Getting Tested for Sjogren's Disease

Performed by your eye doctor. This is the most accessible starting point, and it should be the first step for any dry eye patient with systemic symptoms, severe disease, or a poor response to prior treatment.

• Schirmer's test: a paper strip in the lower lid for 5 minutes measures tear production; 5 mm or less scores a criterion point
• Ocular staining: fluorescein and lissamine green reveal surface damage; a combined score of 5 or higher is a criterion
• Tear osmolarity: a nanoliter sample; elevated readings and inter-eye asymmetry reflect aqueous deficiency
• MMP-9 (InflammaDry): a positive result confirms active surface inflammation
• Tear film analysis: non-invasive breakup time, meibography, and meniscus height help confirm aqueous deficiency

Can be initiated by your eye doctor, in-office or through a lab order.

• Sjo Advanced Diagnostic Panel: a finger-prick sample screens 7 biomarkers, including 3 novel early markers (SP-1, CA-6, PSP) plus the traditional SS-A, SS-B, ANA, and RF, that can identify Sjogren's earlier than conventional panels
• Standard SS-A (anti-Ro) and SS-B (anti-La) antibodies, orderable through any lab; positive SS-A is the highest-weighted single criterion

A negative blood test does not rule out Sjogren's. About 1 in 3 biopsy-confirmed patients do not have anti-SSA antibodies, and some data put the seronegative rate as high as 40%.

Performed by a rheumatologist, ideally with documented eye-exam findings from steps 1 and 2. Sharing your Schirmer's, staining, osmolarity, and biomarker results gives the rheumatologist a head start on scoring.

• Minor salivary gland (lip) biopsy: the definitive histopathologic test, a small lip-tissue sample examined for focal lymphocytic sialadenitis
• Unstimulated salivary flow: 0.1 mL per minute or less scores a point
• Full ACR-EULAR score: the rheumatologist combines all results; a total of 4 or more confirms the classification