Diagnostic Approaches to Sjögren’s Syndrome: a Literature Review and Own Clinical Experience

Abstract

ObjectivesThe purpose of present paper is to critically address the recent advances on diagnostic procedures of Sjögren's syndrome, taking into account the attained local and systemic features of the disease.Material and MethodsA comprehensive review of the available literature regarding to the diagnostic approaches to Sjögren's syndrome was conducted. Eligible studies were identified by searching the electronic literature PubMed, Medline, Embase, and ScienceDirect databases for relevant reports (last search update January 2012) combining the MESH heading term "Sjögren's syndrome", with the words "diagnosis, diagnostic procedures, salivary gland function, ocular tests, histopathology, salivary gland imaging, serology". The authors checked the references of the selected articles to identify additional eligible publications and contacted the authors, if necessary.ResultsPresented article addresses the established diagnostic criteria for Sjögren's syndrome and critically evaluates the most commonly used diagnostic procedures, presenting data from author's own clinical experience. Diagnostic criteria for Sjögren's syndrome are required both by healthcare professionals and patients, namely in order to provide a rational basis for the assessment of the symptoms, establish an individual disease prognosis, and orientate the therapeutic intervention.ConclusionsSjögren's syndrome is quite a common autoimmune disease of which the diagnosis and treatment are not easily established. Due to its systemic involvement, it can exhibit a wide range of clinical manifestations that contribute to confusion and delay in diagnosis. The use of proper diagnostic modalities will help to reduce the time to diagnosis and preserve the health and quality of life of patients with Sjögren's syndrome.

Making the diagnosis of Sjögren’s syndrome in patients with dry eye

“…The clinical work-up of SS typically involves a variety of tests, including tear function tests, serological tests for autoantibody biomarkers, minor salivary gland biopsy, lacrimal gland biopsy, systemic endocrine findings, and tests of salivary function (biscuit test, sialography). 16 , 32 , 51 – 55 Questionnaires are of some value for the assessment of dry eye etiology, 31 , 56 although questionnaires alone are insufficient to confirm a diagnosis of SS. The 5-item Dry Eye Questionnaire was validated in 2010; scores >6 indicate dry eye, and scores >12 may suggest further testing to rule out SS ( Figure 3 ).…”

“…Early diagnosis and treatment of SS is essential to prevent or mitigate development of complications such as cerebrovascular events and myocardial infarction. 12 , 15 , 16 , 19 – 22 Unfortunately, dry eye symptoms are very non-specific, especially in the immediate absence of other SS-related complaints or findings. In a recent US survey of eye care specialists, most practitioners reported relying primarily on patient history to guide treatment decisions.…”

The Potential Role for Early Biomarker Testing as Part of a Modern, Multidisciplinary Approach to Sjögren’s Syndrome Diagnosis

“…Early diagnosis and treatment of SS can be an 15,26,31,33,34]. Delayed diagnosis can also lead to psychological distress associated with unexplained symptoms [26].…”

“…Data show that patients have symptoms for an average of 3.9 years before being diagnosed with SS [9], and it has been estimated that more than half of adults with SS are undiagnosed [7,10,30]. There are many factors that add to the difficulty of diagnosing SS, including variable expression of ocular and non-ocular symptoms, symptoms that do not always present at the same time, and slow disease progression [7,10,31,32].…”

Association between Sjogren's Syndrome and Respiratory Failure: Put Airway, Interstitia, and Vessels Close Together: A National Cohort Study

“…The initial manifestations of SS may include asthma, COPD [29] , or pneumonia [20] , [21] , which may contribute to the diagnosis of SS [20] , [21] , [47] . Concurrently, the subclinical manifestations of SS may delay the diagnosis [23] , [43] , [48] . Thus, the initial symptoms of primary SS can be overlooked or misinterpreted easily, and diagnosis can be delayed for several years.…”