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Diagnosis of Sjögren's Syndrome

Author: Shelley Ensz. Scleroderma is highly variable. See Types of Scleroderma. Read Disclaimer
Overview
Antibodies
Biomarkers
Nailfold Capillaroscopy
Salivary Gland Biopsy
Schirmer's Test
Slit Lamp Test
Ultrasonography of Glands

Overview

Typical diagnostic tests for Sjögren's include Schirmer's eye test, slit-lamp test, tests measuring saliva flow, radiologic salivary scans, and salivary gland biopsy.

Beta-2 Microglobulin in Whole Unstimulated Saliva (sB2M) Can Effectively Distinguish Between Sjögren’s Syndrome (SS) and Non–Autoimmune Sicca Symptoms. In our setting, sB2M effectively distinguished between SS patients and non–autoimmune sicca symptoms and including sB2M in our conventional diagnostic arsenal may assist in the evaluation of patients in whom SS is suspected. Archives of Rheumatology, 06/08/2017.

Bone Mineral Density (BMD) in Sjögren Syndrome (pSS) Patients with and Without Distal Renal Tubular Acidosis (dRTA). Patients with dRTA had similar BMD compared with patients without dRTA. PubMed, Calcif Tissue Int, 2016 Jun;98(6):573-9.

Antibodies

Identification of a novel autoantibody against self–vimentin specific in secondary Sjögren's syndrome (sSS). This novel autoantibody is highly specific in the diagnosis of sSS, and the underlying molecular mechanism of the disease might be epitope spreading involved with vimentin. PubMed, Arthritis Res Ther, 2018 Feb 12;20(1):30.

Antibodies to aquaporins (AQPs) are frequent in patients with primary Sjögren’s syndrome (SS). Antibodies to AQPs (especially to AQP8 and AQP9) are frequent in SS patients and the likely important role of AQPs in salivary gland secretions justifies further research. Rheumatology, 08/31/2017.

New study to investigate how good antibodies go bad. New research aims to re–examine whether IgM, a seemingly harmless antibody, is pathogenic, or capable of causing disease. University at Buffalo News Center, 01/13/2016.

Antibodies to interferon-inducible protein-16 in primary Sjögren's syndrome are associated with markers of more severe disease. Anti-IFI16 antibodies are a prominent specificity in primary SS and are associated with markers of severe disease. PubMed, Arthritis Care Res (Hoboken), 06/02/2015.

Biomarker

The Potential Role for Early Biomarker Testing as Part of a Modern, Multidisciplinary Approach to Sjögren's Syndrome Diagnosis. Timely diagnosis of SS requires appropriate clinical vigilance for potential SS symptoms, referral and collaborative communication among rheumatology, ophthalmology, and oral care professions, and proactive differential work–up that includes both physical and laboratory evaluations. PubMed, Adv Ther. 2017 Apr;34(4):799-812.

High fidelity between saliva proteomics and the salivary glands' biological state defines biomarker-signatures for primary Sjögren's syndrome (SS). The SS-related molecular landscape conveyed by saliva showed great congruence with histopathology features evoked by SS and advances understanding of this disease at a molecular level. PubMed, Arthritis Rheumatol, 2015 Apr;67(4):1084-95.

Nailfold Capillaroscopy

Nailfold capillaroscopic findings in primary Sjögren's syndrome with and without Raynaud's phenomenon and/or positive anti-SSA/Ro and anti-SSB/La antibodies. Patients with RP associated with PSS had more dilated capillaries, but neither pericapillary haemorrhages nor capillary thrombosis was observed. PubMed, Rheumatol Int, 11/23/2015. (Also see Diagnosis of Primary Raynaud's using Nailfold Capillaroscopy)

Salivary Gland Biopsy

Clinical characteristics and biopsy accuracy in suspected cases of Sjögren’s syndrome (pSS) referred to labial salivary gland biopsy, Labial salivary gland biopsy has high sensibility, specificity, positive and negative predictive values for diagnosis of pSS. PMC, BMC Musculoskelet Disord, 2015; 16: 30.

Schirmer's Test for Diagnosis of Sjogren's Syndrome

Schirmer's Test. This is also known as a dry eye test, a tear test, or a tearing test. The Schirmer's test determines whether the eye produces enough tears to keep it moist. Paper strips are inserted under the eyelid. Before the test, you may be given numbing eye drops to prevent tearing due to the irritation from the paper. Most often, the eyes are closed for about 5 minutes. Medline Plus, NIH.

Slit Lamp Test

Slit Lamp Examination. The slit lamp exam uses an instrument that provides a magnified, three-dimensional (3-D) view of the different parts of the eye. During the exam, your health professional can look at the front parts of the eye, including the clear, outer covering (cornea), the lens, the colored part (iris), and the front section of the gel-like fluid (vitreous gel) that fills the large space in the middle of the eye. WebMD.

Ultrasonography of Glands

Scoring hypoechogenic areas in one parotid and one submandibular gland increases feasibility of ultrasound in primary Sjögren's syndrome. Ultrasound examination of the parotid and submandibular glands on one side is sufficient to predict classification of patients according to the ACR–EULAR criteria. PubMed, Ann Rheum Dis, 12/11/2017.

Diagnostic properties of ultrasound of major salivary glands in Sjögren's Syndrome: a meta-analysis. The quality of current studies is low, thus not allowing to judge the likelihood of salivary gland ultrasonography as a reliable and practical tool in diagnosing Sjögren's Syndrome. PubMed, Oral Dis, 05/18/2015.

Salivary Gland Ultrasonography (US) as a Diagnostic Tool for Secondary Sjögren Syndrome (sSS) in Rheumatoid Arthritis (RA). Salivary gland US may aid the diagnosis of sSS in patients with RA. PubMed, J Rheumatol, 05/01/2015. (Also see Rheumatoid Arthritis in Overlap)

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