ACR-EULAR 2016 Criteria Enables Early Diagnosis of Sjögren Syndrome in Patients With SLE

The ACR-EULAR 2016 was useful in diagnosing Sjögren syndrome among patients with SLE and identifying overlap between both these conditions.

The American College of Rheumatology-European Alliance of Associations for Rheumatology (ACR EULAR) 2016 criteria may be useful than the American-European Consensus Group (AECG) of 2002 in the earlier diagnosis of Sjögren syndrome among patients with systemic lupus erythematosus (SLE), according to study results published in Advances in Rheumatology. Glandular dysfunction, anti-Ro, and salivary biopsy were noted to be predictors of Sjögren syndrome.

In a cross-sectional study, researchers evaluated patients with SLE from August 2016 to 2018 who were enrolled in a rheumatology outpatient clinic. Inclusion criteria included patients with SLE classified according to the Systemic Lupus International Collaborating Clinics (SLICC) 2012 and/or ACR 1982 criteria. Patients received a “dryness” questionnaire and those who had symptoms of dryness were referred for additional glandular function evaluation.

Of a total of 237 patients with SLE, 117 were evaluated for frequency of Sjögren syndrome using both the AECG 2002 criteria and the ACR-EULAR 2016 criteria. A total of 94% patients were women and 49.6% were of mixed ethnicity.

According to the AECG 2002 criteria, 23% (n=27/117) of patients with SLE had Sjögren syndrome. Based on the ACR-EULAR 2016 criteria, the prevalence of Sjögren syndrome in SLE was 35% (n=41/117).

The greatest advantage of the new ACR-EULAR 2016 criteria is to enable an early diagnosis and identify patients who present an association of the two diseases, thus providing individualized treatment.

The Kappa agreement between AECG 2002 and ACR-EULAR 2016 was 0.7 (P <.0001). There was no statistically significant difference in demographic characteristics and clinical manifestations between patients who met the 2016 criteria but not the 2002 criteria and those who only met the 2002 criteria.

Patients with SLE and Sjögren syndrome demonstrated moderate disease activity, which was measured by the EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI) of 8.9±7.6.

Predictors for SS were anti/Ro (odds ratio [OR], 17.86; P <.05), focal lymphocytic sialadenitis (OR, 3.69; P <.05), ocular staining score of at least 5 (OR, 7.50; P <.05), Schirmer test positivity (OR, 2.67; P <.05), and whole unstimulated salivary flow of 0.1 mL/min or lesser (OR, 4.13; P <.05).

The frequency of anti-Ro in patients with SLE and Sjögren syndrome was 85% compared with 29% among patients with SLE without Sjögren syndrome.

The presence of oral and ocular dryness were not found to be predictors for the diagnosis of Sjögren syndrome.

A major study limitation was the loss of approximately half of the original sample size due to reasons including death, nonattendance, unacceptance to participate, and presentation of incomplete data. In addition, anti-Ro subtypes could be not evaluated.

The study authors concluded, “The greatest advantage of the new ACR-EULAR 2016 criteria is to enable an early diagnosis and identify patients who present an association of the [2] diseases, thus providing individualized treatment.”


Gianordoli APE, Laguardia RVRB, Santos MCFS, et al. Prevalence of Sjögren’s syndrome according to 2016 ACR-EULAR classification criteria in patients with systemic lupus erythematosus. Adv Rheumatol. 2023;63:11. doi:10.1186/s42358-022-00280-1