Sjogren's syndrome can be difficult to diagnose as the symptoms are similar to those of other health conditions.
Also, 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 make it harder to reach a firm diagnosis.
See your GP if you experience any symptoms of dryness, especially 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 are worried you may have Sjogren's syndrome.
If you answer yes to most of the questions below, you may have Sjogren's syndrome and will probably be advised to go for further testing by your GP.
- Have you had daily, persistent, troublesome dry eyes for more than three months?
- Do you keep having a sensation of sand or gravel 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
Sjogren's syndrome can usually be diagnosed by looking at the results of the screening questions and carrying out a number of clinical tests. These may include:
- the Rose Bengal and Schirmer tests
- a lip biopsy
- blood tests
- salivary flow rate
These are discussed below.
The Rose Bengal and Schirmer tests
These two tests are usually carried out by an ophthalmologist (a doctor who specialises in the treatment of eye conditions).
The Rose Bengal test is used to measure how effective your tear glands are. A non-toxic dye known as Rose Bengal is dropped onto the surface of your eye. The distinctive 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.
In the Schirmer test, small strips of blotting paper are placed under your eyelid. After five minutes, the strips are removed and then studied to see how much of the paper was soaked with tears.
Lip biopsy
During a lip biopsy, a small sample of tissue is removed from your inner lip and examined under a microscope. You will be given an injection of local anaesthetic into the inner surface of your lower lip (which numbs the area), then 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 the presence of Sjogren's syndrome.
Blood tests
Blood tests are carried out to look for special antibodies known as anti-Ro and anti-La (or SS-A and SS-B), which are known to be produced when the immune system has been affected by Sjogren's syndrome.
However, the antibodies are only present in about 60% of patients with Sjogren’s syndrome, so it is possible to have a negative blood test result and still have the condition.
Salivary flow rate
During this test, you are usually asked to spit as much saliva as you can into a cup over a five-minute period. The amount of salvia is then weighed. The test is a good way of measuring how much saliva your glands are producing each minute. An unusually low flow rate can indicate Sjogren's syndrome.
