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Sjogren's syndrome is often misdiagnosed when the symptoms are evaluated separately and a complete diagnostic picture is not considered. For example, the fatigue and joint/muscle pain experienced by many patients with Sjogren's syndrome is often misdiagnosed as fibromyalgia or chronic fatigue syndrome. A variety of other conditions or medications can produce signs and symptoms that may overlap with Sjogren's syndrome and should be considered in the differential diagnosis. These include:

Dry Eye

Conditions which can cause dry eyes include:

• Inflammation (e.g., Stevens-Johnson syndrome, chronic conjunctivitis, blepharitis)
• Medications (e.g. anticholinergics)
• Neurologic conditions that may interfere with tear production
• Amyloidosis - a buildup of amyloid protein in body tissues and organs)
• Sarcoidosis (a rare inflammation of the lymph nodes and other tissue)
• Blink abnormality
• Eyelid scarring
• Trauma to the eye
• Tumors
• Environmental conditions
• Other medical conditions (e.g. autoimmune diseases)

Dry Mouth

Conditions other than Sjogren's syndrome that may cause dry mouth include:

• Viral infections
• Diabetes mellitus
• Amyloidosis
• Sarcoidosis
• Trauma
• Radiation therapy
• Parkinson's disease
• Dehydration
• Infection
• Anxiety

Medications that can cause dry mouth include:

• Antihypertensives (blood pressure medication)
• Parasympatholytic agents
• Psychotherapeutic agents

Parotid Gland Enlargement

In addition to Sjogren's syndrome, other underlying conditions that can cause parotid gland enlargement include:

• Viral infections (e.g., HIV, hepatitis C, mumps)
• Metabolic diseases (e.g., diabetes, chronic pancreatitis, liver cirrhosis)
• Endocrine disorders (e.g., acromegaly or gonadal hypofunction)

Differential diagnosis of Sjogren's syndrome is very important not only for diagnostic purposes but for treatment of systemic aspects of Sjogren's syndrome as well. This is particularly important when considering other autoimmune conditions such as scleroderma, systemic lupus erythematosus, or rheumatoid arthritis, since they can present with nonspecific symptoms that are similar to those of Sjogren's syndrome (e.g., low fever, joint pain, or Raynaud's phenomenon).