Embarrassing Illnesses

 When to seek medical advice

Sjogren's syndrome can be challenging to diagnose as the symptoms can be wide ranging and are shared by other health conditions.

The task is often made more difficult, as you may visit different health professionals with different symptoms. For example, a dentist with symptoms of a dry mouth, an optician with symptoms of dry eyes, and a gynaecologist with symptoms of a dry vagina.

Screening questions for Sjogren's syndrome

Experts in the field have come up with a series of screening questions, which may be useful if you are concerned that you may have Sjogren's syndrome.

If you answer yes to the majority of the questions you may have Sjogren's syndrome and should ask your GP for further testing (see below for more details). The questions are reproduced below.

• Have you had daily, persistent, troublesome dry eye for more than three months?
• Do you have a recurrent sensation of sand or gravel in your eye?
• Do you have to use eye-drops containing tear substitutes more than three times a day?
• Have you had a daily feeling of dry mouth for more than three months?
• Have you had recurrently or persistently swollen salivary glands?
• Do you frequently drink liquids as an aid in swallowing food?

Further testing

Sjogren's syndrome can usually be diagnosed by looking at the results of the screening questions and by carrying out a number of clinical tests. These tests are explained below.

The Rose Bengal and Schirmer tests

These two tests are usually carried out by an ophthalmologist. An ophthalmologist is a doctor who specialises in the treatment of eye conditions.

The Rose Bengal test is used to measure how effective your tear glands are. In this test a non-toxic dye known as Royal Bengal is dropped on the surface of your eye. The distinctive colour of the dye allows the ophthalmologist to see how well your tear film is functioning and how long it takes for your tears to evaporate.

An alternative to the Rose Bengal test is the Schirmer test. In this test, small strips of blotting paper are placed under your eyelid. After five minutes, the strips are removed and then studied to see how much of the paper was soaked.

Lip biopsy

During a lip biopsy, a small sample of tissue is removed from the salivary glands in your lip and then examined under a microscope. Clusters of lymphocytes in the tissue can indicate the presence of Sjogren's syndrome.

Blood tests

Blood tests are carried out to look for special cells known as anti-Ro and anti-La, which are known to be produced when the immune system has been affected by Sjogren's syndrome.

Salivary flow rate

During this test you are usually asked to spit as much saliva as you can into a cup during a five minute period. The amount of salvia is then weighed. The test is a good way of measuring how much saliva your glands are producing per minute. An unusually low flow rate can indicate the presence of Sjogren's syndrome.