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Jaclyn, Hi. Good question! I was Dx'ed with the SCLE "subset" of SLE ( = subsacute cutaneous lupus erythematosus), but I don't have Sjogren's.

Dr. Daniel Wallace, in his lupus hardcover, estimates that (1) 5% to 10% of people with Sjogren's have SLE; and (2) at least 10% of people with lupus have obvious Sjogren's, though that may go as high as 1/3 if more people with lupus were thoroughly tested for Sjogren's. (ASIDE: Dr. Robert Lahita is another excellent author. Look for either/both in libraries & bookstores.)

First point: each disease is evaluated separately.

Sjogren's has a strict ACR (Am. College of Rheumatology) definition, in which you must meet 4 of 6 criteria; OR, if you don't have sicca (dryness), 3 of the 4 not involving sicca. Most definitive test? The lip biopsy.
(1) Ocular symptoms: dry eyes; use artificial tears more than 3 times/day
(2) Oral symptoms: dry & swollen salivary glands; need liquids to swallow
(3) Ocular signs: Schirmer's test (a cornea stain test)
(4) Oral signs: salivary tests = sialography, scintigraphy & sialometry
(5) Positive lip biopsy
(6) Positive SSA &/or SSB autoantibodies, but findings aren't so definitive, as only 50% of people with Sjogren's (primary or secondary) are positive. [Surprising! I thought % would be MUCH higher!]

Lupus has its own ACR criteria, per "sticky post" at top of thread list. To be Dx'ed with SLE (sysmetic lupus), you must meet at least 4 of the 11, but not necessarily all at once. Most common rash is butterfly (facial), but some people never have a butterfly rash. Bloodwork is tricky: ANA is almost always positive, but it's positive in OTHER disease as well. Also, there are 16 or so antibodies & the like seen in lupus, only *two* are considered 100% specific to SLE---anti-ds-DNA & anti-Sm---which is why only these 2 are listed on the ACR criteria list.

Further, there are several interesting "subsets" of SLE, per below. (There are also 2 more, but it's these 2 you probably should know about.)

(a) DLE (discoid LE): Fewer than 4 criteria met. Considered mildest form, but cosmetic ramifications are BIG (rashes scar &/or depigment). ANA positive only about 50%. 10% eventually fulfill criteria for full-blown SLE.

(b) SCLE (subacute cutaneous LE): Viewed as intermediate form, between DLE & SLE. 50% fulfill 4 or more SLE criteria, but usually the milder ones. (For example, kidney & CNS problems are thought to be less likely in SCLE than in SLE.) 50% fulfill fewer than 4 criteria. ANA is negative in perhaps 30% of SCLE patients (compared to much smaller % in classic SLE). Anti-Ro & anti-La are the antibodies most often found. There are two SCLE-specific rashes: (1) annular (targetlike), and (2) papulosquamous or psoriasiform (resembles psoriasis but isn't). Rashes usually don't itch, scar or depigment.


Why I was Dx'ed with SCLE but not Sjogren's or SLE (or so I think!):

1. Met multiple (and milder) ACR *criteria*: sun sensitivity; arthritis; persistent anemia (also episodes of abormal WBC). Didn't have discoid (scarring) rashes or butterfly facial rash, but DID have a lupus-specific rash = SCLE annular form, as confirmed by deep-punch skin biopsies with immunoflourescent stain tests. Also, had many *symptoms*, over many decades, of lower-grade problems seen in lupus, e.g., chronic fatigue, hair & weight loss, migraines, GI (awful & chronic) & urinary (cystitis, stones, UTI's, etc.), sciatica, ETC. but over my life, had 3 severe episodes: severe pneumonia, encephalitis, and what *may* have been a hit of internal vasculitis.
2. Did NOT meet "biggest" lupus ACR criteria, so classic SLE, though close, was not close enough.
3. Was positive for anti-Ro but WITHOUT meaningful eye/mouth issues (had only milder dryness), so Sjogren's-specific tests were not done.

I hope something here rings bells with you. I hope you post more. Bye for now. Sending my best wishes, Vee

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