Sjögren’s can be challenging to recognize or diagnose because symptoms of Sjögren’s may mimic those of menopause, drug side effects, or medical conditions such as lupus, rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome, and multiple sclerosis and thus makes receiving a prompt diagnosis difficult.
Since all symptoms are not always present at the same time and because Sjögren’s is so complex, physicians and dentists sometimes treat each symptom individually and do not recognize that a systemic disease is present. (i.e. an eye care provider may be treating dry eye and not realize the patient has other symptoms, or a primary care physician may be treating joint pain but not realize a patient has dryness symptoms too.)
Fortunately, the Foundation has been able to reduce the time for a proper diagnosis to 2.8 years, down from over 6 years in just 2012.
How is Sjögren's Diagnosed?
There is no single test that will confirm the diagnosis of Sjögren's and thus physicians must conduct a series of tests and ask about symptoms the patient is experiencing.
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.
Physicians will use a number of tests and questions to determine a Sjögren's diagnosis. These tests may include some of the following:
Objective tests used in diagnosis include:
- Blood Tests
SS-A (or Ro) and SS-B (or La): Marker antibodies for Sjögren’s. 70% of Sjögren’s patients are positive for SS-A and 40% are positive for SS-B. Also found in lupus patients.
- Eye Tests
- Schirmer test: Measures tear production.
- Rose Bengal and Lissamine Green: Uses dyes to examine the surface of the eyes for dry spots.
- Dental Tests
- Salivary Flow: Measures the amount of saliva produced over a certain period of time.
- Salivary Gland Biopsy (usually in the lower lip): Confirms lymphocytic infiltration of the minor salivary glands.
Subjective questions used in diagnosis may include:
- Ocular Symptoms*
- How long have you been experiencing dry eye?
- Do you have a foreign body sensation in your eye?
- How often do you use artificial tears each day?
- Oral Symptoms*
- How long have you had dry mouth?
- Do you experience salivary gland swelling?
- Do you need liquids to swallow foods?
*These questions are just a sampling of questions a physician may ask a patient.
In addition to objective and subjective testing, your physician will also take a complete medical history as well as discuss the various symptoms you may be experiencing. Your physician will then consider the results of all these tests and his/her examination to arrive at a final diagnosis.
Further research is being conducted to refine the diagnostic criteria for Sjögren's and to help make diagnosis easier and more accurate.
Once diagnosed, the Foundation recommends discussing the Sjögren's Foundation Clinical Practice Guidelines with your physician to review treatment options.
The Sjögren’s Foundation is working on various international initiatives to discover and validate better and more specific biomarkers, but until then, diagnosing Sjögren’s can sometimes be an “art” based on the physician’s assessment of symptoms plus objective tests.
In 2016, an international group of experts along with the Sjögren’s Foundation, did develop an updated classification criteria for Sjögren’s diagnosis for patients to enter clinical trials. These criteria consider dryness symptoms, changes in salivary (mouth) and lacrimal (eye) gland function, and systemic (whole body) findings. These 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.