In what circumstances do you pursue labial salivary gland biopsy in an asymptomatic patient with high titer ANA and positive SSA?

I seldom, if ever, suggest a lip biopsy in the work-up of patients with Sjogren's syndrome. It is invasive, and even the histo-pathological interpretation is often open to question. I typically refer patients to an ophthalmologist for a diagnosis of keratoconjunctivitis sicca, if present, and if nec...

Utilize the framework of the 2016 ACR/EULAR Classification Criteria (not diagnostic) that have been validated in 3 separate international cohorts (Shiboski et al., PMID 27785888). Generally, the patient would present with some suggestive symptoms/features (i.e., dry eye/mouth). Total of 4 points c/w...