Sjogren's Syndrome (cont.)
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Catherine Burt Driver, MD
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
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How do health care professionals diagnose Sjögren's syndrome?
The diagnosis of Sjögren's syndrome involves noting criterion such as dryness of the eyes and mouth. Significant dryness of the eyes can be determined in the doctor's office by testing the eye's ability to wet a small testing paper strip placed under the eyelid (Schirmer's test using Schirmer tear test strips). More sophisticated testing can be done by an eye specialist (ophthalmologist).
Sjögren's syndrome salivary glands can become larger and harden or become tender. Salivary-gland inflammation can be detected by radiologic nuclear medicine salivary scans. Also, the diminished ability of the salivary glands to produce saliva can be measured with salivary flow testing. The diagnosis is strongly supported by abnormal findings of a biopsy of salivary-gland tissue.
The glands of the lower lip are occasionally used for a biopsy sample of the salivary-gland tissue in the diagnosis of Sjögren's syndrome. The lower lip salivary-gland biopsy procedure is performed under local anesthesia with the surgeon making a tiny incision on the inner part of the lower lip to expose and remove a sample of the tiny salivary glands within.
Patients with Sjögren's syndrome typically produce a variety of extra antibodies against body tissues (autoantibodies). These can be detected through blood testing and include antinuclear antibodies (ANA), which are present in nearly all patients. Typical antibodies that are found in most, but not all patients, are SS-A and SS-B antibodies (Sjögren's syndrome A and B antibodies, also known as anti-Ro and anti-La antibodies), rheumatoid factor, thyroid antibodies, and others. Low red blood count (anemia) and abnormal blood levels of markers of inflammation (sedimentation rate, C-reactive protein) are seen.
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