bone, joint, and muscle disorders
Sjögren Syndrome
Diagnosis of Sjögren Syndrome
Established criteria Tear and saliva tests Blood tests Although a sensation of dry mouth or dry eyes is common, a sensation of dry mouth and dry eyes accompanied by joint inflammation, enlarged salivary glands, nerve damage, certain rashes, or kidney problems may indicate that the person has Sjögren syndrome. Established criteria and various tests can help a doctor diagnose Sjögren syndrome and differentiate it from other disorders that can cause similar symptoms. The diagnosis of Sjögren syndrome is based on all of the information doctors gather, including symptoms, physical examination results, and all test results. Doctors can use an established set of criteria to help them diagnose Sjögren syndrome. Before they can apply the criteria, doctors first ask questions and do a physical examination to determine whether people have eye or mouth symptoms. Doctors can then apply the criteria to people who have at least 1 of these symptoms of dryness in the eyes or mouth: Eye symptoms:People have persistent, troublesome dry eyes every day for 3 months or more, have a frequent sensation of feeling as though sand or gravel is in the eyes, or use tear substitutes 3 or more times per day. Mouth symptoms:People have a dry mouth sensation every day for 3 months or use liquids to help them swallow dry food every day. Once an eye or mouth symptom is diagnosed, doctors use the criteria to determine whether people have other symptoms that support the diagnosis of Sjögren syndrome. Doctors also use the criteria to rule out other disorders a person may have. However, some people who have Sjögren syndrome do not fulfill the strict criteria above for eye or mouth symptoms. The amount of tears produced can be estimated by placing a filter paper strip under each lower eyelid and observing how much of the strip is moistened (Schirmer test). A person who has Sjögren syndrome may produce less than one third of the normal amount. An ophthalmologist can test for damage to the eye’s surface. More sophisticated tests to evaluate saliva production may be done, and a doctor may order scans or the removal of tissue for examination and testing (biopsy) of the salivary glands. Blood tests can detect abnormal antibodies, including SS-A, an antibody that is present in people who have Sjögren syndrome. Antinuclear antibodies (ANA, which are found in people with lupus) and rheumatoid factor (which is found in people with rheumatoid arthritis) can also be found in people with Sjögren syndrome. The erythrocyte sedimentation rate (ESR), a test that measures the rate at which red blood cells settle to the bottom of a test tube containing blood, is elevated in about 70% of people. About 33% of people have a decreased number of red blood cells ( Overview of Anemia ), and up to 25% of people have a decreased number of certain types of white blood cells ( Although blood test results can help doctors diagnose Sjögren syndrome, they alone cannot confirm a definite diagnosis of Sjögren syndrome because sometimes the abnormalities they detect are present in healthy people or in people who have other disorders. 