From the Guidelines
The diagnostic workup for Sjögren's syndrome should begin with a comprehensive clinical evaluation, focusing on sicca symptoms, followed by specific laboratory and diagnostic tests, as outlined in the latest guidelines from 2024 1. The workup should include initial laboratory testing with antinuclear antibodies (ANA), anti-SSA/Ro and anti-SSB/La antibodies, rheumatoid factor, complete blood count, comprehensive metabolic panel, erythrocyte sedimentation rate, and C-reactive protein.
- Ocular assessment should include Schirmer's test and ocular surface staining with fluorescein or lissamine green to evaluate corneal damage.
- Oral evaluation should include unstimulated salivary flow rate measurement and possibly a lip biopsy to detect focal lymphocytic sialadenitis.
- Additional testing may include salivary gland ultrasonography, sialography, or salivary scintigraphy to assess gland structure and function.
- In cases with systemic manifestations, further testing for organ involvement may be necessary, including pulmonary function tests, neurological evaluation, or kidney function assessment, as suggested by recent studies 1. This comprehensive approach is essential because Sjögren's syndrome is a complex autoimmune disorder that can affect multiple organ systems beyond the exocrine glands, and early diagnosis allows for appropriate management of both glandular and extraglandular manifestations, ultimately reducing morbidity and mortality, and improving quality of life 1. Key diagnostic criteria include the weighted sum of five items: anti-SSA/Ro antibody positivity, focal lymphocytic sialadenitis, abnormal ocular staining score, Schirmer's test result, and unstimulated salivary flow rate, with a total score of ≥4 indicating primary Sjögren's syndrome 1.
From the Research
Diagnostic Workup for Sjögren's Syndrome
The diagnostic workup for Sjögren's syndrome involves a combination of clinical, serological, and histological assessments. The key factors to consider in the diagnostic approach include:
- Clinical features, such as dry mouth and dry eyes symptoms, as well as systemic manifestations 2, 3, 4, 5, 6
- Serological tests, including autoantibodies 2, 5
- Histological assessment, such as salivary gland histopathology 2, 5
- Imaging findings, which may be used to support the diagnosis 3
- Laboratory investigations, which may include tests for inflammatory markers and immune complex formation 3, 5
Classification Criteria
The diagnosis of Sjögren's syndrome is made according to the American College of Rheumatology and European League Against Rheumatism (EULAR) classification criteria 2. These criteria take into account the clinical, serological, and histological features of the disease.
Diagnostic Approach
A comprehensive multidisciplinary approach is essential in diagnosing Sjögren's syndrome, particularly in patients presenting with systemic involvements 4. This approach involves close collaboration with different specialties, including rheumatology, ophthalmology, and oral medicine.
Recent Developments
Recently, new classification criteria and disease activity scores have been developed for Sjögren's syndrome, which can be useful tools in everyday clinical practice 5. Additionally, research has focused on the development of new treatments, including biologic drugs, which may help to control the symptoms and systemic manifestations of the disease 2, 5.