Diagnosis of Sjögren’s Syndrome

There is no single test for Sjögren’s syndrome, so doctors will typically ask about your symptoms and conduct a series of tests to diagnose the disorder. A rheumatologist (a specialist in autoimmune diseases) may diagnose the disease. However, an ophthalmologist (eye doctor) or a dentist may also perform certain tests to help make the diagnosis. The diagnosis is based on how well the tear and salivary glands are working and whether there is evidence of autoimmunity.

To diagnose Sjögren’s syndrome, your doctor may ask about your medical history, including about dryness in your eyes and mouth, such as when it started and whether you feel it every day. Your doctor may also order the following tests.

• Eye tests to see if you produce a normal amount of tears, and to find out if there has been any damage to your eyes due to dryness.
• Salivary gland tests can measure how much saliva your mouth produces. Ultrasound imaging and biopsy can help determine if the salivary gland tissues are altered by inflammation.
• Blood tests can identify antibodies that are typically present in people with Sjögren’s syndrome and other autoimmune disorders. While the presence of these antibodies can help doctors diagnose Sjögren’s syndrome, this alone cannot diagnose the disorder because these antibodies may be present in healthy individuals and people with other disorders as well.

Your doctor may order other laboratory or imaging tests to determine if another disease or problem is causing your symptoms.

Treatment of Sjögren’s Syndrome

There is no cure for Sjögren’s syndrome, so treatment focuses on relieving symptoms and preventing complications. Treatments are different for each person and will depend on which parts of your body are affected. Your treatment plan will likely include a combination of self-management approaches and over-the-counter and prescription medications. Be sure to tell your doctor which medications you are currently taking because some make eye and mouth dryness worse.

Eye Treatments

• Eye drops (artificial tears). There are many different types of eye drops, and you may have to try a few to find the one that works best for you. Some people need prescription eye drops that contain medications to suppress the immune system and reduce inflammation in the eye.
• Eye ointments. These are thicker than eye drops and keep the eyes wet for several hours. They can blur your vision, so most people use them while they sleep.
• Plugs to block the tear ducts. Small plugs placed in the tear duct in the corners of the eyes block drainage and keep tears in the eyes longer. The procedure only takes a few minutes and is done in an ophthalmologist’s (eye doctor’s) office.

Mouth Treatments

• Artificial saliva. Using a saliva substitute prescribed by a doctor helps to make the mouth feel wet.
• Saliva production stimulators. These medications cause salivary glands to make more saliva. These medications also stimulate tear production.
• Anti-fungal medications. These medications treat fungal infections, such as candidiasis (also called thrush), which are more common in people with dry mouths.

Treatments for Other Problems Related to Sjögren’s Syndrome

• Over-the-counter or prescribed pain relievers. These medicines alleviate joint and muscle pain, and discomfort from swollen glands.
• Disease-modifying anti-rheumatic drugs (DMARDs) and anti-malarial drugs are often prescribed in people with joint pain, rashes, and other serious effects of the disease. While these medicines have not specifically been approved for Sjögren’s syndrome, they may be helpful in some people with the disorder.
• Corticosteroids. These medications help control inflammation and pain. Because they are potent drugs, your doctor will prescribe the lowest dose possible to achieve the desired benefit. They are usually reserved for people with rare, serious effects of the disorder.
• Acid reflux medications. Reduced saliva production may raise the stomach’s acidity in people with Sjögren’s syndrome. Some people may take these medicines to counteract this effect.

Who Treats Sjögren’s Syndrome?

Sjögren’s syndrome is primarily treated by:

• Rheumatologists, doctors who treat diseases of the joints, muscles, and bones. Rheumatologists are also specialists in autoimmune diseases.

Other specialists who may be involved in your care include:

• Dentists, who care for your gums and teeth.
• Mental health professionals, who can help people cope with difficulties in the home and workplace that may result from their medical conditions.
• Nephrologists, who treat kidney disease problems. 
• Neurologists, who specialize in treating diseases of the nervous system, which includes the brain and spinal cord.
• Ophthalmologists, who specialize in the care of the eyes.
• Otolaryngologists, who specialize in caring for the ears, nose, and throat.
• Primary care doctors, such as family physicians or internal medicine specialists, who coordinate care between the different health care providers and treat other problems as they arise.
• Pulmonologists, who specialize in treating diseases of the lungs.