The diagnosis of Sjögren's syndrome is a complex and multifaceted process that requires the integration of clinical symptoms, laboratory tests, and specialized imaging techniques. Physicians typically begin assessment based on patient-reported symptoms such as dry mouth and dry eyes, followed by objective testing to confirm the diagnosis. Early diagnosis is crucial for preventing organ damage, and thus, multiple diagnostic criteria and assessment tools have been developed in the medical field.
The diagnostic process generally involves three core components: initial symptom screening, objective physiological indicator testing, and exclusion of other similar diseases. International diagnostic standards are continuously updated, with recent emphasis on combining autoimmune markers with histopathological evidence. Patients should actively describe the duration and severity of symptoms, which is vital for physicians to establish an initial evaluation framework.
When first encountering patients, physicians will inquire in detail about the nature and progression of symptoms. Dry mouth must meet the criterion of "persistent for more than 3 months daily and affecting daily eating habits," while dry eyes require ruling out environmental factors such as dry climate. Physical examination includes observing the dryness of oral mucosa, measuring tear production, and assessing for swelling or tenderness of the salivary glands.
During medical history collection, particular attention is paid to family history of autoimmune diseases, as studies show approximately 15-20% of Sjögren's syndrome patients have a familial tendency. Physicians will also evaluate symptoms of other autoimmune diseases, such as joint pain, skin rashes, or fatigue, to exclude conditions like systemic lupus erythematosus or rheumatoid arthritis.
Blood tests are key for diagnosis, primarily detecting autoantibodies such as anti-SSA/Ro, anti-SSB/La, and rheumatoid factor. The positivity rate for anti-SSA can reach 60-70%, but these antibodies can also appear in other autoimmune diseases, so results must be interpreted in conjunction with other tests.
Ophthalmic examinations often use Schirmer's test to measure tear secretion, with less than 5 mm/5 minutes under anesthesia indicating abnormality. Parotid gland imaging can reveal structural changes in the glandular ducts, while salivary flow rate testing quantifies secretion function loss. Recent studies show that ultrasound examination of the parotid glands can detect structural abnormalities and serve as a non-invasive screening tool.
Histopathological examination is an important diagnostic indicator. Lip gland biopsy involves tissue sampling from the lower eyelid to observe lymphocytic infiltration. This procedure should be performed by experienced pathologists to distinguish between Type 1 and Type 2 Sjögren's syndrome based on pathological features.
In 2016, the European League Against Rheumatism (EULAR) recommended a staged diagnostic process, starting with symptom screening tools to filter high-risk groups. Common assessment tools include:
The application of digital health tools is gradually increasing. Some medical institutions have developed symptom tracking apps that record symptom changes in real-time and generate trend analysis charts, assisting physicians in monitoring disease activity.
Distinguishing Sjögren's syndrome from other autoimmune diseases is a key challenge. It is necessary to differentiate primary Sjögren's from conditions like primary biliary cholangitis and systemic lupus erythematosus, which often present with skin rashes and glomerulonephritis. Drug-induced symptoms, such as dry mouth caused by antihistamines, should be ruled out through medication history.
Secondary Sjögren's syndrome often coexists with rheumatoid arthritis or systemic sclerosis. In such cases, other organ involvement indicators should be evaluated. Certain infections like hepatitis or HIV can also cause similar symptoms, requiring viral serology tests to exclude infectious causes.
Special populations require tailored assessment focus: elderly patients may have symptoms influenced by medications, and pediatric patients should consider developmental physiological differences. Physicians should establish individualized diagnostic pathways based on age, symptom duration, and autoimmune markers.
Early detection can effectively prevent irreversible organ damage, such as dental caries and oral infections caused by long-term salivary secretion deficiency, or corneal ulcers due to tear deficiency. Early treatment can slow the progressive atrophy of salivary and lacrimal glands, improving patients' quality of life.
Studies show that it takes an average of 3-5 years from symptom onset to diagnosis, during which the optimal treatment window may be missed. Modern diagnostic standards incorporating imaging examinations have increased diagnostic accuracy to over 85%. Early use of artificial tears and saliva stimulants can significantly improve symptoms and prevent severe complications like keratoconjunctivitis sicca.
A multidisciplinary team (MDT) approach has become a trend, combining expertise from immunology, ophthalmology, and dentistry, which can shorten diagnostic time by 40%. This integrated assessment is especially valuable for patients with atypical symptoms.
Dry mouth can be alleviated by drinking small amounts frequently, chewing sugar-free gum to stimulate saliva, and using artificial tears or tear duct plugs for dry eyes. Avoiding smoking, alcohol, and spicy foods, using humidifiers to maintain environmental humidity, can also reduce symptom frequency.
Does a positive result for autoimmune antibody tests confirm the diagnosis of Sjögren's syndrome?Positive autoimmune antibodies (such as anti-SSA/Ro or anti-SSB/La) are important indicators, but must be combined with salivary flow tests, eye staining examinations (like Schirmer's test), and biopsy results for comprehensive diagnosis. A single positive result cannot confirm the diagnosis alone; it requires physician assessment of the overall symptoms.
What should be noted when Sjögren's syndrome patients undergo radiological examinations?Some patients may need to undergo low-dose radiation for salivary gland imaging or salivary flow tests. It is recommended to inform the physician of their medical history in advance to adjust the examination plan. For long-term medication use, regular monitoring of kidney function and blood indices is advised to avoid interactions with radiation procedures.
How to distinguish symptoms of Sjögren's syndrome from menopausal symptoms?Menopause mainly presents with hot flashes and emotional fluctuations due to hormonal changes, whereas Sjögren's symptoms are more focused on dry mouth and eyes, with significant reductions in saliva and tear secretion, often accompanied by joint pain or internal organ involvement. Diagnosis requires assessment of autoimmune markers and organ function tests.
Can patients with Sjögren's syndrome receive vaccinations during treatment?Most vaccines can be administered normally, but patients on corticosteroids or immunosuppressants should discuss timing with their doctor. Live vaccines (such as varicella or MMR) should be avoided due to the risk of infection with suppressed immune systems. Inactivated vaccines like influenza are recommended annually to prevent complications.
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