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• Parotid gland biopsy - performed in the presence of parotid gland swelling where lymphoma may be suspected.
• Dental examination - a careful dental examination by a dentist should be performed to evaluate the presence of rampant tooth decay (dental caries) which may be one of the first signs of dry mouth.

Eye Examination

Tests to evaluate the extent and severity of dry eye include:

• Schirmer test - This test is designed to evaluate the extent of dry eye by measuring the amount of tear production. Patients with Sjogren's syndrome usually produce less than 8 ml of tears over a 5-minute time interval.
• Slit-lamp examination - This test is performed in conjunction with the Rose-Bengal dye test. Rose-Bengal dye is introduced into the conjunctival sac of the eye. After blinking twice, the slit-lamp examination evaluates the cornea for evidence of punctuate keratopathy (corneal irritation) as well as detects destroyed conjunctival tissue which may be due to keratoconjunctivitis sicca (dry eye).

Since keratoconjunctivitis sicca can be associated with other medical conditions, neither of these tests alone is diagnostic for Sjogren's but positive results of both tests combined confirms the diagnosis of Sjogren's syndrome.

Laboratory Studies

Laboratory studies that are performed to determine the presence of important markers of Sjogren's syndrome include:

• Antinuclear Antibodies (ANA) - Approximately 90% of patients with primary Sjogren's syndrome have elevated antinuclear antibodies (ANA) in their blood suggestive of an autoimmune disorder.
• Rheumatoid Factor (RF) - About 60% of patients with primary Sjogren's syndrome have elevated rheumatoid factor (RF) in their blood which is also consistent with an autoimmune disorder. It is important to note that detection of elevated levels of ANA or RF is not specifically diagnostic for Sjogren's syndrome since these substances may also be elevated in a broad range of other autoimmune, inflammatory, or infectious disorders.
• The presence of so-called "Sjogren's antibodies" (Ro/SS-A and La/SS-B) in the blood is more specific for Sjogren's syndrome, however, these antibodies are also detected in a significant number of patients with systemic lupus erythematosus (SLE).
• Immunoglobulin levels - Approximately 80% of patients with Sjogren's syndrome show signs of diffuse hypergammaglobulinemia (abnormally high levels of antibodies in the blood) specifically elevated levels of IgG, IgM, and IgA antibody subtypes.

Other Laboratory Studies

• Complete Blood Count (CBC) - Blood tests for Sjogren's syndrome may reveal several abnormalities including:

  • leucopenia - reduced number of white blood cells
  • thrombocytopenia - reduced number of platelets
  • anemia - reduced number of red blood cells

• Erythrocyte Sedimentation Rate (ESR) - this is elevated for the majority of Sjogren's syndrome patients

• Chest X-ray
• Other tests may be ordered by your doctor depending upon your specific symptoms

Upon diagnosis, the physician may see partial glandular destruction leading to dysfunction of remaining tissue. In addition, evidence of dry eye must be carefully evaluated as it is important to establish if the level of dry eye is compatible with the level of Sjogren's syndrome. Thus the doctor must make sure that the objective signs of dry eye are in agreement with the level of symptoms reported by the patient. In addition, while the lack of saliva may be a prominent symptom reported by the patient, it is not associated with any pain. If the patient complains of pain, other conditions causing dry mouth should be explored.