From the Guidelines
To differentiate between Sjögren's syndrome and Multiple Sclerosis (MS), the most important tests include MRI of the brain and spinal cord, cerebrospinal fluid analysis, anti-Ro/SSA and anti-La/SSB antibodies, and salivary gland assessment. For MS, an MRI with contrast will typically show characteristic white matter lesions disseminated in time and space, while CSF analysis may reveal oligoclonal bands and elevated IgG index 1. For Sjögren's, serological testing for anti-Ro/SSA and anti-La/SSB antibodies is crucial, with positive results strongly supporting Sjögren's, as stated in the latest guidelines from 2024 1.
Some key points to consider when differentiating between these two conditions include:
- The presence of dry eye and dry mouth symptoms, which are characteristic of Sjögren's syndrome 1
- The results of serological tests, such as anti-Ro/SSA and anti-La/SSB antibodies, which can help confirm a diagnosis of Sjögren's syndrome 1
- The presence of white matter lesions on MRI, which is characteristic of MS 1
- The results of CSF analysis, which can help confirm a diagnosis of MS 1
It's also important to note that these conditions can occasionally coexist, so comprehensive testing is essential for accurate diagnosis, especially since both can present with neurological symptoms like fatigue, cognitive issues, and sensory disturbances.
In terms of specific tests to order, the following may be considered:
- MRI of the brain and spinal cord to evaluate for white matter lesions and other characteristic findings of MS 1
- Cerebrospinal fluid analysis to evaluate for oligoclonal bands and elevated IgG index, which can help confirm a diagnosis of MS 1
- Serological testing for anti-Ro/SSA and anti-La/SSB antibodies to help confirm a diagnosis of Sjögren's syndrome 1
- Salivary gland assessment, including minor salivary gland biopsy, to evaluate for focal lymphocytic sialadenitis and other characteristic findings of Sjögren's syndrome 1
- Tests for dry eyes, such as Schirmer's test, and dry mouth, such as unstimulated salivary flow, to evaluate for symptoms of Sjögren's syndrome 1
From the Research
Differential Diagnosis of Sjögren's Syndrome and Multiple Sclerosis
To differentiate between Sjögren's syndrome and multiple sclerosis, several tests can be ordered. The most important ones include:
- CSF examination: to rule out multiple sclerosis 2
- Antibody tests: such as anti-SS-A and anti-SS-B antibodies, which are commonly found in Sjögren's syndrome 2, 3, 4
- Cranial and spinal MRI: to evaluate the presence of lesions in the brain and spinal cord, which can be found in both conditions 2, 5
- Sialography and minor salivary ducts biopsy: to assess the presence of glandular involvement, which is characteristic of Sjögren's syndrome 2
- Tear function tests: such as the Schirmer test and tear film break-up time, to evaluate the presence of dry eye, which is a common symptom of Sjögren's syndrome 3
- Serological tests: for autoantibody biomarkers, such as antinuclear antibody and rheumatoid factor, which can be found in Sjögren's syndrome 3, 4
Laboratory Tests
Laboratory tests can help differentiate between Sjögren's syndrome and multiple sclerosis. Some of the useful tests include:
- Anti-SS-A and anti-SS-B antibodies: which are commonly found in Sjögren's syndrome 2, 3, 4
- Antinuclear antibody: which can be found in both conditions, but is more commonly associated with Sjögren's syndrome 3, 4
- Rheumatoid factor: which can be found in Sjögren's syndrome, but is not specific for the condition 3
- Newer biomarkers: such as autoantibodies to salivary gland protein-1, parotid secretory protein, and carbonic anhydrase VI, which may allow for earlier diagnosis of Sjögren's syndrome 3
Imaging Studies
Imaging studies can also help differentiate between Sjögren's syndrome and multiple sclerosis. Some of the useful studies include: