| Symptom | Questions |
|---|---|
| Oral symptoms | •Does your mouth feel dry? •Do you need liquids to swallow dry foods? •Do you frequently sip/drink water? •Do you have a burning sensation in the mouth? •Do you have painful sores or red patches at the corners of the mouth (angular cheilitis)? •Do you get frequent dental cavities, particularly gumline cavities? •Do your teeth tend to chip, crack, and/or erode on the surfaces? •Do you suffer from gum inflammation or receding gums (gingivitis?) |
| Ocular symptoms | •Do your eyes frequently feel dry, irritated, itchy, or painful? •Do you have a sensation that there might be a foreign body in your eye? •Are your eyes light sensitive? •Do you frequently use eye drops for irritation or dryness? •Is your vision frequently blurry, or do you have unexplained vision changes? |
| Other symptoms | •Have you noticed gland swelling in your face or along the jaw line (swollen parotid and/or submandibular glands)? •Do you suffer dryness of the vagina (is intercourse painful?) or skin (is your skin itchy or flaking?)? •Do your feet, legs, or hands ever feel numb, have a change in sensation, or have burning pain (peripheral neuropathy)? •Do you suffer from extreme fatigue? •Do your joints or muscles ache when you are not sick (arthralgias, myalgias)? •Do you ever notice your fingers turning pale or blue in the cold (Raynaud’s disease)? |
- in collaboration with theConsensus Expert Panel (CEP) Members
At the rheumatologist
Patients suspected of SS should undergo a thorough medical history and physical examination with attention to characteristic features of SS, other systemic rheumatologic autoimmune diseases (eg, systemic lupus erythematosus and rheumatoid arthritis), and conditions that may resemble SS.
Diagnostic testing, including ophthalmologic consultation for an ocular examination, selected blood tests, and other testing, are also important elements of the evaluation.
Many patients do not require diagnostic testing beyond the initial blood tests and examination by an expert in eye disease, although some patients may require formal testing of salivary function, a labial salivary gland biopsy, and/or imaging studies. An oral medicine specialist can facilitate a more comprehensive diagnostic evaluation through assessment of salivary hypofunction and performance of the labial salivary gland biopsy.
- Author:
- Alan N Baer, MD, MACR
- Section Editor:
- Robert Fox, MD, PhD
- Deputy Editor:
- Paul L Romain, MD
AECC criteria The American-European criteria for clinical research.
Please note these criteria were designed for clinical research trials and NOT for diagnosis.They were designed by a group of American and European rheumatologists to be the international criteria for classification of SS i.e. for scientific communication and clinical research. They were not developed for use in routine clinical practice and not every patient who has SS will fulfill the proposed criteria. Unfortunately, for people with SS, many doctors no longer diagnose patients with SS unless they fulfil these criteria.
Four out of the six criteria are required for primary Sjogren's.
These are:
1. Subjective dry mouth
2. Subjective dry eye
3. Abnormal Schirmer test or Rose Bengal / Lissamine green staining
4. Abnormal unstimulated sialometry (or scint)
5. Abnormal lip gland biopsy - focal sialoadenitis
6. Presence of either or both antibodies anti-SSA / SSB
• Salivary gland scintigraphy
• Parotid sialography
• Sialometry
From Classification and diagnosis of Sjögren's syndrome-I
Robert Fox, MD, PhD and Paul Creamer, MD
Seronegative autoimmune diseases.
- persistent symptoms of dry eyes and/or mouth,
- parotid gland enlargement,
- an unexplained increase in dental caries, or
- abnormal results of specific serologic tests (eg, anti-Ro/SSA and/or anti-La/SSB antibodies, rheumatoid factor, and hyperglobulinemia).
