The doctor needs to take a good history, seeking out features of dryness. The physical examination is helpful looking at the eyes and the mouth and observing whether they are dry, red and irritated and the skin is dry. A specialist eye examination is valuable and occasionally kidney and lung function tests are needed. Dry mouth and eyes alone may result from aging, medication or a condition known as Amyloidosis.
Blood tests provide pointers to Sjögren’s syndrome; however, by themselves they do not make the diagnosis. A full blood count may be helpful. Some patients are mildly anaemic, the white cell count may be reduced and the erythrocyte sedimentation rate (ESR) is usually elevated. Measuring your antibody levels may be useful. Commonly patients with Sjögren’s syndrome have high levels of serum autoantibodies. Antinuclear antibodies occur not only in lupus, but also in patients with Sjögren’s syndrome. There are some more specialised types of antinuclear antibodies- SSA and SSB antibodies. These are typically found in patients with Sjögren’s syndrome.
An eye examination is very helpful and can be performed by your family doctor without needing a specialised ophthalmologist. The Schirmir filter paper test provides a crude measure of tear production and is a useful screening test for people with Sjögren’s syndrome. Normal people wet the filter paper very rapidly, but in Sjögren’s syndrome even after five minutes the filter paper may be dry. An ophthalmologist may perform the SLIT LAMP EXAMINATION where a special lamp scans the surface of the eye and identifies abnormalities of secretion or of the cornea. Ophthalmologists also perform the Rose Bengal test. This is a dye that is put into the eye that identifies mucous material in a pattern characteristic of Sjögren’s syndrome. Some people find it a bit irritating but it is not harmful. A lip biopsy may be taken under local anaesthesia to sample the salivary glands. Examination of the biopsy sample under the microscope shows collections of white cells and damage to the glands in people with Sjögren’s syndrome.