In Rheumatoid Arthritis and Sjögren’s Syndrome, we discussed how patients living with RA have an increased risk of developing secondary Sjögren’s Syndrome (SS). Early diagnosis and treatment are important for the prevention of complications in Sjögren’s. However, reaching a diagnosis can often be difficult and may take an average of six and a half years from the onset of symptoms, according to the Sjögren’s Syndrome Foundation.
Sjögren’s syndrome symptoms frequently overlap with or “mimic” those of other diseases including lupus, rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome and multiple sclerosis. Dryness can also occur for other reasons, such as a side effect of medications such as anti-depressants and high blood pressure medication.
There is no single test that will confirm diagnosis. Your doctor will base a diagnosis on medical history, physical exam, combination of symptoms, and results from clinical and laboratory tests. A rheumatologist is often responsible for diagnosing and managing Sjögren’s Syndrome. Criteria for diagnosis considers dryness symptoms, changes in salivary (mouth) and lacrimal (eye) gland function, and systemic (whole body) findings.
Common eye tests include:
- Schirmer test – This test measures tear production to see how the lacrimal (tear) glands are working. The doctor puts thin paper strips under the lower eyelids and measures the amount of wetness on the paper after 5 minutes. People with Sjögren’s syndrome usually produce less than 8 millimeters of tears.
- Staining with vital dyes (rose bengal or lissamine green) – These tests show the extent to which dryness has damaged the surface of the eye. To perform one of these tests, the doctor puts a drop of a liquid containing a dye into the lower eyelid. The dye stains the surface of the eye, highlighting any areas of injury, thereby allowing the doctor to see with the slit lamp how much damage has occurred on the surface of the eye.
- Slit lamp examination – This test, in which an ophthalmologist uses equipment to magnify and carefully examine the eye, shows how severe the dryness is and whether the outside of the eye is inflamed.
Common mouth tests include:
- Mouth exam – The doctor will look outside the mouth for signs of major salivary gland swelling and inside the mouth for signs of dryness. Signs of dry mouth include a dry, sticky lining (called oral mucosa); dental caries (cavities) in characteristic locations; thick saliva, or none at all coming out of the major salivary ducts; redness of the mouth lining, often associated with a smooth, burning tongue; and sores at the corners of the lips. The doctor might also try to get a sample of saliva, to check its quality and see how much of it the glands are producing.
- Salivary gland scintigraphy - A nuclear medicine test that measures salivary gland function.
- Lip biopsy – This test is the best way to find out whether dry mouth is caused by Sjögren’s syndrome. To perform this test the doctor removes tiny minor salivary glands from the inside of the lower lip and examines them under the microscope. If the glands contain white blood cells in a particular pattern, the test is positive for the salivary component of Sjögren’s syndrome.
Blood tests may include: