Sjögren's syndrome and what tests help confirm the disease

Dry eyes and mouth are usually attributed to fatigue, prolonged work at a monitor, insufficiently humidified air, age-related changes or dehydration. However, when these symptoms do not go away for months, become more intense, interfere with talking, swallowing, reading, using contact lenses or sleeping, it is worth thinking about it - the cause may be deeper than household factors. One of the possible diseases that should be ruled out in this case is Sjögren's syndrome.

It is an autoimmune disorder in which the immune system attacks the salivary and lacrimal glands, reducing the production of tears and saliva. However, the disease is not limited to the mucous membranes. As the NIDCR notes, Sjögren's syndrome can be accompanied by dryness of the skin, nasal passages, vagina, and can also affect other organs - the kidneys, blood vessels, lungs, liver, pancreas and nervous system.

A diagnosis is never made based on just one symptom or one test. The NIAMS emphasizes that there is no single universal test to confirm Sjögren's syndrome, so the doctor relies on a combination of clinical manifestations, history, and a comprehensive examination.

When to suspect Sjögren's syndrome

Suspicion does not arise when the eyes are dry after a sleepless night or the mouth is dry after coffee. A more indicative situation is when the dryness becomes constant, recurs daily and is combined with other symptoms.

Sjögren's syndrome may be indicated by:

• dry eyes, feeling of sand or burning;
• the need to frequently use moisturizing drops;
• dry mouth, especially when talking or eating;
• difficulty swallowing dry food without water;
• frequent caries or gum inflammation;
• cracked lips;
• change in taste;
• enlargement or tenderness of the salivary glands;
• joint pain;
• prolonged fatigue;
• dry skin or mucous membranes;
• periodic numbness or tingling;
• unexplained changes in blood tests.

The NHS describes Sjögren's syndrome as a condition in which the glands that produce fluids, including tears and saliva, do not work properly. Typical symptoms include dry eyes, dry mouth, fatigue, muscle and joint pain, the NHS says.

Why dry eyes and mouth don't always mean Sjögren's syndrome

Dryness can have many causes. It can be triggered by medications, mouth breathing, diabetes, thyroid disease, deficiencies, dehydration, contact lenses, hormonal changes, allergies, radiation therapy, or other conditions.

That is why the doctor does not limit himself to the phrase «there is dryness, therefore it is Sjögren's.» The task of diagnosis is to confirm or exclude the autoimmune nature of the symptoms.

For example, if dry mouth is accompanied by thirst and frequent urination, a doctor may check glucose. If fatigue, paleness, and a burning tongue are present, indicators of anemia and deficiencies may be needed. If joint pain and dry eyes are present, autoimmune markers play a greater role.

The first stage of diagnosis

The first stage usually begins with a doctor's consultation. It is important to discuss not only the dryness, but also all associated symptoms, the duration of the complaints, medications, other autoimmune diseases, and family history.

The doctor may specify:

• when the drought began;
• is it every day;
• Is it necessary to drink water with food?;
• whether the eyes are dry in the morning or evening;
• were there frequent dental problems;
• Is there joint pain?;
• is there a rash, numbness, cough, shortness of breath;
• is there an increase in salivary glands;
• what medications the patient is taking;
• whether you have rheumatoid arthritis, lupus, or other autoimmune conditions.

The Mayo Clinic notes that diagnosing Sjögren's syndrome involves a physical examination and tests, which may include blood tests, eye tests, salivary gland imaging, and biopsy.

What blood tests can help?

Laboratory tests are needed to look for signs of autoimmune processes, inflammation, anemia, changes in immune response, and associated conditions. They do not replace an examination by an ophthalmologist, dentist, or rheumatologist, but they are often an important part of the diagnostic pathway.

Johns Hopkins Medicine notes that ANA and anti SSA results help determine if there are signs of an autoimmune disorder, and also describes the Schirmer test as a way to assess whether the tear glands are producing enough tears.

One of the basic studies could be complete blood count, especially if there is weakness, pallor, prolonged fatigue, frequent infections, or suspicion of a systemic process.

Anti SSA Ro and Anti SSB La

Anti SSA Ro is one of the most significant laboratory markers in suspected Sjögren's syndrome. Its presence can support the diagnosis, especially if there are typical symptoms of dryness and other objective signs of the disease.

Anti SSB La can also be determined as part of an autoimmune panel, but it is not interpreted separately, but together with Anti SSA Ro, ANA, symptoms, examination, and results of other tests.

It is important to understand that negative antibodies do not always completely rule out Sjögren's syndrome. In some patients, eye tests, salivary tests, and minor salivary gland biopsy may play a diagnostic role. That is why it is not worth making a conclusion based on one form.

Classification criteria and why they are not equal to self-diagnosis

International criteria are used in medical practice to help standardize the diagnosis of primary Sjögren's syndrome. The 2016 ACR EULAR criteria are based on a combination of five items: Anti SSA Ro, minor salivary gland biopsy with focal lymphocytic sialadenitis, ocular staining, Schirmer's test, and unstimulated salivary flow.

In these criteria, Anti SSA Ro and a positive biopsy have more weight than individual functional tests. However, this does not mean that the patient should calculate the scores themselves. The criteria are intended to assist physicians and not replace clinical diagnosis.

Eye tests for suspected Sjögren's syndrome

Dry eyes need to be confirmed objectively, as the sensation of dryness can be present in a variety of conditions. An ophthalmologist can perform tests that assess tear production and the condition of the eye's surface.

Such examinations include:

• Schirmer's test;
• staining of the cornea and conjunctiva;
• tear film assessment;
• examination of the surface of the eye under a slit lamp.

The Mayo Clinic describes the Schirmer test as a method of measuring dry eyes, in which a small piece of filter paper is placed under the lower eyelid to assess the amount of tears.

These tests are important because a person may experience dryness, but the extent of eye damage needs to be medically assessed. This affects not only the diagnosis, but also the choice of treatment and corneal protection.

Salivary secretion and salivary gland studies

Dry mouth can also be assessed not only by complaints. The doctor may prescribe a test that measures the amount of saliva or refer for imaging of the salivary glands.

The NHS says that a test may be used to assess the amount of saliva produced, where the person spits or lets saliva flow into a container for five minutes. A lip biopsy may also be used, where a small piece of tissue from the salivary glands is examined under a microscope.

Salivary gland studies may be especially important if:

• dry mouth continues daily;
• there is frequent caries;
• difficulty swallowing dry food;
• parotid or submandibular glands enlarge;
• blood tests do not give a clear answer;
• The doctor suspects a seronegative course.

Minor salivary gland biopsy

A minor salivary gland biopsy is usually performed from the inner surface of the lower lip. It can help to see the characteristic lymphocytic inflammation in the salivary gland tissue.

This is not the first test for all patients. A biopsy may be considered if symptoms are typical but blood tests do not confirm the diagnosis, or if stronger morphological confirmation is needed.

The NIAMS notes that a dentist or other specialist may perform tests to aid in diagnosis, and generally, the diagnosis is made based on a combination of symptoms and examinations.

What conditions need to be ruled out?

Sjögren's syndrome can resemble other conditions, which is why diagnosis often involves not only looking for autoantibodies but also ruling out other causes of dryness, fatigue, or inflammation.

The doctor may check:

• diabetes;
• thyroid dysfunction;
• anemia;
• deficit iron, B12 or folic acid;
• side effects of medications;
• chronic infections;
• viral hepatitis;
• OX;
• rheumatoid arthritis;
• systemic lupus erythematosus;
• effects of radiation therapy;
• salivary gland diseases.

If there is prolonged dryness, enlarged lymph nodes, frequent infections, or risk factors, the doctor may include the following in the examination: HIV blood test, because some infections can produce symptoms similar to autoimmune or systemic conditions.

When tests should not be postponed

A routine check-up is appropriate if dryness persists for a long time but the general condition is stable. However, there are situations when it is better to consult a doctor sooner.

Do not postpone the examination if you have:

• severe dry eyes with pain or blurred vision;
• dry mouth that makes it difficult to swallow;
• enlargement of the salivary glands;
• prolonged fever;
• night sweats;
• unexplained weight loss;
• severe fatigue;
• joint pain and swelling;
• rash;
• numbness or weakness in the limbs;
• shortness of breath or persistent cough;
• swelling;
• changes in complete blood count.

Sjögren's syndrome can have not only local manifestations of dryness, but also systemic symptoms. Therefore, it is important not to limit yourself to eye drops or frequent drinking of water if the condition recurs daily and gradually worsens the quality of life.

How to prepare for consultation and tests

Before visiting a doctor, it is useful to gather information that will help you not to miss important details.

Prepare:

• a list of symptoms and the time of their appearance;
• a list of all medications and supplements;
• information about autoimmune diseases in the family;
• results of previous analyses;
• data from an ophthalmologist or dentist, if they already exist;
• a description of what aggravates or relieves dryness;
• information about frequent infections, tooth decay, or enlarged salivary glands.

For some blood tests, it may be recommended to donate blood in the morning or on an empty stomach, especially if biochemistry, glucose, or other metabolic parameters are being tested at the same time. Medications should not be changed independently without consulting a doctor.

FAQ

Can Sjögren's syndrome be confirmed with just a blood test?

Not always. Tests for ANA, Anti SSA Ro, Anti SSB La, and other markers can be very helpful, but the diagnosis is made based on a combination of symptoms, examination, laboratory data, eye tests, salivary evaluation, and sometimes biopsy.

What analysis is most important when Sjögren's syndrome is suspected?

One of the most important is Anti SSA Ro. But its result should be evaluated together with other data. Some patients may need a Schirmer test, salivary flow assessment, or minor salivary gland biopsy.

Can Sjögren's syndrome occur with negative antibodies?

Yes, this is possible. If the symptoms are typical but the antibodies are negative, the doctor may order additional tests, including eye tests, saliva tests, or a biopsy.

Which doctor should you consult if you suspect Sjögren's syndrome?

Typically, a rheumatologist is involved in the diagnosis. An ophthalmologist, dentist, family doctor, and other specialists may also be needed in case of systemic manifestations.

Is it necessary to treat dryness without confirming the diagnosis?

Symptomatic relief of dryness may be needed, but it is important not to stop at just drops or water if symptoms persist. The cause of the dryness must first be understood and autoimmune, endocrine, infectious, and deficiency conditions must be ruled out.

At first, Sjögren's syndrome may not have any obvious symptoms. It often comes down to dry eyes and mouth, fatigue, or joint pain, which the patient has long considered to be a consequence of fatigue, age, or adverse conditions. Blood tests can help detect autoimmune markers and related changes, and eye tests, salivary flow measurements, and biopsy can confirm the diagnosis. The key here is not just one test, but a comprehensive, step-by-step examination with a doctor.

Author: Ulyana Anatolyivna Dzyuba

Director of Medi Lab Plus LLC, a doctor of the highest category. Has over 45 years of practical experience in medicine and laboratory diagnostics. Founder and head of the laboratory since 2007. More details…