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Medical Author:

Kanchan Pema, MD

Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Because the symptoms of Sjögren's 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, 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's 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's syndrome. Testing will be focused on identifying underlying diseases such as rheumatoid arthritis. These tests will may also be used to detect involvement of various body systems and more serious complications. Your health-care professional may refer you to a rheumatologist who has special expertise in Sjögren's syndrome and related disorders.

• Complete blood cell count (CBC): Blood cell counts are most often normal, but the level of hemoglobin may be low (anemia). A low platelet count or white blood cell count may suggest lupus.



• Blood chemistry will help identify liver, kidney, or electrolyte disturbances.



• 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's 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's syndrome. While many antibodies can cause a positive ANA test, some are common in people with Sjögren's syndrome; these are sometimes called Sjögren's 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's syndrome. The absence of these antibodies does not exclude the disease.



• Thyroid-stimulating hormone: People with Sjögren's syndrome are more likely to have autoimmune hypothyroidism than the general population.



• Hepatitis C antibodies



• Human immunodeficiency virus (HIV) antibodies



• Human T-cell leukemia virus-1 (HTLV-1) antibodies

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's 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 or narrowing of the salivary ducts.



• Salivary scintigraphy: This test uses a radioactive tracer to measure saliva production.



• Parotid gland flow (sialometry): This test measures the actual amount of saliva produced over a set period of time.



• Ultrasound and magnetic resonance imaging (MRI) to evaluate masses

Eye tests: If you have dry eyes, you will probably be referred to an ophthalmologist (a specialist in eye disorders). This physician may conduct various tests to try to determine the cause of your symptoms and whether there is damage to your eyes.

• Schirmer test: This simple test measures tear production using a strip of filter paper placed on the lower eyelid for five minutes.



• Rose Bengal staining/slit-lamp exam: If you have dry eyes, you will probably be referred to an ophthalmologist (a specialist in eye disorders). This physician may conduct various tests to try to determine the cause of your symptoms and whether there is damage to your eyes.

Other tests: Some symptoms or lab findings may prompt biopsy of other tissues, such as the kidney, the intestine, the lung, or lymph nodes.

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