# ACR/EULAR Sjögren classification criteria

ACR/EULAR Sjögren

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/acr_eular_sjogren`
HTML: https://magentlab.com/docs/acr-eular-sjogren
Markdown: https://magentlab.com/docs/acr-eular-sjogren.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Apply the 2016 ACR/EULAR classification criteria for primary Sjögren's syndrome (Shiboski Table 3): require published inclusion and no exclusion, then return the five-item weighted score and whether the ≥4 cut point classifies primary Sjögren's syndrome. Not a diagnosis.

## When to use

When an agent already has caller-assigned Shiboski 2016 inclusion, exclusion, and the five criteria items and needs the published primary Sjögren classification result for research, not a diagnosis.

## When not to use

- Not a medical device and not a diagnosis of Sjögren's syndrome. Classification criteria for research, not AECG 2002 and not 2012 ACR-only criteria.
- Inclusion (inclusion_met true) and exclusion (exclusion_present false) must be met or the request is HTTP 400 and is not scored.
- magent does not stain eyes, measure saliva, assay anti-SSA/Ro, or read labial salivary gland biopsies. Anti-SSB/La without SSA is not an item.
- Classification criteria for research, not a treatment decision.

## Formula

```
ACR/EULAR 2016 primary Sjögren classification (Shiboski Table 3): required inclusion_met true and exclusion_present false (else do not score). Score = labial_biopsy_fs_ge_1 3 + anti_ssa_ro 3 + ocular_staining 1 + schirmer 1 + uws 1; max 9; classified iff score ≥4. Not a diagnosis. Not AECG 2002. Not 2012 ACR-only criteria
```

## Citation

[2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren's Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts](https://doi.org/10.1002/art.39859)
Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, Rasmussen A, Scofield H, Vitali C, Bowman SJ, Mariette X, the International Sjögren's Syndrome Criteria Working Group
Arthritis Rheumatol. 2017;69(1):35-45
DOI: [10.1002/art.39859](https://doi.org/10.1002/art.39859)

## Worked example

### Labial biopsy and ocular staining, classified

Given: `anti_ssa_ro=false, exclusion_present=false, inclusion_met=true, labial_biopsy_fs_ge_1=true, ocular_staining=true, schirmer=false, uws=false`

1. Required: inclusion_met true, exclusion_present false
2. labial_biopsy_fs_ge_1 3 + ocular_staining 1; anti_ssa_ro, schirmer, and uws 0
3. score = 4 (max 9) ≥4; classified true


### Inclusion met, no items, not classified

Given: `anti_ssa_ro=false, exclusion_present=false, inclusion_met=true, labial_biopsy_fs_ge_1=false, ocular_staining=false, schirmer=false, uws=false`

1. Scoring flags false
2. Score = 0 (max 9) <4; classified false


### Anti-SSA/Ro only, not classified

Given: `anti_ssa_ro=true, exclusion_present=false, inclusion_met=true, labial_biopsy_fs_ge_1=false, ocular_staining=false, schirmer=false, uws=false`

1. anti_ssa_ro 3; remaining items 0
2. Score = 3 (max 9) <4; classified false. Anti-SSB/La without SSA is not an item.


### All five items, classified

Given: `anti_ssa_ro=true, exclusion_present=false, inclusion_met=true, labial_biopsy_fs_ge_1=true, ocular_staining=true, schirmer=true, uws=true`

1. labial_biopsy_fs_ge_1 3 + anti_ssa_ro 3 + ocular_staining 1 + schirmer 1 + uws 1
2. Score = 9 (max 9) ≥4; classified true


## Also searched as

- ACR EULAR Sjögren
- 2016 Sjögren classification criteria
- Shiboski 2016 Sjögren
- primary Sjögren syndrome classification
- ACR/EULAR 2016 pSS
- anti-SSA/Ro Sjögren
- labial salivary gland focus score
- Schirmer unstimulated saliva Sjögren

## Parameters

- `inclusion_met` (boolean, required): Must be true. Shiboski 2016 inclusion as assigned by the caller: at least one AECG ocular or oral dryness question positive, or suspicion of Sjögren's syndrome from ESSDAI with at least one positive domain item. false is invalid and is not scored. magent does not take a dryness history.
- `exclusion_present` (boolean, required): Must be false. Shiboski 2016 exclusion as assigned by the caller: none of head and neck radiation, active HCV with PCR confirmation, AIDS, sarcoidosis, amyloidosis, graft-versus-host disease, or IgG4-related disease. true is invalid and is not scored. magent does not diagnose exclusion conditions.
- `labial_biopsy_fs_ge_1` (boolean, required): Labial salivary gland with focal lymphocytic sialadenitis and focus score ≥1 foci/4 mm² (Shiboski 2016 Table 3). true scores 3; false scores 0. magent does not read biopsies.
- `anti_ssa_ro` (boolean, required): Anti-SSA/Ro positive as assigned by the caller (Shiboski 2016 Table 3). true scores 3; false scores 0. Anti-SSB/La without SSA is not an item. magent does not assay autoantibodies.
- `ocular_staining` (boolean, required): Ocular staining score ≥5 or van Bijsterveld ≥4 in at least one eye (Shiboski 2016 Table 3). true scores 1; false scores 0. magent does not stain eyes.
- `schirmer` (boolean, required): Schirmer's test ≤5 mm/5 minutes in at least one eye (Shiboski 2016 Table 3). true scores 1; false scores 0. magent does not perform Schirmer testing.
- `uws` (boolean, required): Unstimulated whole saliva flow rate ≤0.1 ml/minute (Shiboski 2016 Table 3). true scores 1; false scores 0. magent does not measure saliva.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/acr_eular_sjogren`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "anti_ssa_ro": "false",
      "exclusion_present": "false",
      "inclusion_met": "true",
      "labial_biopsy_fs_ge_1": "true",
      "ocular_staining": "true",
      "schirmer": "false",
      "uws": "false"
    },
    {
      "anti_ssa_ro": "false",
      "exclusion_present": "false",
      "inclusion_met": "true",
      "labial_biopsy_fs_ge_1": "true",
      "ocular_staining": "true",
      "schirmer": "false",
      "uws": "false"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/acr-eular-sjogren

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/acr_eular_sjogren",
  "items": [
    {
      "components": [
        {
          "factor": "labial_biopsy_fs_ge_1",
          "points": 3,
          "present": true
        },
        {
          "factor": "anti_ssa_ro",
          "points": 0,
          "present": false
        },
        {
          "factor": "ocular_staining",
          "points": 1,
          "present": true
        },
        {
          "factor": "schirmer",
          "points": 0,
          "present": false
        },
        {
          "factor": "uws",
          "points": 0,
          "present": false
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, Rasmussen A, Scofield H, Vitali C, Bowman SJ, Mariette X, the International Sjögren's Syndrome Criteria Working Group",
        "doi": "10.1002/art.39859",
        "id": "shiboski-2016",
        "pmid": "27785888",
        "source": "Arthritis Rheumatol. 2017;69(1):35-45",
        "title": "2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren's Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts"
      },
      "formula": "acr_eular_sjogren",
      "formula_expression": "ACR/EULAR 2016 primary Sjögren classification (Shiboski Table 3): required inclusion_met true and exclusion_present false (else do not score). Score = labial_biopsy_fs_ge_1 3 + anti_ssa_ro 3 + ocular_staining 1 + schirmer 1 + uws 1; max 9; classified iff score ≥4. Not a diagnosis. Not AECG 2002. Not 2012 ACR-only criteria",
      "max_score": 9,
      "score": 4,
      "classified": true
    },
    {
      "components": [
        {
          "factor": "labial_biopsy_fs_ge_1",
          "points": 3,
          "present": true
        },
        {
          "factor": "anti_ssa_ro",
          "points": 0,
          "present": false
        },
        {
          "factor": "ocular_staining",
          "points": 1,
          "present": true
        },
        {
          "factor": "schirmer",
          "points": 0,
          "present": false
        },
        {
          "factor": "uws",
          "points": 0,
          "present": false
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, Rasmussen A, Scofield H, Vitali C, Bowman SJ, Mariette X, the International Sjögren's Syndrome Criteria Working Group",
        "doi": "10.1002/art.39859",
        "id": "shiboski-2016",
        "pmid": "27785888",
        "source": "Arthritis Rheumatol. 2017;69(1):35-45",
        "title": "2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren's Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts"
      },
      "formula": "acr_eular_sjogren",
      "formula_expression": "ACR/EULAR 2016 primary Sjögren classification (Shiboski Table 3): required inclusion_met true and exclusion_present false (else do not score). Score = labial_biopsy_fs_ge_1 3 + anti_ssa_ro 3 + ocular_staining 1 + schirmer 1 + uws 1; max 9; classified iff score ≥4. Not a diagnosis. Not AECG 2002. Not 2012 ACR-only criteria",
      "max_score": 9,
      "score": 4,
      "classified": true
    }
  ]
}
```

## Response fields

- `formula` (string): acr_eular_sjogren
- `formula_expression` (string): Shiboski 2016 ACR/EULAR primary Sjögren classification expression
- `score` (integer): Shiboski 2016 Table 3 points. Integer 0–9.
- `max_score` (integer): 9
- `classified` (boolean): true iff score ≥4. Classification criteria for research, not a diagnosis of Sjögren's syndrome. Not AECG 2002. Not 2012 ACR-only criteria.
- `components` (array): Per-item Shiboski 2016 points
- `citation` (object): Shiboski 2016 Arthritis Rheumatol citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "components": [
    {
      "factor": "labial_biopsy_fs_ge_1",
      "points": 3,
      "present": true
    },
    {
      "factor": "anti_ssa_ro",
      "points": 0,
      "present": false
    },
    {
      "factor": "ocular_staining",
      "points": 1,
      "present": true
    },
    {
      "factor": "schirmer",
      "points": 0,
      "present": false
    },
    {
      "factor": "uws",
      "points": 0,
      "present": false
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, Rasmussen A, Scofield H, Vitali C, Bowman SJ, Mariette X, the International Sjögren's Syndrome Criteria Working Group",
    "doi": "10.1002/art.39859",
    "id": "shiboski-2016",
    "pmid": "27785888",
    "source": "Arthritis Rheumatol. 2017;69(1):35-45",
    "title": "2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren's Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts"
  },
  "formula": "acr_eular_sjogren",
  "formula_expression": "ACR/EULAR 2016 primary Sjögren classification (Shiboski Table 3): required inclusion_met true and exclusion_present false (else do not score). Score = labial_biopsy_fs_ge_1 3 + anti_ssa_ro 3 + ocular_staining 1 + schirmer 1 + uws 1; max 9; classified iff score ≥4. Not a diagnosis. Not AECG 2002. Not 2012 ACR-only criteria",
  "max_score": 9,
  "score": 4,
  "classified": true
}
```

## Errors

- HTTP 400 `invalid_sjogren`: inclusion_met must be true and exclusion_present must be false (Shiboski 2016 ACR/EULAR primary Sjögren inclusion and exclusion). Returned before settlement; you are not charged.
- HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [ACR/EULAR gout](https://magentlab.com/docs/acr-eular-gout) — Apply the 2015 ACR/EULAR gout classification criteria (Neogi Table 2): require the entry episode, classify immediately if MSU crystals are present, otherwise return the Step 3 score (max 23) and whether score ≥8 classifies gout. Not a gout diagnosis.
- [ACR/EULAR PMR](https://magentlab.com/docs/acr-eular-pmr) — Apply the 2012 EULAR/ACR polymyalgia rheumatica classification criteria (Dasgupta Table 4): require age ≥50, bilateral shoulder aching, and abnormal CRP and/or ESR, then return the clinical score with or without optional ultrasound and whether the published cut point classifies PMR. Not a PMR diagnosis.

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.