DIAGNOSIS
No single gene, microorganism or hormone is known to cause Sjogren's syndrome.
As a result, diagnosis is often difficult. Its symptoms can mimic those of other
diseases, and no two people with Sjogren's syndrome have exactly the same set of
symptoms or medical history. Moreover, individual symptoms may be reported to
different health care professionals-such as dry mouth to the dentist or dry eyes
to an optometrist-so the condition can often go undiagnosed. In fact, the
diagnosis of Sjogren's can take up to five years and an average of three health
care professionals' evaluation. Diagnosis has been further complicated by the
fact that, until publication of the European-American consensus group report in
2002, even experts in this field were unable to agree upon classification
criteria.
Once Sjogren's is suspected, a detailed history and physical exam, blood tests
for autoantibodies, tests to determine the degree of dry eye and mouth, and
sometimes lip biopsies, can point to the presence of Sjogren's.
Symptoms can
include:
Dry mouth. If you have Sjogren's syndrome, you produce far
less saliva than normal. This makes chewing, swallowing and
speaking difficult, and it may diminish your sense of taste as
well as produce halitosis, or bad breath.
Dry eyes. Your eyes may feel dry and gritty-they may also
burn and turn red and be extremely sensitive to sunlight. A thick
substance may accumulate in the inner corner of your eyes while
you sleep. If not properly treated, Sjogren's syndrome can
sometimes lead to ulcers of the cornea. On rare occasions, this
can cause blindness.
Swollen salivary glands. Two sets of major salivary glands
produce saliva. They are located under your tongue and in the
cheeks in front of your ears. They may feel swollen and tender.
This may occur along with a fever. Swollen salivary glands occur
in about one-half of people with the disorder. There are also
minor salivary glands scattered throughout your mouth.
Dental cavities. Saliva fights bacteria and defends against
cavities. If you have Sjogren's syndrome, your saliva will be
decreased and your teeth may develop cavities more easily.
Dry nose, throat and lungs. Your throat feels dry and
tickly, and you may have a dry cough, hoarseness, a decreased
sense of smell and nosebleeds. Sjogren's can also lead to
pneumonia, bronchitis and ear problems.
Vaginal dryness. Because Sjogren's can affect the
mechanisms for secreting vaginal fluids, you may find sexual
penetration difficult.
Fatigue. Sjogren's may cause you to tire more easily, or
feel an underlying fatigue. Fatigue may be due to the underlying
inflammatory process, anemia, hypothyroidism and/or disrupted
sleep. Fatigue is also frequently a symptom of other autoimmune
disorders, such as rheumatoid arthritis or lupus.
Joint pain. If the immune system attack spreads to the
joints, movement of fingers or other joints can become difficult
or painful. Joint involvement may also indicate you have another
autoimmune disorder, such as rheumatoid arthritis or lupus.
Other problems. Sjogren's syndrome can affect other parts
of the body, such as blood vessels, the nervous system, muscles,
skin and other organs. This can lead to muscle weakness, confusion
and memory problems, dry skin and feelings of numbness and
tingling. Sjogren's syndrome can also affect the liver and spleen.
There is also a 40-fold increased risk of developing lymphoma
(cancer of the lymphocytes). Although this is unusual, it is
another reason why medical exams and continued follow-up are
critical.
With such a broad array of symptoms, in varying severity from
patient to patient, diagnosis can be difficult. You and your
health care professional may go through several steps before
confirming the diagnosis of Sjogren's syndrome.
Physical examination. Your health care professional will probably
ask you to describe your symptoms. He or she will then look for
other signs of Sjogren's, such as red, itchy eyes; swollen
salivary glands; a dry, cracked tongue; and enlarged salivary
glands in your neck. You'll also want to discuss what medications
you are taking-both prescription and over-the-counter, as many
medications have anticholinergic effects that may cause dryness of
the mouth and eyes.
Blood tests. Antinuclear antibodies (ANA), antibodies to SS-A/Ro
and SS-B/La and rheumatoid factor may be found in patients with
Sjogren's syndrome. However, not everyone with Sjogren's has these
markers, and not everyone with these markers has Sjogren's
syndrome. Blood tests also gauge liver and kidney function,
inflammation, blood count and blood-sugar levels.
Schirmer test. This helps determine how dry your eyes are. It
involves placing a small piece of filter paper under your lower
eyelid to measure tear production.
Rose Bengal and Lissamine Green: These dyes are used to detect
epithelial defects on the surface of the eye, usually in
conjunction with a slit-lamp examination by an ophthalmologist.
Lip biopsy. In this test, the health care professional removes a
few minor salivary glands from inside your lower lip. The tissue
is examined under a microscope. The appearance of the tissue helps
determine if you have Sjogren's syndrome.
