Sjögren’s Syndrome – Diagnosis | Johns Hopkins

Sjögren’s Syndrome – Diagnosis | Johns Hopkins


(uplifting music) – So, I think the first
step is for a rheumatologist to recognize that the patient might have symptoms suggesting Sjogren’s syndrome. The cardinal symptoms are dryness, dryness of the eyes, dryness of the mouth, but they also may present in other ways. Some patients actually present it with a neurologic problem. Some patients present it with
an internal organ problem, such as the kidney for instance, and it’s only as one does the
evaluation that one realizes that Sjogren’s syndrome
is actually underlying this particular internal organ problem, but it’s primarily the
dryness of the eyes and mouth that leads someone to think
first about Sjogren’s syndrome. Once that suspicion is there, then a rheumatologist will
often due blood tests, looking for characteristic antibodies that are seen in the majority of patients, but not everybody with Sjogren’s syndrome, and in those patients, we
often have to do other tests to confirm a diagnosis. So, the diagnosis requires
that we partly confirm that, in fact, there is a deficiency of tear and saliva production, doing special tests of the
eyes, doing special measurements of how much saliva is being produced, but it also may require,
actually, a biopsy from the lip to look for the characteristic information in the glands themselves
that produce saliva. (uplifting music) Patients with Sjogren’s syndrome not only have characteristic antibodies called Anti-SSA and SSB, and those are seen in about
60 to 80% of the patients, but they have other changes in their blood that are characteristic. So, they may have a low white count. They may have very high
levels of serum globulins. They may have something
called rheumatoid factor. They may have positive ANA tests. So, we look for all of
these to build a case that the patient’s dryness relates to an underlying autoimmune disease, which we know is Sjogren’s syndrome. (uplifting music) A diagnosis may require other testing. So, we commonly do something
called ultrasonography where we look at the salivary glands and the structural
changes that they undergo. When a salivary gland is inflamed, as it is in Sjogren’s syndrome, there are changes that occur
in the texture of the gland that we can see with
an ultrasound machine. We can also do something called
salivary gland scintigraphy where we look at the
function of the gland, its ability to take up a
radioactive tracer and excrete it. That can be a measure of
how intact those glands are, in terms of their function. So, Sjogren’s can effect
the nervous system in various ways. It effects both the
peripheral nervous system and the central nervous system. So, in the context of the
peripheral nervous system, patients will have what’s
called a peripheral neuropathy where there’s burning or numbness in the distribution of the neurofibers, often at the distal portions
of the feet and the hands, and this requires an
examination by a physician to look for the characteristic signs of peripheral neuropathy, also
electrodiagnostic studies, and occasionally, we
have to do skin biopsies to actually quantify the neurofibers that are present in the skin. (uplifting music)

1 comment / Add your comment below

  1. Thank you for these educational videos. I have sjogrens that is secondary to ra , However, I am having much muscle weakness and tingling. Can you have ra and me. I'm confused. I have expressed this to my Dr, he does not comment.

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