Diagnostic Tests for Sjogren's Syndrome
Sjogren's Syndrome: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Sjogren's Syndrome
includes:
Sjogren's Syndrome Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Sjogren's Syndrome:
- Vision & Eye Health: Home Testing:
Sjogren's Syndrome Diagnosis: Book Excerpts
Tests and diagnosis discussion for Sjogren's Syndrome:
The doctor will first take a detailed medical history,
which includes asking questions about general health, symptoms, family
medical history, alcohol consumption, smoking, or use of drugs or
medications. The doctor will also do a complete physical exam to check
for other signs of Sjögren's.
You may have some tests, too. First, the doctor will want
to check your eyes and mouth to see whether Sjögren's is causing your
symptoms and how severe the problem is. Then, the doctor may do other
tests to see whether the disease is elsewhere in the body as well.
Common eye and mouth tests are
-
Schirmer test--This test measures tears to see
how the lacrimal gland is working. It can be done in two ways: In
Schirmer I, the doctor puts thin paper strips under the lower eyelids
and measures the amount of wetness on the paper after 5 minutes.
People with Sjögren's usually produce less than 8 millimeters of
tears. The Schirmer II test is similar, but the doctor uses a cotton
swab to stimulate a tear reflex inside the nose.
-
Staining with vital dyes (rose bengal or lissamine
green)--The tests show how much damage dryness has done to the
surface of the eye. The doctor puts a drop of a liquid containing a
dye into the lower eye lid. These drops stain on the surface of the
eye, highlighting any areas of injury.
-
Slit lamp examination--This test shows how severe
the dryness is and whether the outside of the eye is inflamed. An
ophthalmologist (eye specialist) uses equipment that magnifies to
carefully examine the eye.
-
Mouth exam--The doctor will look in the mouth for
signs of dryness and to see whether any of the major salivary glands
are swollen. Signs of dryness include a dry, sticky mouth; cavities;
thick saliva, or none at all; a smooth look to the tongue; redness in
the mouth; dry, cracked lips; and sores at the corners of the mouth.
The doctor might also try to get a sample of saliva to see how much
the glands are producing and to check its quality.
-
Salivary gland biopsy of the lip--This test is
the best way to find out whether dry mouth is caused by Sjögren's
syndrome. The doctor removes tiny minor salivary glands from the
inside of the lower lip and examines them under the microscope. If the
glands contain lymphocytes in a particular pattern, the test is
positive for Sjögren's syndrome.
Because there are many causes of dry eyes and dry mouth,
the doctor will take other possible causes into account. Generally, you
are considered to have definite Sjögren's if you have dry eyes, dry
mouth, and a positive lip biopsy. But the doctor may decide to do
additional tests to see whether other parts of the body are affected.
These tests may include
-
Routine blood tests--The doctor will take blood
samples to check blood count and blood sugar level, and to see how the
liver and kidneys are working.
-
Immunological tests--These blood tests check for
antibodies commonly found in the blood of people with Sjögren's
syndrome. For example:
Antithyroid antibodies are created when
antibodies migrate out of the salivary glands into the thyroid gland.
Antithyroid antibodies cause thyroiditis (inflammation of the
thyroid), a common problem in people with Sjögren's.
Immunoglobulins and gamma globulins are
antibodies that everyone has in their blood, but people with Sjögren's
usually have too many of them.
Rheumatoid factors (RFs) are found in the blood
of people with rheumatoid arthritis, as well as in people with
Sjögren's. Substances known as cryoglobulins may be detected; these
indicate risk of lymphoma.
Similarly, the presence of antinuclear antibodies
(ANAs) can indicate an autoimmune disorder, including
Sjögren's.
Sjögren's antibodies, called SS-A (or
SS-Ro) and SS-B (or SS-La), are specific
antinuclear antibodies common in people with Sjögren's. However, you
can have Sjögren's without having these ANAs.
-
Chest x ray--Sjögren's can cause inflammation in
the lungs, so the doctor may want to take an x ray to check
them.
-
Urinalysis--The doctor will probably test a
sample of your urine to see how well the kidneys are working.
(Source: excerpt from
Questions and Answers About Sjögren's Syndrome: NIAMS)
Diagnosis of Sjogren's Syndrome: medical news summaries:
The following medical news items
are relevant to diagnosis of Sjogren's Syndrome:
Diagnostic Tests for Sjogren's Syndrome: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Sjogren's Syndrome.
Conjunctival injection:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
When you take the patient’s history, always ask if he has associated pain. If so, when did the pain begin, and where is it located? Is it constant or intermittent? Also, ask about itching, burning, photophobia, blurred vision, halo vision, excessive tearing, or a foreign body sensation in his eye. Does the patient have a history of eye disease or trauma? If he has suffered ocular trauma, avoid touching the affected eye. Test his visual acuity and intraocular pressure (IOP) only if his eyelids can be opened without applying pressure. Place a metal shield over the affected eye to protect it, if necessary.
If the patient’s condition permits, examine the affected eye. First, determine the location and severity of conjunctival injection. Is it circumcorneal or localized? Peripheral or diffuse? Note any conjunctival or lid edema, ocular deviation, conjunctival follicles, ptosis, or exophthalmos. Also note the type and amount of any discharge.
Test the patient’s visual acuity to establish a baseline. Note if the patient has had vision changes: Is his vision blurred or his visual acuity markedly decreased? Next, test pupillary reaction to light.
Perform IOP measurements. To gauge increased IOP without a tonometer, gently place your index finger over the closed eyelid; if the globe feels rock-hard, IOP is elevated.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Red Eye:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Vision. Visual acuity should be checked; it is usually normal in episcleritis, scleritis, blepharitis, and conjunctivitis unless associated keratitis, such as in epidemic keratoconjunctivitis, is present. Decreased vision is demonstrable in keratitis and acute angle-closure glaucoma, but only mildly decreased in uveitis.
B. Inspection. The location of conjunctival redness is important. It is usually peripheral or diffuse in conjunctivitis, whereas in keratitis it is central or diffuse. It is localized in episcleritis or scleritis. In uveitis, it is central with a “ciliary flush.” In glaucoma there is a central perilimbal injection. Tenderness of the globe is usually only present in scleritis or uveitis. Pupillary reaction is normal, except in glaucoma where it is often a fixed mid-dilated pupil and in uveitis where a sluggish, miotic pupil is invariably present. Consensual photophobia is present in uveitis also, because of iris response and movement. The corneal appearance is normal except for scarring and ulceration of Chlamydia trachomatis and the haziness or edema of glaucoma.
C. Special tests. Staining of the cornea with fluoroscein is normal, except with corneal ulceration and abrasion, herpes zoster or simplex keratitis, or a bacterial corneal ulcer. Tonometry will demonstrate increased intraocular pressure in glaucoma. If a slit lamp is available, a narrow chamber angle will be seen with glaucoma. The slit lamp is also helpful to confirm the swelling and to inspect scleritis, not present in episcleritis.
Testing
A. Microbiology studies. Immunofluorescent tests on ocular scrapings for
C. trachomatis and culture for Neisseria gonorrhoeae are sometimes required. Bacterial cultures are generally reserved for infections of the neonate, in persistent conjunctivitis, or with keratitis if a break has occurred in the corneal epithelium (5). Viral cultures are rarely performed. Gram’s stain or Giemsa’s stain of epithelial scrapings may also be helpful. Urethral cultures may be indicated. Immunofluorescent detection of the herpes-specific antigen is also possible.
B. Other laboratory studies. Additional testing is primarily indicated for scleritis or uveitis because of a high frequency of associated rheumatologic disorders. Workup should include a complete blood count, sedimentation rate, C-reactive protein, antinuclear antibodies, rheumatoid factor, and a serologic test for syphilis (VDRL). A spine x-ray study can be helpful in diagnosing ankylosing spondylitis.
Diagnostic assessment
The red eye most commonly results from conjunctivitis, which is benign. Other causes can threaten sight, so a thorough evaluation must be done to prevent permanent visual impairment. Chlamydial conjunctivitis of a chronic nature causes trachoma, which is the leading cause of blindness in humans. The history and physical for both are very important. The history should include trauma, infectious exposure, and the length of symptoms. The examination should be thorough and methodical as stressed in the introductions. An immediate referral to an ophthalmologist should be made with severe deep pain, proptosis, perilimbal injection, tenderness, photophobia, and decreased vision.
References
1. Bertolini J, Pelucio M. The red eye. Emerg Med Clin North Am 1995;13(3):561–579.
2. Davey CC. The red eye. Br J Hosp Med 1996;55(3):89–94.
3. Morrow GL, Abbott RL. Conjunctivitis. Am Fam Physician 1998;57(4):735–746.
4. Hara JH. The red eye: diagnosis and treatment. Am Fam Physician 1996;54(8):
2423–2430.
5. Ruppert SD. Differential diagnosis of pediatric conjunctivitis (red eye). Nurse Practitioner 1996;21(7):12–26.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Red Eye:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Decreased vision, pain, photophobia, and a history of trauma are important indicators of serious pathology.
In conjunctivitis, the anterior chamber is clear and the pupil active. There is great overlap in the clinical spectrum of bacterial and viral conjunctivitis. Ciliary flush (dilation of the fine capillaries around the iris border producing a violet-red halo) is a differentiating sign indicating anterior uveal inflammation caused by iritis/uveitis, infectious keratitis, or acute angle closure glaucoma, rather than conjunctivitis.
An active corneal process is indicated by a foreign body sensation with the patient unable to spontaneously open the eye or keep it open. These patients will also have photophobia. The eye is tender in patients with
scleritis, iritis, and glaucoma, but not in conjunctivitis. A pinpoint pupil is seen in cases of corneal abrasion, iritis, or infectious keratitis.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Conjunctival injection:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Test the patient’s visual acuity and intraocular pressure (IOP) only if his eyelids can be opened without applying pressure. Place a metal shield over the affected eye to protect it if necessary.
If the patient’s condition permits, examine the affected eye. First, determine the location and severity of conjunctival injection. Is it circumcorneal or localized? Peripheral or diffuse? Note any conjunctival or lid edema, ocular deviation, conjunctival follicles, ptosis, or exophthalmos. Also note the type and amount of any discharge.
Next, test the patient’s visual acuity to establish a baseline. Note if the patient has had vision changes: Is his vision blurred or his visual acuity markedly decreased? Next, test pupillary reaction to light.
Perform IOP measurements. To gauge increased IOP without a tonometer, gently place your index finger over the closed eyelid; if the globe feels rock-hard, IOP is elevated.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Red Eye:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Historyand physical exam can distinguish many causes of red eye, includingconjunctivitis, trauma, lid disorders, nasolacrimal duct obstruction,allergic reaction, preseptal cellulitis, orbital cellulitis, keratitis,and uveitis.Age of child and presence of purulenteye discharge help narrow causes of conjunctivitis.If purulentdischarge occurs in neonates up to 3 wks of age, Gram stain andappropriate bacterial and chlamydial cultures should be performed.In this age group, it is especially important to determine whetherinfection is caused by N. gonorrhoeae.When infant presents with mucopurulentor purulent eye discharge between 3 wks and 3 mos of age, chlamydialeye culture should be performed.Because chlamydial infection is unusualafter 3 mos of age, infants with eye discharge may be presumed tohave bacterial infection, and broad-spectrum antimicrobial eye dropsmay be given as therapeutic trial without culture. If infectiondoes not resolve or is recurrent, bacterial culture should be performed.Presence of eosinophils on Wright stain from conjunctival scrapingsuggests allergic conjunctivitis. Fluorescein staining should be performedwith suspected corneal abrasion. Slit-lamp exam should be performedwith suspected keratitis or uveitis. Visual acuity should alwaysbe measured in anyone with significant eye pathology (e.g., trauma,keratitis, or uveitis).Ophthalmologic consultation is necessarywhenever significant eye pathology or injury occurs or is suspectedwith or without loss of vision.
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Conjunctival injection:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
When you take the patient's history, always ask if he has associated pain. If so, when did the pain begin, and where is it located? Is it constant or intermittent? Also, ask about itching, burning, photophobia, blurred vision, halo vision, excessive tearing, or a foreign body sensation in his eye. Does the patient have a history of eye disease or trauma? If he has suffered ocular trauma, avoid touching the affected eye. Does he wear contact lenses? If so, ask how often they're removed or changed if they're disposable. Test his visual acuity and intraocular pressure (IOP) only if his eyelids can be opened without applying pressure. Place a metal shield over the affected eye to protect it if needed.
If the patient's condition permits, examine the affected eye. First, determine the location and severity of conjunctival injection. Is it circumcorneal or localized? Peripheral or diffuse? Note any conjunctival or lid edema, ocular deviation, conjunctival follicles, ptosis, or exophthalmos. Also note the type and amount of any discharge.
Test the patient's visual acuity to establish a baseline. Note if the patient has had vision changes: Is his vision blurred or his visual acuity markedly decreased? Next, test pupillary reaction to light.
Perform IOP measurements. To gauge increased IOP without a tonometer, gently place your index finger over the closed eyelid; if the globe feels rock-hard, IOP is elevated.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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