{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:23:24Z","timestamp":1783643004159,"version":"3.55.0"},"reference-count":113,"publisher":"Korean Association of Internal Medicine","issue":"4","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["kjim.org"],"crossmark-restriction":true},"short-container-title":["Korean J Intern Med"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:p>Sj\u00f6gren syndrome (SS), traditionally regarded as a sicca-predominant condition, is now recognized as a systemic autoimmune disease characterized by type I interferon activation, B-cell hyperactivity, and periepithelial lymphocytic infiltration. This conceptual shift has prompted changes in terminology, with \u201cSS\u201d increasingly replaced by \u201cSj\u00f6gren disease (SjD)\u201d and \u201csecondary SS\u201d by \u201cassociated SjD,\u201d reflecting the concept of polyautoimmunity and ensuring equal clinical standing. In this review, we trace the historical evolution of SS classification criteria and examine their limitations in real-world clinical practice. Current classification criteria employ a weighted scoring system incorporating objective measures, including anti-Ro antibodies, salivary gland histopathology, and exocrine function tests. However, their diagnostic application in routine care is constrained by spectrum bias, clinical heterogeneity, the presence of mimickers, and shared clinical features with other autoimmune diseases. Over-reliance on serological markers, driven by their accessibility, may further contribute to misdiagnosis. We highlight that accurate diagnosis requires flexible clinical reasoning and contextual interpretation beyond rigid adherence to classification criteria. Individualized diagnostic strategies should integrate demographics, laboratory findings, salivary ultrasonography, and histopathology. Practical challenges in diagnosing and evaluating disease activity in associated SjD are also discussed.<\/jats:p>","DOI":"10.3904\/kjim.2025.340","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T01:47:12Z","timestamp":1782956832000},"page":"620-635","update-policy":"https:\/\/doi.org\/10.3904\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["From Sj\u00f6gren syndrome to Sj\u00f6gren disease: rethinking classification and diagnostic complexity"],"prefix":"10.3904","volume":"41","author":[{"given":"Jennifer Jooha","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howook","family":"Jeon","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Uijeongbu St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun-Sook","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Rheumatobiology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hae-Rim","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Ki","family":"Kwok","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoon-Kyoung","family":"Sung","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases and Hanyang University Institute for Rheumatology Research, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jisoo","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin-Seok","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Hwan","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7615-8611","authenticated-orcid":true,"given":"Yun Jong","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea"},{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea"},{"name":"Department of Medical Device Development, Seoul National University Graduate School, Seongnam, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Korean Society of Sjogren Disease Research 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