As with other autoimmune disorders, the symptoms of Sjogren's syndrome develop slowly over time. Due to the slow progression of symptoms, there is typically up to a 10-year gap between the onset of symptoms and diagnosis of the disorder. Also, because of the typical age range of onset of Sjogren's syndrome (middle-age women), some symptoms of Sjogren's syndrome can be confused with symptoms often seen with normal aging (e.g., vaginal dryness) of menopausal women which can delay the accurate diagnosis of Sjogren's syndrome.

Diagnosis of Sjogren's syndrome is often difficult to establish with people who present with less definitive symptoms or borderline antibody values. In addition, sicca symptoms, namely dry eyes and dry mouth, can be present with many other medical conditions that add to the difficulty in identifying primary Sjogren's syndrome.

Early and accurate diagnosis of Sjogren's syndrome is important because initiation of appropriate therapy can prevent further damage. For example:

• Treating the symptoms of dry mouth can reduce oral problems such as cavities, periodontal diseases, oral infections
• Treating the symptoms of dry eyes can minimize ocular damage
• Earlier diagnosis and initiation of treatment for systemic complications of Sjogren's syndrome can improve prognosis (chance of recovery)

There is no single diagnostic test available for Sjogren's syndrome. Rather, a thorough medical history, a review of signs and symptoms, a physical examination, and select diagnostic and laboratory tests are used to establish the diagnosis. In many cases, patients are referred to several medical specialists (e.g., rheumatologist, ophthalmologist, and dentist) who, by working together, are able to link the pieces of the puzzle to arrive at an accurate diagnosis.

Diagnostic Evaluation of Sjogren's Syndrome

A diagnostic evaluation for patients with suspected Sjogren's syndrome usually includes the following:

• Patient medical history
• Physical examination
• Oral examination
• Ocular examination
• Laboratory studies
• Other studies

A detailed patient history is crucial in the diagnostic "work-up" for Sjogren's syndrome. Information gathered by the doctor usually includes:

• History of symptoms - oral and ocular changes, fatigue, anxiety, joint or muscle pain
• Duration and pattern of symptoms
• Medications that the patient is presently taking that may cause similar symptoms
• History of other comorbid diseases

The physical examination relating to the diagnosis of Sjogren's syndrome is very important because it may reveal certain important aspects of the disease, including:

• Salivary gland enlargement
• Regional lymph node swelling and tenderness
• Severely cracked lips
• Ulceration of the tongue
• Smooth tongue with atrophy of the papillae (taste buds)
• Halitosis - bad breath
• Pooling of saliva in the floor of the mouth
• Appearance of the eyes (e.g., red, watery)
• Excess production of mucus in lower part of eyes

Studies that are performed to evaluate the extent and severity of oral symptoms in order to reach a diagnosis of Sjogren's syndrome include: