New Discoveries in Sjögren’s Disease Hold Promise

Sjögren’s disease is evolving as physicians and researchers better understand its causes and types.

One recent change has been renaming the condition, from Sjögren’s syndrome to Sjögren’s disease, said Sara McCoy, MD, PhD, a rheumatologist, physician-scientist and the director of the University of Wisconsin Health Sjögren’s Disease Clinic, Madison, in a recent broadcast of ACR on Air, the ACR’s podcast hosted by Jonathan Hausmann, MD, a pediatric and adult rheumatologist in Boston, who is co-chair for the Sjögren’s OMERACT working group and is on the Board of Directors for the Sjögren’s Foundation.¹

Drilling Down to a Diagnosis

Dr. McCoy said it’s not always clear if dryness is caused by Sjögren’s or something else. Questions you can ask patients with dry eye to help with diagnosis include:

Dr. McCoy

• Do you have a recurrent sensation of sand or gravel in the eye?
• Have you had dry eye daily for more than three months?
• Do you have to use tear substitutes more than three times a day?

Ask patients with dry mouth:

• Have you had dry mouth for more than three months?
• Do you have to take a sip of water to swallow a saltine cracker?
• Have you ever had recurrent or persistent swelling of the salivary glands?

Dr. McCoy performs a Schirmer’s test and a salivary flow test at the same time. A Schirmer’s test involves the use of special paper to test tear production in the eye over five minutes. An unstimulated salivary flow test measures the amount of saliva passively produced by a patient within five minutes after first clearing out their mouth. Passive saliva collection is akin to drooling for five minutes. Dr. McCoy has patients do both tests at the same time for efficiency.

It can be harder to diagnose Sjögren’s disease if a patient does not have strong symptoms of dryness and dryness only becomes apparent during testing. “Some of the patients who say they’re dry aren’t necessarily as dry as you might think and vice versa,” she said.

When it comes to antibody testing, Dr. McCoy orders an SS-A test (anti-Ro 52/60 antibody), both to check for a positive result and to find the patient’s actual SS-A level. Although using other antibodies for a Sjögren’s diagnosis, such as an early antigen panel or carbonic anhydrase VI, has been discussed, not enough evidence supports their use for a Sjögren’s diagnosis.