From the Guidelines
Lupus reflex panel and Sjögren's syndrome testing are indicated in patients with suspected autoimmune disorders, particularly when clinical symptoms suggest these specific conditions, as supported by the most recent evidence from 2024 1. For lupus evaluation, an initial ANA (antinuclear antibody) test is typically performed first, with reflex testing for specific antibodies like anti-dsDNA, anti-Smith, and anti-SSA/SSB if the ANA is positive. For Sjögren's syndrome, testing typically includes anti-SSA/Ro and anti-SSB/La antibodies, along with other evaluations like salivary gland function tests or lip biopsies in some cases. These tests should be ordered when patients present with characteristic symptoms:
- for lupus, these include joint pain, skin rashes, photosensitivity, and multi-system involvement;
- for Sjögren's, dry eyes, dry mouth, fatigue, and joint pain are common presentations. Testing is most valuable when interpreted in the context of clinical findings, as positive results alone don't confirm diagnosis. Early testing is beneficial as it can lead to earlier diagnosis and treatment, potentially preventing disease progression and complications, as noted in the management guidelines for Sjögren's syndrome 1. However, these tests should be ordered selectively based on clinical suspicion rather than as routine screening to avoid false positives and unnecessary follow-up, considering the recommendations for monitoring patients with systemic lupus erythematosus 1. The latest classification criteria for Sjögren's syndrome, based on a weighted sum of five items including anti-SSA/Ro antibody positivity and focal lymphocytic sialadenitis, support the importance of targeted testing 1. In clinical practice, the decision to test for lupus or Sjögren's syndrome should be guided by the presence of suggestive symptoms and the potential to improve patient outcomes through early diagnosis and treatment, as emphasized by the preferred practice pattern for dry eye syndrome 1.
From the Research
Indications for Lupus Reflex Panel and Sjogren's Testing
- Lupus reflex panel and Sjogren's testing may be indicated in patients with suspected autoimmune disorders, particularly those with symptoms of systemic lupus erythematosus (SLE) or Sjogren's syndrome (SS) 2, 3.
- The presence of dryness of eye and mouth, positive anti-SSA and anti-SSB antibody in the serum, and abnormal Schirmer's test or biopsy of the minor salivary glands may suggest SS, which can be associated with SLE 2.
- Psychiatric manifestations, such as psychotic disorders, major depressive disorders, and cognitive disorders, can occur in both SLE and SS, and may be an indication for testing 3.
- Cardiovascular reflex tests (CVRTs) may also be abnormal in patients with SLE, indicating autonomic nervous system dysfunction 4.
- Biological therapy, including rituximab and belimumab, may be considered in patients with severe SLE or SS who are refractory to conventional immunosuppressants 5.
- Hydroxychloroquine may be effective in treating primary Sjogren's syndrome, with decreased immunoglobulin levels and improved clinical symptoms 6.
Testing Considerations
- Lupus reflex panel and Sjogren's testing should be considered in patients with suspected autoimmune disorders, particularly those with symptoms of SLE or SS.
- A comprehensive diagnostic workup, including laboratory tests and clinical evaluation, is necessary to confirm the diagnosis of SLE or SS.
- The choice of testing and treatment should be individualized based on the patient's clinical presentation, disease severity, and response to previous treatments.