Early diagnosis and treatment are important for preventing complications. Unfortunately, reaching a diagnosis can often be difficult and has been found to take an average of 3 years from the onset of symptoms. 

Sjögren’s symptoms frequently overlap with or “mimic” those of other diseases including lupus, rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome, and multiple sclerosis. Symptoms of dryness also can occur for reasons other than Sjögren’s, such as a side effect of medications (for example, antidepressants, allergy and high blood pressure medications), further making a diagnosis of Sjögren’s difficult.

Rheumatologists have primary responsibility for diagnosing and managing Sjögren’s and can conduct a series of tests and ask about symptoms. Your eye doctor or an oral medicine specialist also might run tests if Sjögren’s is suspected. See below for a description of the most common tests for Sjögren’s that might be done.

There is no single test that will confirm a diagnosis, and someone does not have to test positive for all tests related to Sjögren’s to be diagnosed with the disease. However, the more tests that are positive, the easier the diagnosis. If a patient is not positive for the blood test for the autoantibody SSA, one of the clearest blood test markers for Sjögren’s, then the diagnosis is more difficult. Since about 30% of patients are negative for this marker, being negative does not mean the patient does not have Sjögren’s. A physician will have to determine the diagnosis through symptoms and other tests. A positive lip biopsy is considered the “gold standard” for diagnosing Sjögren’s, and if a patient and her or his doctor decide to confirm a diagnosis with this test, the patient most likely will be sent out to a specialist. Until we discover and validate better and more specific biomarkers, diagnosing Sjögren’s can sometimes be an “art” based on the physician’s assessment of symptoms plus objective tests.

An international group of experts have formulated classification criteria for Sjögren’s to be used for diagnosis in clinical trials. These criteria were recently updated with the Foundation's help in bringing the international community together. They consider dryness symptoms, changes in salivary (mouth) and lacrimal (eye) gland function, and systemic (whole body) findings. Published classification criteria are designed for use in clinical trials and not for diagnosing patients in a clinic for general management and treatment. As such, they are very strict so that there is absolutely no doubt that a patient has Sjögren’s, something that is important to prove for participating in a clinical trial. Patients that do not meet these criteria can still have Sjögren’s.

Blood tests your physician may perform include:

  • • ANA (Anti-Nuclear Antibody)
    ANAs are a group of antibodies that react against normal components of a cell nucleus. About 70% of Sjögren’s patients have a positive ANA test result.
  • • RF (Rheumatoid Factor)
    This antibody test is indicative of a rheumatic disease, including rheumatoid arthritis (RA), lupus and Sjögren’s. It doesn’t, however, specify which rheumatic disease a person has. In Sjögren’s patients, 60-70% have a positive RF.
  • • SS-A (or Ro) and SS-B (or La)
    These are the marker antibodies for Sjögren's. Seventy percent of Sjögren’s patients are positive for SS-A and 40% are positive for SS-B (these may also be found in lupus patients).
  • • ESR (Erythrocyte Sedimentation Rate)
    This test measures inflammation. An elevated ESR indicates the presence of an inflammatory disorder, including Sjögren’s.
  • • IGs (Immunoglobulins)
    These are normal blood proteins that participate in immune reactions and are usually elevated in Sjögren’s patients.

The ophthalmologic (eye) tests include:

  • • Schirmer Test
    Measures tear production.
  • • Rose Bengal and Lissamine Green
    Eyedrops containing dyes that an eye care specialist uses to examine the surface of the eye for dry spots.

The dental tests include:

  • • Salivary Flow
    Measures the amount of saliva produced over a certain period of time.
  • • Salivary scintigraphy
    A nuclear medicine test that measures salivary gland function.

A salivary gland biopsy (usually in the lower lip) might be done by a specialist to confirm inflammatory cell (lymphocytic) infiltration of the minor salivary glands.

Your physician will consider the results of these tests along with your physical examination to arrive at a final diagnosis. The SSF has made discovery of biomarkers a priority for its research grants program. Better biomarkers will help speed the diagnosis of Sjögren’s and also eventually elucidate a patient’s risk factors for developing specific complications of the disease. Once diagnosed, the Foundation recommends discussing the newly published SSF Clinical Practice Guidelines with your physician to review treatment options.

The Sjögren’s Syndrome Foundation has been working for the last five years on a Breakthrough Goal to “To shorten the time to diagnose Sjögren’s by 50% in 5 years!” Read about our progress here! 

 

 

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