Sandhya P, et al. - Subjects were screened by tracing reports of anti-SSA (anti-Ro) antibody assays between January 2008 and October 2015 by the researchers in order to assess the determinants of diagnosis in primary Sjögren's syndrome (pSS) in tertiary care settings. At first visit, a total of 275 subjects with pSS consulted 24 different specialties. Rheumatology accounted for 128 cases. For all specialties together and for the rheumatologist, initial suspicion for pSS was 48.4% and 64.84%, respectively, at first consultation. The median number of visits before proceeding to the final diagnosis was 1 and 3 when the initial impression was pSS and if the initial clinical impression was a non-SS differential, respectively. Strong predictors of early diagnosis were the first impression of pSS, inquiry about sicca symptoms and ordering anti-SSA (anti-Ro) antibody test at first consultation, however, none of the clinical variables showed to be beneficial predictors of early diagnosis. Therefore, even in tertiary care centers, the diagnosis of pSS was difficult as sufferers present with myriad characteristics to different specialties. For all specialties together and for the rheumatologist, the initial suspicion was limited to 48.4% and 64.84%, respectively. Moreover, high suspicion of pSS along with ordering anti-SSA (anti-Ro) antibody could speed the diagnosis.