The diagnosis of Sjögren's syndrome is a complex and multifaceted process that requires the integration of clinical symptoms, laboratory tests, and specialized imaging techniques. Physicians typically begin their assessment with the patient's reported symptoms of dry mouth and dry eyes, followed by objective tests to confirm the diagnosis. Early diagnosis is crucial for preventing organ damage, which has led the medical community to develop various diagnostic criteria and assessment tools.
The diagnostic process generally includes three core components: preliminary symptom screening, objective physiological indicator testing, and the exclusion of other similar diseases. International diagnostic standards are continually updated, with recent emphasis on integrating autoimmune indices and histopathological evidence. Patients should actively describe the duration and severity of their symptoms, which is vital for physicians to establish a preliminary assessment framework.
When physicians first encounter patients, they will inquire in detail about the nature and progression of symptoms. The dry mouth symptom must meet the standard of "persisting for more than 3 months daily and affecting daily diet," while dry eyes must rule out environmental factors such as dry climates. During the physical examination, the degree of dryness of the oral mucosa, tear secretion volume, and the assessment of swelling or tenderness of the salivary glands will be observed.
The medical history collection phase will particularly focus on the family history of autoimmune diseases, as studies show that about 15-20% of patients with Sjögren's syndrome have a familial tendency. Physicians will simultaneously assess symptoms of other autoimmune diseases, such as joint pain, skin rashes, or fatigue, to exclude related diseases like systemic lupus erythematosus or rheumatoid arthritis.
Blood tests are a key step in diagnosis, primarily testing for autoimmune antibodies such as anti-SSA/Ro, anti-SSB/La, and rheumatoid factor. The positivity rate for anti-SSA can be as high as 60-70%, but it should be noted that these antibodies may also appear in other autoimmune diseases, thus requiring integration with other test results.
Ocular examinations often use the Schirmer test to measure tear secretion volume; a tear secretion volume of less than 5 millimeters in 5 minutes without anesthesia is considered abnormal. Sialography can reveal changes in the ductal structure of the glands, while salivary flow rate tests can quantify the degree of secretory function loss. Recent studies have shown that ultrasound examination of salivary gland structural abnormalities can serve as a non-invasive screening tool.
Histopathological examination is an important indicator for definitive diagnosis, with lip gland biopsy requiring tissue extraction from the lower eyelid to observe the degree of lymphocytic infiltration. This examination must be evaluated by an experienced pathologist to distinguish between the pathological features of type I and type II Sjögren's syndrome.
In 2016, the European League Against Rheumatism (EULAR) recommended a staged diagnostic process, initially filtering high-risk groups through symptom screening tools. Commonly used assessment tools include:
The application of digital health tools is gradually becoming popular, with some medical institutions developing symptom tracking apps that can record symptom changes in real-time and generate trend analysis charts to assist physicians in monitoring disease activity.
Differentiating from other autoimmune diseases is a key diagnostic challenge. It is necessary to distinguish from primary biliary cholangitis and the dry mouth symptoms of systemic lupus erythematosus, which are usually accompanied by rashes and glomerulonephritis. Symptoms induced by medications, such as dry mouth caused by antihistamines, must be ruled out through medication history.
Secondary Sjögren's syndrome is often comorbid with rheumatoid arthritis or systemic sclerosis, at which point other organ involvement indicators need to be assessed. Certain infections, such as hepatitis or HIV, may also lead to similar symptoms, necessitating serological tests to exclude infectious sources.
Diagnosis in special populations requires adjustments in assessment focus: elderly individuals may misinterpret symptom severity due to medication effects, while pediatric patients must consider physiological differences related to developmental stages. Physicians need to establish individualized diagnostic pathways based on age, symptom duration, and autoimmune indices.
Early detection can effectively prevent irreversible organ damage, as prolonged insufficient salivary secretion can lead to dental caries and oral infections, while lack of tears may induce corneal ulcers. Early treatment can delay the progressive atrophy of salivary and lacrimal glands, improving the quality of life for patients.
Research shows that the average time from symptom onset to diagnosis is 3-5 years, during which the golden treatment window may be missed. The updating of modern diagnostic standards has incorporated imaging examinations, increasing the diagnostic accuracy to over 85%. Early use of artificial tears and salivary stimulants can significantly improve symptoms and prevent progression to severe complications such as dry eye syndrome.
The multidisciplinary diagnostic team (MDT) model has become a trend, combining expertise from immunology, ophthalmology, and dentistry, which can shorten the diagnostic time by 40%. This integrated assessment is particularly valuable for patients with atypical symptoms.
Dry mouth can be alleviated by drinking small amounts frequently, chewing sugar-free gum to stimulate saliva production, and using artificial tears or punctal plugs to relieve dry eyes. Avoiding smoking, alcohol, and spicy foods, as well as using a humidifier to maintain environmental humidity, can also reduce the frequency of symptom flare-ups.
If the autoimmune antibody test for Sjögren's syndrome is positive, does that mean a definitive diagnosis?Positive autoimmune antibodies (such as anti-SSA/Ro or anti-SSB/La) are important indicators, but they must be interpreted in conjunction with salivary flow rate tests, ocular staining tests (such as the Schirmer test), and tissue biopsy results. A single positive result cannot confirm a diagnosis on its own; a comprehensive assessment of overall symptoms by a physician is necessary.
What precautions should Sjögren's syndrome patients take when undergoing radiological examinations?Some patients may need to undergo low-dose radiation for sialography or salivary flow rate tests, so it is advisable to inform the physician of their medical history in advance to adjust the examination plan. If long-term medication is required, regular monitoring of kidney function and blood indicators should be conducted to avoid interactions between medications and radiological examinations.
How can Sjögren's syndrome symptoms be distinguished from menopausal symptoms?Menopausal symptoms primarily manifest as hot flashes and mood swings due to hormonal changes, while Sjögren's syndrome symptoms are more focused on dryness of the mouth and eyes, with significant reductions in saliva and tear production, and may accompany joint pain or visceral involvement. Diagnosis requires differentiation through autoimmune indices and organ function tests.
Can patients with Sjögren's syndrome receive vaccinations during treatment?Most vaccines can be administered normally, but the timing of vaccination should be discussed with a physician when using steroids or immunosuppressants. Live vaccines (such as varicella or measles vaccines) should be avoided, as a suppressed immune system may increase the risk of infection. Inactivated vaccines such as the flu vaccine are recommended annually to prevent complications.
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