Lynn M. Petruzzi and Frederick B. Vivino
AORN Journal, Denver, Colorado (March, 2003)

A number of conditions can cause Sicca Symptoms, such as those seen with Sjögren's Syndrome (SS). Other disorders, like sarcoidosis, head and neck radiation, mouth breathing, allergies, chronic sialadenitis (i.e., inflammation of the salivary gland) and more than 400 medications can produce dryness.

Identification of SS, however, as the cause of the patient's Sicca Symptoms not only will lead to more effective treatment but also facilitate more effective and timely medical evaluation when extraglandular organs are involved.

Primary SS is diagnosed when a person with no known connective tissue disease presents with xerophthalmia and xerostomia.

Secondary SS occurs when a person with a defined connective tissue disorder develops Sicca Symptoms.

Approximately 50% of patients with SS have the secondary form. Conditions associated with secondary SS include rheumatoid arthritis, lupus, scleroderma, including the CREST variant (i.e., calcinosis, Raynaud's Disease, esophageal dysmotility, sclerodactyl, tele-angiectasia), mixed connective tissue disease; and relapsing polychondritis (i.e., inflammation of cartilage) and polymyositis (i.e., simultaneous inflammation of many muscles).

Although there are no uniformly accepted criteria for the diagnosis of SS, diagnosis is based on symptoms as well as documented evidence of xerophthalmia, xerostomia, serologic autoimmunity, or positive salivary gland biopsy.

As a general rule in clinical practice, meeting three of four criteria indicates a high probability of Sjögren's Syndrome .