How Is Sjögren’s Disease Diagnosed?

There is no single test that confirms Sjögren’s disease. Instead, doctors use your medical history, a physical exam, and a series of tests to reach a diagnosis.^1,2

Why is diagnosis hard?

Sjögren’s can be tricky to spot. Its symptoms vary from person to person and look like those of other conditions. Dryness and fatigue can also be caused by other diseases or by drug side effects, which adds to the confusion.¹

Because symptoms do not all appear at once, different doctors may treat each symptom on its own without seeing the bigger picture. An eye doctor may treat dry eye, while a primary care doctor treats joint pain, and neither realizes that a single disease connects them. This is part of why diagnosis can take time.³

Medical history and exam

Diagnosis usually starts with your overall health. Your doctor will ask about your symptoms and take a full medical history. They will also conduct a physical exam to check for signs of dry mouth and dry eyes, and for signs of related diseases such as lupus or rheumatoid arthritis.^2,4

Several types of doctors may be involved. A rheumatologist, a doctor who treats autoimmune and joint diseases, often leads the diagnosis. Your eye doctor or an oral medicine specialist may also run tests.³

Blood and antibody tests

Blood tests are a key part of diagnosis. Your doctor may check for:^1,3

• Sjögren’s antibodies – Two antibodies, called anti-SSA (Ro) and anti-SSB (La), are markers for Sjögren’s. About 70 percent of people with Sjögren’s test positive for anti-SSA, and about 40 percent for anti-SSB. These can also appear in lupus. Patients can also have both antibodies present, which may indicate more severe disease.
• Blood cell counts – These check the levels of different blood cells.
• Signs of inflammation – Tests can look for inflammation in the body.
• Organ function – Blood work can show problems with the liver and kidneys.

Eye tests

Doctors use special tests to measure eye dryness and check for damage:^1,3

• Schirmer tear test – A small piece of filter paper is placed under your lower eyelid to measure how many tears you make.
• Slit-lamp exam – An eye doctor uses a magnifying device to look closely at the surface of your eyes. Dye drops can make damage to the cornea easier to see.
• Dye tests – Certain types of colored dyes highlight dry spots on the eye’s surface.

Salivary and other tests

Other tests look at your salivary glands and tissue:^1,3

• Salivary flow test – This measures how much saliva your mouth makes over a set time.
• Imaging tests – A sialogram is a special X-ray that shows how saliva flows. Salivary scintigraphy uses a small amount of a radioactive tracer to track gland function.
• Salivary gland biopsy – A doctor removes a tiny piece of tissue from the lower salivary glands inside the lower oral mucosa (the membrane lining the inside of the lower lip and cheeks). Under a microscope, clusters of inflammatory cells can point to Sjögren’s.

Getting an answer

Your doctor weighs the results of all these tests, along with your history and exam, to reach a diagnosis. No 2 cases look exactly alike, so the path to a diagnosis is not always the same. If your test results are not clear-cut, that does not rule out Sjögren’s. Some people have the disease even when certain tests are negative. The salivary gland biopsy is the gold standard for testing when serologies come back negative.³

Talk to your doctor

If you have ongoing dryness, fatigue, or joint pain, do not wait to bring it up. Make a list of your symptoms and when they began, and share it with your doctor. Getting the right diagnosis can take time, but it is the first step toward getting adequate care.