The diagnosis is based on

• Disease history
• Examinations
• Antibody (SSA) or lip biopsy
• Exclude another disease (Differential diagnoses)

Sickness (* is included in classification criteria)

• Time for:
  • Symptom debut
  • Diagnosis
• * Subjective symptoms of dryness
  • *Eyes
    • Daily dry eyes for at least 3 months or
    • Repeated feeling of debris in the eyes
    • Do you use artificial fog fluid at least 3 daily
  • *Mouth
    • Daily feeling of dry mouth for at least 3 months
    • Must drink often to swallow dry foods

Other symptoms

• Exhaustion / fatigue (despite a lot of sleep)
• Vaginal dryness

• arthralgia / Arthritis
• Muscle pain (some have low grade Myositis with increased CK in serum)
• Parotitis (had swollen parotis or submandibular glands
• Purpura (usually on the legs and arms)
• Sun rash by SSA antibody in blood
• Lung symptoms (Dry cough, dyspnea at stress)
• Kidney stones (Renal tubular acidosis)
• Earlier Lymphoma (non-Hodgkin's lymphoma may be related to Sjøgren's syndrome)

* Investigational Findings

• * Tear production is reduced
  • Schirmers test less than 5mm on at least one of the eyes
  • Staining score (corneal examination by ophthalmologist)
• * Saliva (saliva) production is reduced
  • Dry mouth and drink for dry food
• * Antibody (SSA = Sjøgren's Syndrome A) is present
• * Focus score on salivary gland biopsy (lip) shows at least 1 foci / 4 square millimeter
  • Tongue sticking, sialometry less than 1,5ml / 15min). Vaginal dryness

Other investigations

• Weight (reference for later)
• Palpate:
  • Gland glands
  • Submandibularis glands
  • Lymph nodes on the neck
• Look in the mouth
  • Dry oral mucous membranes
  • Oral candida
  • Bad tooth status

• Heart (rhythm, murmur)
• Lungs (crepitations)
• Blood pressure
• Skin (often dry skin, eczema, purpura)
• Arthritis (Arthritis)
• Neurological (sensibility, neuralgia, movements)

• Schirmer's test (can be performed by a nurse at the rheumatological department)
  • Less than 5mm moisture bilaterally (5mm or lower in just one eye is less specific, but sufficient for classification criteria), more than 10mm is normal
• Sialometry / Unstimulated Saliva Measurement (Can be Performed by Nursing at Rheumatology Department)
  • Do not drink, eat or chew gum last hour before the examination
  • The patient is at ease
  • Measured over 15 min
  • Less than 1,5ml / 15 is pathologically low

Additional investigation that can be considered

Blood tests

• SSA (Sjøgrens Syndrome A, Ro antibody) in high titer (over 240) at most. SSA also occurs at SLE and Myositis (often lower titer) and in many healthy ones
• SSB (Sjøgrens syndrome B, La antibody) occurs with SSA at less than 50%
  • Both SSA and SSB dispose of fetal heart block in fetus in the event of pregnancy
• Sedimentation rate (ESR) often high at high IgG (common)
• CRP (often low)
• TSH, f-T4 (concomitant hypothyroidism),
• Calcium in high values ​​(hyperparathyroid function can cause drowsiness, nausea and pain)
• ALT, creatinine, p-amylase (pancreatitis component), CK (myositite component), electrophoresis, complement factors C3 and C4.

Urine-stix

• To exclude nephritis (more typically by SLE) and glucosuria

Radiological

• CT examination of lungs (matt-glass, fibrosis. cysts: LIP-suspect)
• MRI caput if CNS symptoms (MS-like)

Lymphoma risk at Sjögren's syndrome

Risk factors for non-Hodgkin's lymphoma are, among other things, persistently low number of lymphocytes (leukocytes) in the blood and low complement factors C3 and C4 (reference: Jonsson MW, 2012).

Pregnancy at Sjøgren's syndrome

• An increased risk has been found for miscarriages and premature birth in Sjøgren's syndrome. SSA and SSB antibodies can cause fetal heart block and / or neonatal lupus (rash in the newborn). Please read more about pregnancy at Sjøgrens syndrome here (in Danish)

Doubt if the diagnosis is correct?

• Most (more than 90%) with Sjøgren's syndrome are women
• All (almost) have subjective dryness (sicca phenomena) in the eyes and mouth
• Most have Antibodies SSA / Ro in high titer (severe rash) in the blood
• At high age (more than 80 years) approx. 40% dryness off Another reason (Age-related degeneration of exocrine glands, drugs)
• Differential diagnoses, please see here (in Danish)

Excludes dryness caused by other condition

• IgG4 related disease
• Hepatitis C
• Amyloidosis
• Sarcoidosis
• Earlier radiation therapy to the head or neck

Drugs that can give dryness

• Antidepressants
• Beta-blocker
• Diuretics
• Antihistamines
• Anticolinergic Parkinson's Drugs

Please read about differential diagnoses here

Treatment

• Artificial tear fluid, extra good oral hygiene.
• Rarely needed immunosuppressive drugs

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