Speckled immunofluorescence staining pattern of antinuclear antibodies on HEp-20-10 cells Diagnosing Sjögren's syndrome <unk>  is complicated by the range of symptoms that a patient may manifest, and the similarity between symptoms of Sjögren's syndrome and those of other conditions. Also, patients with<unk>  symptoms approach different specialities for treatment, which can make diagnosis difficult. Since dry eyes and dry mouth are very common symptoms, and frequently occur in people over 40, affected people may believe that the symptoms are age-related, so ignore them. Some medications can cause symptoms similar to those of Sjögren's syndrome. The combination of several tests, which can be done in a series, can eventually diagnose Sjögren's syndrome. Blood tests can be done to determine if a patient has high levels of antibodies that are indicative of the condition, such as antinuclear antibody (ANA) and rheumatoid factor (because Sjögren's syndrome frequently occurs secondary to rheumatoid arthritis), which are associated with autoimmune diseases. Typical<unk>  ANA patterns are<unk> A/Ro and<unk> B/La, of which anti-SSB/La is far more specific; anti-SSA/Ro is associated with numerous other autoimmune conditions, but is often present in<unk> , but aAnti-SSA and anti-SSB tests are frequently not positive in<unk> . The rose bengal test uses a stain that measures state and function of the lacrimal glands. This test involves placing the nontoxic dye rose bengal on the eyes. The dye's distinctive colour helps in determining the state and functioning of tear film and the rate of tear evaporation. Any distinctive colour change can indicate<unk> , but confirming the condition requires many related diagnostic tools. Schirmer's test measures the production of tears: a strip of filter paper is held inside the lower eyelid for five minutes, and its wetness is then measured with a ruler. Producing less than of liquid is usually indicative of<unk> . This measurement analysis varies among people depending on other eye-related conditions and medications in use when the test is taken. A slit-lamp examination can reveal dryness on the surface of the eye. Symptoms of dry mouth and dryness in the oral cavity are caused by the reduced production of saliva from the salivary glands (parotid gland, submandibular gland, and sublingual gland). To check the status of salivary glands and the production of saliva, a salivary flow-rate test is performed, in which the person is asked to spit as much as they can into a cup, and the resulting saliva sample is collected and weighed. This test's results can determine whether the salivary glands are functioning adequately. Not enough saliva produced could mean the person has<unk> . An alternative test is nonstimulated whole saliva flow collection, in which the person spits into a test tube every minute for 15 minutes. A resultant collection of less than is considered a positive result. +Chisholm-Mason grade Grade Lymphocytes 1 Slight infiltrate 2 Moderate infiltrate orless than one focus* 3 One focus* 4 More than one focus* * Focus = an aggregrateof 50 lymphocytes or more. A lip/salivary gland biopsy takes a tissue sample that can reveal lymphocytes clustered around salivary glands, and damage to these glands from inflammation. This test involves removing a sample of tissue from a person's inner lip/salivary gland and examining it under a microscope. On such biopsies, the single most important test result in the diagnosis of the oral component of<unk>  is likely the focus score, which is the number of mononuclear cell infiltrates containing at least 50 inflammatory cells in a 4 mm2 glandular section. The Chisholm-Mason grades are also widely used for salivary gland biopsies (see table). A radiological procedure is available as a reliable and accurate test for Sjögren's syndrome, in the form of a sialogram. A contrast agent is injected into the parotid duct, which opens from the cheek into the vestibule of the mouth opposite the neck of the upper second molar tooth. The test is intended to detect any blockage in the salivary gland ducts (i.e. parotid duct) and the amount of saliva that flows into the mouth. For Sjögren's syndrome, sudomotor function through electrochemical skin conductance may help in the diagnosis process. Sjögren's syndrome can be excluded from people with past head and neck radiation therapy, acquired immunodeficiency syndrome, pre-existing lymphoma, sarcoidosis, graft-versus-host disease, and use of anticholinergic drugs.
Sjögren syndrome
Sjögren–Larsson syndrome
CREST syndrome
Auto-brewery syndrome
Neuro-Behçet's disease
Chilaiditi syndrome
Juvenile dermatomyositis
Tumid lupus erythematosus