From the Guidelines
Testing for Sjögren's syndrome should include a combination of blood tests, such as anti-SSA (Ro) and anti-SSB (La) antibodies, antinuclear antibody (ANA), and rheumatoid factor (RF), as well as eye and mouth examinations, and sometimes tissue biopsies, as recommended in the most recent study from 2024 1. When diagnosing Sjögren's syndrome, it is essential to consider the patient's symptoms, such as dry eye and dry mouth, and to evaluate the relative contribution of aqueous production deficiency and evaporative loss of tear volume. Some key points to consider when testing for Sjögren's syndrome include:
- Blood tests: anti-SSA (Ro) and anti-SSB (La) antibodies, antinuclear antibody (ANA), rheumatoid factor (RF), and tests for inflammation markers like ESR and CRP
- Eye examinations: Schirmer's test to measure tear production, and ocular surface staining to assess damage
- Mouth examinations: measuring saliva production and examining salivary glands
- Tissue biopsies: a lip biopsy, where minor salivary glands are examined for inflammatory cells, is often considered the gold standard for diagnosis According to the study from 2024 1, a point-of-care test is available that includes the traditional serology as well as additional biomarkers (salivary protein 1 [SP1], carbonic anhydrase 6 [CA6] and parotid secretory protein [PSP]) for Sjögren’s syndrome. Additionally, the study from 2019 1 provides guidance on the management of patients with Sjögren-related dry eye, including the evaluation of symptoms, determination of the relative contribution of aqueous production deficiency and evaporative loss of tear volume, and the use of objective parameters to stage the severity of dry eye disease. It is also important to note that Sjögren's syndrome can affect multiple organs, and therefore, additional testing may be recommended based on the patient's specific symptoms, as suggested in the study from 2017 1. Overall, early testing and proper treatment can help manage symptoms and prevent complications, and healthcare providers should use a combination of clinical findings, symptoms, and test results to make a diagnosis, as recommended in the most recent study from 2024 1.
From the Research
Sjögren's Disease Testing
- Sjögren's syndrome is a systemic autoimmune disease characterized by dry eyes and dry mouth, and can be classified as primary or secondary 2.
- The diagnosis of Sjögren's syndrome can be challenging and may require coordination with a team of specialists, including dentists, otolaryngologists, rheumatologists, and ophthalmologists 2.
- Anti-SSA/Ro and anti-La/SSB antibodies are hallmark antibodies in primary Sjögren's syndrome, present in 60-70% of patients, and can be useful in diagnosis 3.
- The presence of anti-Ro/SSA and anti-La/SSB antibodies has been associated with an earlier disease onset, glandular dysfunction, and extraglandular manifestations 3.
- The distribution of anti-Ro52-kD/SSA and anti-Ro60-kD/SSA autoantibodies may differ between primary and secondary Sjögren's syndrome patients 4.
Diagnostic Markers
- Anti-Ro/SSA and anti-La/SSB antibodies are important markers for the diagnosis of primary Sjögren's syndrome 3, 4.
- The presence of these antibodies can help identify patients with more active disease and may be associated with extraglandular manifestations 3.
- Other diagnostic markers, such as rheumatoid factor, may also be elevated in patients with Sjögren's syndrome 5.
Testing for Sjögren's Syndrome
- There is no single test for Sjögren's syndrome, and diagnosis may require a combination of clinical evaluation, laboratory tests, and specialist consultation 2.
- Laboratory tests may include ELISA for anti-Ro/SSA and anti-La/SSB antibodies, as well as other autoantibody tests 3, 4.
- Clinical evaluation should include assessment of dry eyes and dry mouth, as well as evaluation for extraglandular manifestations such as fatigue, musculoskeletal pain, and glandular swelling 2, 6, 5.