What is the Sjögren's (Sjögren's syndrome) workup?

From the Guidelines

The Sjögren's syndrome workup typically includes a combination of clinical evaluation, laboratory tests, and sometimes specialized procedures, with the most recent and highest quality study 1 suggesting that initial evaluation should include a comprehensive history focusing on sicca symptoms and systemic manifestations. The workup for Sjögren's syndrome is complex and multifaceted, requiring a comprehensive approach to diagnose and manage the condition effectively.

• Initial evaluation should include a comprehensive history focusing on sicca symptoms (dry eyes and dry mouth), as well as systemic manifestations.
• Laboratory testing should include complete blood count, comprehensive metabolic panel, erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, antinuclear antibody (ANA), anti-Ro/SSA and anti-La/SSB antibodies, and immunoglobulin levels.
• Specific Sjögren's-related antibodies (anti-Ro/SSA and anti-La/SSB) are particularly important as they are present in 50-70% of patients.
• Additional testing may include ocular assessment with Schirmer's test (measuring tear production) and ocular surface staining, as well as oral evaluation with salivary flow rate measurement.
• In some cases, minor salivary gland biopsy from the lower lip may be necessary to demonstrate characteristic lymphocytic infiltration, which is considered the gold standard for diagnosis.
• Imaging studies such as salivary gland ultrasonography or sialography may also be helpful, as suggested by 1 and 1. This comprehensive approach is necessary because Sjögren's is a complex autoimmune disorder with variable presentation, affecting multiple organ systems beyond just the exocrine glands, and proper diagnosis requires ruling out other conditions that can cause similar symptoms, as noted in 1, 1, 1, 1, 1, and 1.

From the Research

Sjogrens Workup

The workup for Sjögren's syndrome typically involves a combination of clinical evaluation, laboratory tests, and diagnostic procedures. Some of the key components of the workup include:

• Clinical evaluation: A thorough medical history and physical examination to assess for symptoms of dryness, such as xerostomia and keratoconjunctivitis sicca 2, 3, 4
• Laboratory tests:
  • Serologic testing for antinuclear auto-antibodies (anti-Ro/SSA and anti-La/SSB) and rheumatoid factors 2, 3, 4
  • Sialometry and sialochemistry to assess salivary gland function 5, 6
• Diagnostic procedures:
  • Biopsy of a minor salivary gland to assess for focal lymphocytic infiltration 3
  • Sjögren's syndrome can be diagnosed using a combination of these tests, as well as the patient's medical history and physical examination results 5, 2, 6, 3, 4

Diagnostic Criteria

The diagnosis of Sjögren's syndrome is based on a combination of clinical and laboratory criteria. Some of the key diagnostic criteria include:

• Objective signs and symptoms of dryness, such as xerostomia and keratoconjunctivitis sicca 3
• Characteristic appearance of a biopsy sample from a minor salivary gland 3
• Presence of autoantibodies, such as anti-SS-A 3
• Exclusions to the diagnosis include infections with HIV, human T-lymphotropic virus type I, or hepatitis C virus 3

Classification Criteria

Sjögren's syndrome can be classified as primary or secondary, depending on whether it occurs alone or in association with another autoimmune disease 2, 3, 4. The classification criteria for Sjögren's syndrome have been updated in recent years, and now include a combination of clinical, laboratory, and histological criteria 4.