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Last reviewed: 21 Apr 2025
Last updated: 13 Mar 2024

Summary

Definition

History and exam

Key diagnostic factors

  • fatigue
  • dry eyes
  • dry mouth
Full details

Other diagnostic factors

  • vasculitis
  • dental caries
  • presence of risk factors
  • increased oral fungal and bacterial infections
  • musculoskeletal pain
  • thyroid disease
  • urogenital disease
  • pulmonary disease
  • gastrointestinal disease
  • peripheral neuropathy
  • corneal ulceration
  • no saliva pool
  • enlarged salivary glands
  • facial pain
  • burning mouth syndrome
Full details

Risk factors

  • female
  • systemic lupus erythematosus (SLE)
  • rheumatoid arthritis
  • systemic sclerosis (scleroderma)
  • HLA class II markers
  • age 40 to 70
  • genetic inheritance
Full details

Diagnostic investigations

1st investigations to order

  • Schirmer's test
  • anti-60 kD (SS-A) Ro and anti-La (SS-B)
Full details

Investigations to consider

  • sialometry
  • minor salivary gland biopsy
  • lissamine green test
  • fluorescein corneal staining test
  • parotid sialography
  • salivary gland technetium-99m pertechnetate scintigraphy
  • skin biopsy
  • angiography
  • urinalysis
  • serum electrolytes
Full details

Emerging tests

  • MRI salivary glands
  • ultrasound salivary glands
Full details

Treatment algorithm

ONGOING

dry eyes

dry mouth

with fatigue

with musculoskeletal manifestations

with vasculitis

with renal tubular acidosis

with neuropathy

Contributors

Authors

Biji T. Kurien, PhD

Staff Scientist

Arthritis and Clinical Immunology Research Program

Oklahoma Medical Research Foundation

Research Associate

Department of Veterans Affairs

Oklahoma City

OK

Disclosures

BTK is an author of several articles cited in this topic.

R. Hal Scofield, MD

Professor

Section of Endocrinology and Diabetes

Department of Medicine

University of Oklahoma Health Sciences Center

Member

Arthritis and Clinical Immunology Research Program

Oklahoma Medical Research Foundation

Associate Chief of Staff for Research and Staff Physician

Department of Veterans Affairs Medical Center

Oklahoma City

OK

Disclosures

RHS has received compensation from Jessen Pharmaceuticals as a member of a clinical trial advisory board, and honorarium from Merck and Company for consultation on an investigational agent for Sjogren syndrome. RHS is the principal investigator for grants from the US National Institute of Health and the US Department of Veteran Affairs for institutions studying Sjorgren syndrome. RHS is an author of several articles cited in this topic.

Peer reviewers

Nora Sandorfi, MD

Associate Professor of Medicine

University of Pennsylvania

Philadelphia

PA

Disclosures

NS declares she has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Foulks GN, Forstot SL, Donshik PC, et al. The Sjogren's Syndrome Foundation clinical practice guidelines. Ocular management in Sjogren's patients. 2015 [internet publication].Full text

Vivino FB, Zero D, Brennan M, et al. Sjogren's Syndrome Foundation's clinical practice guidelines. Oral management: caries prevention in Sjogren's patients. 2015 [internet publication].Full text

Carsons SE, Vivino FB, Parke A, et al. Treatment guidelines for rheumatologic manifestations of Sjögren's syndrome: use of biologic agents, management of fatigue, and inflammatory musculoskeletal pain. Arthritis Care Res (Hoboken). 2017 Apr;69(4):517-27.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available here.

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