MedifocusHealth

A thorough diagnostic evaluation for patients with suspected Sjogren's syndrome usually includes the following:

• Patient history
• Physical examination
• Oral examination
• Eye examination
• Laboratory studies
• Other studies

Patient History

A detailed patient history is crucial in the diagnostic "work-up" for Sjogren's syndrome. Information gathered by the doctor usually includes:

• History of symptoms - oral changes, ocular changes, fatigue, anxiety, joint or muscle pain
• Duration and pattern of symptoms
• Medications that the patient is presently taking that may cause similar symptoms
• History of other comorbid conditions

Physical Examination

The physical examination relating to the diagnosis of Sjogren's syndrome is very important because it may reveal certain important aspects of the disease, including:

• Salivary gland enlargement
• Regional lymph node swelling and tenderness
• Severely cracked lips
• Ulceration of the tongue
• Smooth tongue with atrophy of the papillae (taste buds)
• Halitosis - bad breath
• Pooling of saliva in the floor of the mouth
• Appearance of the eyes (e.g., red, watery)
• Excess production of mucus in lower part of eyes

Oral Examination

Studies that are performed to evaluate the extent and severity of oral symptoms in order to reach a diagnosis of Sjogren's syndrome include:

• Sialometry - this is a test which measures salivary flow rate. Collection devises are placed over the various salivary glands while saliva flow is stimulated with citric acid. It evaluates stimulated and unstimulated saliva flow rates for a set period of time. A flow rate of 0.5L or less in 1 minute for stimulated saliva, or a flow rate of 0.5L or less in 5 minutes for unstimulated saliva is indicative of xerostomia (reduction of salivary production). This test cannot, however, distinguish between the various possible causes of xerostomia.
• Parotid sialography - This is a radiographic evaluation of the salivary duct system and reveals any gross distortions of the parotid ductules such as a stone or a mass. An iodine containing contrast material is introduced into the ductal system and the distribution pattern of the contrast dye through the salivary ducts is observed.
• Salivary (parotid) gland scintigraphy - This test is used to measure the timed uptake and excretion of a radioactive compound (technetium) by the major salivary glands and is a sensitive indicator of salivary gland function. It is also known as radionuclide imaging. In patients with Sjogren's syndrome, the uptake of the radioactive technetium compound is delayed and excretion into the oral cavity may not be noted at all.
• Minor salivary gland biopsy (also called lip gland biopsy) - A biopsy sample of the minor salivary glands of the lower lip is obtained and is examined under a microscope to measure the extent of mononuclear cell infiltration. A Focus Score of 1 or higher, reflecting an aggregate of at least 50 mononuclear cells per 4 mm, is considered to be consistent with Sjogren's syndrome. This is a highly specific test for the components of saliva in Sjogren's syndrome patients and was in the past the "gold standard" technique used to diagnose Sjogren's syndrome (diagnostic criteria have since changed; see below). It may cause temporary soreness but healing is rapid with no significant scarring.