Sjogren's syndrome - Diagnosing Sjögren's syndrome
- Introduction
- Symptoms of Sjögren's syndrome
- Causes of Sjögren's syndrome
- Diagnosing Sjögren's syndrome
- Treating Sjögren's syndrome
- Complications of Sjögren's syndrome
Sjögren's syndrome can be difficult to diagnose because the symptoms are similar to those of other health conditions.
You may see different health professionals for your different symptoms, such as a dentist for a dry mouth, an optician for dry eyes and a gynaecologist for a dry vagina, which can sometimes make it difficult to reach a firm diagnosis.
See your GP if you experience any symptoms of dryness, particularly of your eyes and mouth.
Screening questions
Experts in the field have come up with a series of screening questions, which may be useful if you're worried you may have Sjögren's syndrome.
If you answer "yes" to most of the questions below, you may have Sjögren's syndrome and will probably be advised to have further tests.
- Have you had daily, persistent, troublesome dry eyes for more than three months?
- Do you keep having a sensation of grit in your eye?
- Do you need to use eye drops containing tear substitutes more than three times a day?
- Have you had a daily feeling of dry mouth for more than three months?
- Do you keep getting swollen salivary glands (located between your jaw and your ears)?
- Do you frequently drink liquids to help you swallow food?
Further testing
Tests used to diagnose Sjögren's syndrome include:
- tear break-up time and Schirmer tests
- a lip biopsy
- blood tests
- salivary flow rate
These are explained below.
Tear break-up time and Schirmer tests
Tear break-up time and Schirmer tests are usually carried out by an ophthalmologist (a doctor who specialises in treating eye conditions).
The tear break-up time test measures how effective your tear glands are. A non-toxic dye is dropped onto the surface of your eye and the colour of the dye allows the ophthalmologist to see how well your tear film is functioning and how long it takes for your tears to evaporate.
This test is also carried out using a slit lamp. A slit lamp is a low-power microscope with a high-intensity light source that can be focused to shine in a narrow beam. The specialist will use the slit lamp to examine your tear glands more closely.
In the Schirmer test, small strips of blotting paper are placed into your lower eyelid. After five minutes, the strips are removed to see how much of the paper is soaked with tears.
Lip biopsy
During a lip biopsy, a small tissue sample is removed from your inner lip and examined under a microscope. A local anaesthetic is injected into the inner surface of your lower lip to numb the area, before a small cut is made to remove a few of your minor salivary glands.
Clusters of lymphocytes (a type of white blood cell) in the tissue can indicate Sjögren's syndrome.
Blood tests
Blood tests are carried out to look for antibodies known as anti-Ro and anti-La (or SS-A and SS-B), which are produced when the immune system has been affected by Sjögren's syndrome.
These antibodies are only present in about 60% of people with Sjögren’s syndrome, so it's possible to have a negative blood test result and still have the condition.
Salivary flow rate
A salivary flow rate test measures how much saliva your glands produce.
You'll usually be asked to spit as much saliva as you can into a cup over a five-minute period. The amount of saliva is then weighed or measured. An unusually low flow rate can indicate Sjögren's syndrome.
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