Diagnosis

Sjogren's syndrome can be difficult to diagnose because the signs and symptoms vary from person to person and can be similar to those caused by other diseases. Side effects of a number of medications also mimic some signs and symptoms of Sjogren's syndrome.

Tests can help rule out other conditions and help pinpoint a diagnosis of Sjogren's syndrome.

Blood tests

Your doctor might order blood tests to check for:

  • Levels of different types of blood cells
  • Presence of antibodies common in Sjogren's syndrome
  • Evidence of inflammatory conditions
  • Indications of problems with your liver and kidneys

Eye tests

Your doctor can measure the dryness of your eyes with a test called a Schirmer tear test. A small piece of filter paper is placed under your lower eyelid to measure your tear production.

A doctor specializing in the treatment of eye disorders (ophthalmologist) might also examine the surface of your eyes with a magnifying device called a slit lamp. He or she may place drops in your eye that make it easier to see damage to your cornea.

Imaging

Certain imaging tests can check the function of your salivary glands.

  • Sialogram. This special X-ray can detect dye that's injected into the salivary glands in front of your ears. This procedure shows how much saliva flows into your mouth.
  • Salivary scintigraphy. This nuclear medicine test involves the injection into a vein of a radioactive isotope, which is tracked over an hour to see how quickly it arrives in all your salivary glands.

Biopsy

Your doctor might also do a lip biopsy to detect the presence of clusters of inflammatory cells, which can indicate Sjogren's syndrome. For this test, a sliver of tissue is removed from salivary glands in your lip and examined under a microscope.

Treatment

Treatment for Sjogren's syndrome depends on the parts of the body affected. Many people manage the dry eye and dry mouth of Sjogren's syndrome by using over-the-counter eyedrops and sipping water more frequently. But some people need prescription medications, or even surgical procedures.

Medications

Depending on your symptoms, your doctor might suggest medications that:

  • Decrease eye inflammation. Prescription eyedrops such as cyclosporine (Restasis) or lifitegrast (Xiidra) may be recommended by your eye doctor if you have moderate to severe dry eyes.
  • Increase production of saliva. Drugs such as pilocarpine (Salagen) and cevimeline (Evoxac) can increase the production of saliva, and sometimes tears. Side effects can include sweating, abdominal pain, flushing and increased urination.
  • Address specific complications. If you develop arthritis symptoms, you might benefit from nonsteroidal anti-inflammatory drugs (NSAIDs) or other arthritis medications. Yeast infections in the mouth should be treated with antifungal medications.
  • Treat systemwide symptoms. Hydroxychloroquine (Plaquenil), a drug designed to treat malaria, is often helpful in treating Sjogren's syndrome. Drugs that suppress the immune system, such as methotrexate (Trexall), also might be prescribed.

Surgery

A minor procedure to seal the tear ducts that drain tears from your eyes (punctal occlusion) might help relieve your dry eyes. Collagen or silicone plugs are inserted into the ducts to help preserve your tears.

Lifestyle and home remedies

Many Sjogren's syndrome symptoms respond well to self-care measures.

To relieve dry eyes:

  • Use artificial tears, an eye lubricant or both. Artificial tears — in eyedrop form — and eye lubricants — in eyedrop, gel or ointment form — help relieve the discomfort of dry eyes. You don't have to apply eye lubricants as often as artificial tears. Because of their thicker consistency, eye lubricants can blur your vision and collect on your eyelashes, so you might want to use them only overnight.

    Your doctor might recommend artificial tears without preservatives, which can irritate the eyes of people with dry eye syndrome.

  • Increase humidity. Increasing the indoor humidity and reducing your exposure to blowing air can help keep your eyes and mouth from getting uncomfortably dry. For example, avoid sitting in front of a fan or air conditioning vent, and wear goggles or protective eyewear when you go outdoors.

To help with dry mouth:

  • Don't smoke. Smoking can irritate and dry out your mouth.
  • Increase your fluid intake. Take sips of fluids, particularly water, throughout the day. Avoid drinking coffee or alcohol since they can worsen dry mouth symptoms. Also avoid acidic beverages such as colas and some sports drinks because the acid can harm the enamel of your teeth.
  • Stimulate saliva flow. Sugarless gum or citrus-flavored hard candies can boost saliva flow. Because Sjogren's syndrome increases your risk of dental cavities, limit sweets, especially between meals.
  • Try artificial saliva. Saliva replacement products often work better than plain water because they contain a lubricant that helps your mouth stay moist longer. These products come as a spray or lozenge.
  • Use nasal saline spray. A nasal saline spray can help moisturize and clear nasal passages so that you can breathe freely through your nose. A dry, stuffy nose can increase mouth breathing.

Oral health

Dry mouth increases your risk of dental cavities and tooth loss. To help prevent those types of problems:

  • Brush your teeth and floss after every meal
  • Schedule regular dental appointments, at least every six months
  • Use daily topical fluoride treatments and antimicrobial mouthwashes

Other areas of dryness

If dry skin is a problem, avoid hot water when you bathe and shower. Pat your skin — don't rub — with a towel, and apply moisturizer when your skin is still damp. Use rubber gloves when doing dishes or housecleaning. Vaginal moisturizers and lubricants help women who have vaginal dryness.

Preparing for your appointment

Depending on your symptoms, you might start by seeing your family doctor, dentist or eye doctor. But you might eventually be referred to a doctor who specializes in the treatment of arthritis and other inflammatory conditions (rheumatologist).

What you can do

Make a list that includes:

  • Detailed descriptions of your symptoms and when they began
  • Information about your current and past medical problems
  • Information about your parents' or siblings' medical history
  • All medications and dietary supplements you take, including doses
  • Questions you want to ask the doctor

For Sjogren's syndrome, basic questions include:

  • What is likely causing my symptoms?
  • Are there other possible causes?
  • What tests do I need?
  • What treatment approach do you recommend?
  • How soon can I expect my symptoms to improve with treatment?
  • Am I at risk of long-term complications from this condition?
  • I have other health conditions. How can I best manage them together?
  • Do you have brochures or other printed materials that I can have? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including

  • Do your symptoms follow a pattern — worsening throughout the day or when you go outdoors?
  • Do you have chronic conditions such as high blood pressure or arthritis?
  • Have you recently started new medications?
  • Do any close relatives have rheumatoid arthritis, lupus or a similar disease?
Aug. 09, 2017
References
  1. Sjogren's syndrome. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health_info/Sjogrens_Syndrome/sjogrens_syndrome_ff.asp. Accessed May 23, 2017.
  2. Baer AN. Diagnosis and classification of Sjogren's syndrome. https://www.uptodate.com/home. Accessed May 23, 2017.
  3. Sjogren's syndrome. American College of Rheumatology. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Sjogrens-Syndrome. Accessed May 23, 2017.
  4. Sjogren's syndrome. Arthritis Foundation. http://www.arthritis.org/about-arthritis/types/sjogrens-syndrome/. Accessed May 23, 2017.
  5. Sjogren's syndrome. Sjogren's Syndrome Foundation. http://www.sjogrens.org/home/about-sjogrens/symptoms. Accessed May 23, 2017.
  6. Baer AN. Treatment of dry mouth and other non-ocular sicca symptoms in Sjögren's syndrome. https://www.uptodate.com/home. Accessed May 23, 2017.