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Childhood Sjögren syndrome: Features of an international cohort and application of the 2016 ACR/EULAR classification criteria


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Objective: Sjögren syndrome in children is a poorly understood autoimmune disease. We aimed to describe the clinical and diagnostic features of children diagnosed with Sjögren syndrome and explore how the 2016 ACR/EULAR classification criteria apply to this population. Methods: An international workgroup retrospectively collected cases of Sjögren syndrome diagnosed under 18 years of age from 23 centres across eight nations. We analysed patterns of symptoms, diagnostic workup, and applied the 2016 ACR/EULAR classification criteria. Results: We identified 300 children with Sjögren syndrome. The majority of patients n = 232 (77%) did not meet 2016 ACR/EULAR classification criteria, but n = 110 (37%) did not have sufficient testing done to even possibly achieve the score necessary to meet criteria. Even among those children with all criteria items tested, only 36% met criteria. The most common non-sicca symptoms were arthralgia [n = 161 (54%)] and parotitis [n = 140 (47%)] with parotitis inversely correlating with age. Conclusion: Sjögren syndrome in children can present at any age. Recurrent or persistent parotitis and arthralgias are common symptoms that should prompt clinicians to consider the possibility of Sjögren syndrome. The majority of children diagnosed with Sjögren syndromes did not meet 2016 ACR/EULAR classification criteria. Comprehensive diagnostic testing from the 2016 ACR/EULAR criteria are not universally performed. This may lead to under-recognition and emphasizes a need for further research including creation of paediatric-specific classification criteria.

Division of Pediatric Rheumatology Department of Pediatric and Adolescent Medicine Mayo Clinic

Division of Rheumatology Department of Pediatrics University of Utah School of Medicine

Division of Rheumatology The Children's Hospital of Philadelphia

Department of Internal Medicine and Pediatrics The University of Chicago Medical Center

Department of Pediatrics Duke University School of Medicine

Department of Pediatrics Hematology and Oncology Medical University of Gdansk

Children's Mercy Hospital University of Missouri-Kansas City

Division of Rheumatology Irccs Ospedale Pediatrico Bambino Gesù

Department of Pediatric Rheumatology Institute of Rheumatology

Department of Pediatrics Columbia University Medical Center

Division of Rheumatology Children's National Hospital George Washington University School of Medicine and Health Sciences

National Institutes of Health National Institute of Arthritis and Musculoskeletal and Skin Diseases

Department of Pediatrics University of Texas McGovern Medical School at Houston

Division of Pediatric Rheumatology Children's Healthcare of Atlanta Emory University School of Medicine

Instituto de Puericultura e Pediatria Martagão Gesteira Universidade Federal Do Rio de Janeiro

Pediatric Rheumatology Hospital Sant Joan de Déu

Universitat de Barcelona Barcelona

Rheumatology Unit Department of Medicine School of Medical Science University of Campinas

Division of Rheumatology Department of Pediatrics University of Indiana School of Medicine Riley Hospital for Children at Indiana University Health

Pediatric Rheumatology Unit São Paulo State University (UNESP), Botucatu

Rheumatology Service Royal Children's Hospital Melbourne and Murdoch Children's Research Institute

Division of Pediatric Allergy Immunology and Rheumatology Department of Pediatrics College of Medicine University of Florida

Division of Oral Medicine Department of Oral and Maxillofacial Diagnostic Sciences College of Dentistry University of Florida

Rheumatology Department Hospital General Universitario Gregorio Marañón

Division of Immunology Boston Children's Hospital Department of Pediatrics Harvard Medical School

Department of Rheumatic Diseases Tokyo Metropolitan Tama Medical Center

Division of Rheumatology Allergy and Immunology Stead Family Department of Pediatrics Carver College of Medicine University of Iowa

Pediatric Rheumatology Unit São Paulo State University (UNESP), Botucatu

Document Type Journal article
Language English
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