
authors.affiliation: Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Department of Pathology, University Health Network, Toronto General Hospital, Toronto, ON, Canada, Ophthalmology Service, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, and Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Francisco
authors.initials: F
authors.lastname: Cárdenas-Velázquez
authors.affiliation: Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Department of Pathology, University Health Network, Toronto General Hospital, Toronto, ON, Canada, Ophthalmology Service, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, and Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Carlos
authors.initials: C
authors.lastname: Hernández-Hernández
authors.affiliation: Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Department of Pathology, University Health Network, Toronto General Hospital, Toronto, ON, Canada, Ophthalmology Service, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, and Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: María
authors.initials: M
authors.lastname: Luisa Calderillo
authors.affiliation: Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Department of Pathology, University Health Network, Toronto General Hospital, Toronto, ON, Canada, Ophthalmology Service, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, and Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Verónica
authors.initials: V
authors.lastname: Marroquín
authors.affiliation: Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Department of Pathology, University Health Network, Toronto General Hospital, Toronto, ON, Canada, Ophthalmology Service, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, and Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Claudia
authors.initials: C
authors.lastname: Recillas-Gispert
authors.affiliation: Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Department of Pathology, University Health Network, Toronto General Hospital, Toronto, ON, Canada, Ophthalmology Service, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, and Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Juanita
authors.initials: J
authors.lastname: Romero-Díaz
authors.affiliation: Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Department of Pathology, University Health Network, Toronto General Hospital, Toronto, ON, Canada, Ophthalmology Service, Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, and Mount Sinai Hospital and University Health Network, University of Toronto, Toronto, ON, Canada. JSanchez-Guerrero@mtsinai.on.ca.
authors.forename: Jorge
authors.initials: J
authors.lastname: Sánchez-Guerrero
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D001327:Autoimmune Diseases / Q000175:diagnosis; D002965:Classification / Q000379:methods; D003937:Diagnosis, Differential; D005060:Europe; D005240:Feasibility Studies; D012680:Sensitivity and Specificity; D012859:Sjogren's Syndrome / Q000145:classification / Q000175:diagnosis; D012955:Societies, Medical; D014481:United States; D003245:Consensus Statements as Topic
keywords: Sjögren’s syndrome; classification criteria; connective tissue diseases; epidemiology