Exams and Tests

Because the symptoms of Sjögren syndrome can be caused by many different disorders, the syndrome is often diagnosed incorrectly or not diagnosed at all.

• To correctly identify the cause of your symptoms, your health care provider will ask you many detailed questions about your symptoms, your medical and surgical history, your family history, the medications and supplements you take, and your habits and lifestyle.
  
  
• A thorough physical examination will try to determine whether your symptoms are due to Sjögren syndrome or to another disorder and whether internal organs are involved.

Lab tests: There is no one lab test that can confirm the diagnosis of Sjögren syndrome. These tests will focus on identifying underlying diseases such as rheumatoid arthritis and on detecting involvement of various body systems. Your health care provider may refer you to a rheumatologist who has special expertise in Sjögren syndrome and related disorders.

• Complete blood cell count (CBC): Blood cell counts are most often normal, but level of hemoglobin may be low (anemia). A low platelet count may suggest lupus.
  
  
• Blood chemistry
  
  
• Serum protein electrophoresis
  
  
• Rheumatoid factor (RF): The test for rheumatoid factor, which is not specific for rheumatoid arthritis, is positive in 80-90% of people with Sjögren syndrome. It is also positive in some people with other autoimmune disorders.
  
  
• Antinuclear antibodies (ANA): ANA are present in many patients with autoimmune disorders such as systemic lupus erythematosus or Sjögren syndrome. While many antibodies can cause a positive ANA test, some are common in people with Sjögren syndrome; these are sometimes called Sjögren antibodies, anti-Ro/SS-A and anti-La/SS-B. The results of the ANA tests are positive in about 50-75% of people with Sjögren syndrome.
  
  
• Thyroid-stimulating hormone: People with Sjögren syndrome are more likely to have hypothyroidism than the general population.

Salivary gland tests: Several tests can be done to try to determine the cause of mouth dryness.

• Biopsy: This is the single most accurate test for confirming a diagnosis of Sjögren syndrome. The tissue is usually removed through a tiny incision on the inner lip. The tissue is subjected to tests and looked at under a microscope by a pathologist (a specialist in diagnosing diseases by studying tissues). The pathologist looks for infiltration by lymphocytes.
  
  
• Sialography: This is a type of x-ray that uses a contrast medium to highlight details of the parotid glands and the rest of the salivary system. This is especially helpful for finding obstructions of the salivary ducts.
  
  
• Salivary scintigraphy: This test uses a harmless radioactive tracer to measure saliva production.
  
  
• Parotid gland flow: This test measures the actual amount of saliva produced over a set period of time.

Eye tests: If you have dry eyes, you will probably be referred to an ophthalmologist (specialist in eye disorders), who may conduct various tests to try to determine the cause of your symptoms.

• Schirmer test: This simple test measures tear production using a strip of filter paper placed on the lower eyelid for 5 minutes.
  
  
• Slit-lamp exam: This test uses a special type of light to see “inside” the eye. This test can check tear production. Temporary stains can be used to detect damage to the corneas.

Other tests: Symptoms in other body systems may necessitate biopsy of other tissues, such as the kidney, the intestine, the lung, or lymph nodes.

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