Quantitative immunohistologic criteria are superior to the lymphocytic focus score criterion for the diagnosis of Sjögren's syndrome

Arthritis Rheum. 1992 Sep;35(9):1075-87. doi: 10.1002/art.1780350913.


Objective: The aim of the present study was to evaluate the diagnostic value of quantitative immunohistologic criteria for Sjögren's syndrome (SS) in labial salivary gland biopsies.

Methods: Quantitative immunohistologic examination was performed on labial salivary gland biopsy samples from 80 healthy controls, 32 patients with primary SS, 14 patients with secondary SS, 5 with "probable" SS, 36 with keratoconjunctivitis sicca (KCS) with a lymphocytic focus score less than 1 on the lip biopsy, and 18 with rheumatoid arthritis (RA) without clinical evidence of SS.

Results: This is the first study to show that immunohistologic criteria for SS, based on the percentages of IgA-containing and IgG-containing plasma cells, are able to 1) confirm the diagnosis of SS in labial salivary glands of KCS patients in the absence of grade IV lymphocytic adenitis; and 2) distinguish between a grade IV focal lymphocytic adenitis in the labial salivary glands of SS patients and of RA patients without SS.

Conclusion: Quantitative immunohistologic criteria were shown to be much more sensitive and disease specific than the widely accepted grade IV lymphocytic adenitis criterion, which corresponds to a lymphocytic focus score greater than 1, and these criteria should be included in the international diagnostic criteria for Sjögren's syndrome.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biopsy
  • Child
  • Child, Preschool
  • Humans
  • Immunoglobulin A / metabolism
  • Immunoglobulin G / metabolism
  • Immunoglobulin M / metabolism
  • Infant
  • Lymphadenitis / pathology*
  • Middle Aged
  • Observer Variation
  • Plasma Cells / immunology
  • Plasma Cells / pathology
  • Regression Analysis
  • Salivary Glands, Minor / immunology
  • Salivary Glands, Minor / pathology*
  • Sjogren's Syndrome / diagnosis*
  • Sjogren's Syndrome / immunology
  • Sjogren's Syndrome / pathology


  • Immunoglobulin A
  • Immunoglobulin G
  • Immunoglobulin M