SYSTEMIC SCLEROSIS - Diagnostic criteria

ACR/EULAR classification criteria for systemic sclerosis:

A total score of 9 or more is required for classification as systemic sclerosis.

1. Skin thickening of the fingers:

   - Proximal to the metacarpophalangeal joints (9 points).

2. Fingertip lesions:

   - Digital tip ulcers (2 points).

   - Fingertip pitting scars (3 points).

3. Telangiectasia (2 points).

4. Abnormal nailfold capillaries (2 points).

5. Pulmonary involvement:

   - Interstitial lung disease or pulmonary arterial hypertension (2 points).

6. Raynaud's phenomenon (3 points).

7. SSc-specific autoantibodies:

   - Anti-centromere, anti-topoisomerase I (Scl-70), or anti-RNA polymerase III (3 points).

SLE

SLE (American College of Rheumatology criteria )

1)Malar rash

2)Discoid rash

3)Photosensitivity skin rash

4)Oral or nasopharyngeal ulceration

5)Non erosive arthritis involving ≥ 2 peripheral joints

6)Serositis (pleuritis or pericarditis)

7)Renal disorder (persistent proteinuria or cellular casts)

8)Neurologic disorder (unexplained seizures or psychosis)

9)Hematologic disorder (hemolytic anemia, leukopenia, lymphopenia,or thrombocytopenia)

10)Immunologic disorder (positive LE cell, anti-DNA antibody, anti-Sm antibody, false-positive syphilis serology)

11)Elevated antinuclear antibodies

*Minimum of 4 criteria required

SJÖGREN SYNDROME

 sicca symptoms are mandatory

 supportive evidence including ocular signs (positive Schirmer test testing reduced tear formation, rose bengal score > 3 for staining of conjunction and cornea)

 typical histologic appearances salivary gland biopsy

antibodies to Ro (SS-A) or La (SS-B) or

 reduced salivary flow.

RHEUMATOID ARTHRITIS - Diagnostic criteria

American Rheumatism Association revised criteria

1)Morning stiffness (lasting at least 1 hr)

2)Arthritis (soft tissue swelling or fluid) of 3 or more joints (PIP, MCP,wrist, elbow, knee, ankle, MTP joints)

3)Arthritis of hand joints (swelling of at least 1 wrist, MCP, or PIP joint)

4)Symmetrical arthritis (i.e., simultaneous arthritis of the same joints on both sides of the body)

5)Rheumatoid nodules

6)Serum rheumatoid factor positivity (at a level such that < 5% of normal controls are positive)

7)Radiographic hand or wrist changes typical of rheumatoid arthritis

At least 4 criteria for a minimum of 6 weeks

Sjogren's syndrome

Classification criteria for sjogren's syndrome 

1) Labial salivary gland with focal lymphocytic sialadenitis and focus score of > 1 foci/4mm²    

        3 points

2) Anti-SS-A/Ro positive

        3 points

3) Ocular Staining Score 5 (or van Bijsterveld score > 4) in at least one eye

         1 point

4) Schirmer's test < 5 mm/5 minutes in at least one eye

         1 point

5) Unstimulated whole saliva flow rate < 0.1 ml/minute

          1 point

A score of 4 classifies a patient who meets the inclusion criteria:

⁃ ocular and/or oral dryness or suspicion of SjS according to EULAR SjS Disease Activity Index (ESSDAI)

and does not have any of the exclusion criteria:

⁃ history of head and neck radiation, active HCV infection, AIDS, sarcoidosis, amyloidosis, graft-versus-host disease, IgG4-related disease.

* ACR/EULAR classification criteria