ArticleFrontiers in medicine2025
Real-world diagnostic value of integrating oral and ocular dryness testing in suspected Sjögren's disease.
Article in Frontiers in medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Sjögren's disease is an autoimmune condition requiring a systemic evaluation that integrates serologic, histopathologic, and glandular assessments for diagnosis. Current 2016 ACR/EULAR classification criteria includes anti-Ro serology, labial salivary gland biopsy (LSGB), and measures of oral/ocular dryness. However, oral/ocular dryness evaluations are rarely performed by rheumatologists during routine clinical care. Thus, the real-world diagnostic value of contemporaneous oral/ocular dryness testing remains poorly understood. Objective: To evaluate the added value of contemporaneous oral/ocular dryness testing (Schirmer's test and unstimulated whole salivary flow) in meeting classification criteria for subjects evaluated with suspected Sjögren's disease. Methods: 73 subjects referred for suspected Sjögren's disease were evaluated. Correlations between LSGB results and dryness tests, as well as LSGB results and anti-Ro serology, were evaluated. 31 subjects completed testing of oral/ocular dryness (Schirmer's test and unstimulated whole salivary flow), anti-Ro serology, and LSGB. Diagnostic pathways were analyzed to assess the contributions of non-invasive tests (serologies and oral/ocular dryness tests) and invasive testing (LSGB) in meeting the threshold for classification criteria. Results: A significant association ( Conclusion: Objective oral/ocular dryness testing, though rarely performed in routine rheumatologic care, is a valuable complement to serology and biopsy in diagnosing Sjögren's disease. While LSGB is essential for confirming classification in anti-Ro-negative subjects, it adds only modest value to meeting classification criteria in anti-Ro-positive subjects relative to contemporaneous glandular dryness testing. These findings support integrating objective dryness measures into routine diagnostic workflows to reduce reliance on invasive biopsies and improve diagnostic accuracy, especially in seropositive populations.
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