Editing Sjögren's disease (section)

===Tests===

The combination of several tests, which can be done in a series, can eventually diagnose Sjögren's disease.<ref name="ReferenceB"/><ref name="Fox, R. I 2005">{{cite journal | author = Fox R. I. | year = 2005 | title = Sjögren's syndrome | journal = Lancet | volume = 366 | issue = 9482| pages = 321–331 | doi=10.1016/s0140-6736(05)66990-5| pmid = 16039337 | s2cid = 16426363 }}</ref>

====Blood tests====
[[File:Main antinuclear antibody patterns on immunofluorescence.png|thumb|Main [[antinuclear antibody]] patterns on [[immunofluorescence]].<ref>{{cite journal| author=Al-Mughales JA| title=Anti-Nuclear Antibodies Patterns in Patients With Systemic Lupus Erythematosus and Their Correlation With Other Diagnostic Immunological Parameters. | journal=Front Immunol | year= 2022 | volume= 13 | issue=  | pages= 850759 | pmid=35359932 | doi=10.3389/fimmu.2022.850759 | pmc=8964090 | doi-access=free }}<br />Minor edits by
Mikael Häggström, MD<br />- Attribution 4.0 International (CC BY 4.0) license</ref> Individuals with Sjögren syndrome usually have a speckled or homogeneous pattern, and rarely a centromere pattern.<ref>{{cite web|url=https://www.hopkinssjogrens.org/disease-information/diagnosis-sjogrens-syndrome/blood-and-urine-tests/|title=Blood and Urine Tests|website=[[Johns Hopkins School of Medicine]]|access-date=2023-05-28}}</ref>]]
Blood tests can be done to determine if a patient has high levels of antibodies that are indicative of the condition, such as [[antinuclear antibody]] (ANA) and [[rheumatoid factor]] (because Sjögren's disease frequently occurs secondary to rheumatoid arthritis), which are associated with autoimmune diseases. Typical SS ANA patterns are [[Anti-SSA/Ro autoantibodies|SSA/Ro]] and [[Anti-nuclear antibody#Anti-Ro/SS-A and anti-La/SS-B|SSB/La]], of which anti-SSB/La is far more specific; anti-SSA/Ro is associated with numerous other autoimmune conditions, but is often present in SS. However anti-SSA and anti-SSB tests are frequently not positive in SS.{{citation needed|date=October 2020}}

====Rose bengal test====
The [[rose bengal]] test uses a stain that measures the state and function of the [[lacrimal gland]]s. This test involves placing the [[nontoxic]] dye rose bengal on the eyes. The dye's distinctive colour helps in determining the state and functioning of the tear film and the rate of tear evaporation. Any distinctive colour change can indicate SS, but confirming the condition requires many related [[Medical test|diagnostic tools]].<ref name="Fox, R. I 2005"/>

====Schirmer test====
[[Schirmer's test]] measures the production of tears: a strip of [[filter paper]] is held inside the lower eyelid for five minutes, and its wetness is then measured with a ruler. Producing less than {{Convert|5|mm|abbr=on}} of liquid is usually indicative of SS. This measurement analysis varies among people depending on other eye-related conditions and medications in use when the test is taken.<ref name="Fox, R. I 2005"/> A [[slit-lamp examination]] can reveal dryness on the surface of the eye.{{citation needed|date=October 2020}}

Use of Schirmer strips to test oral dryness is possible.<ref>{{cite journal |last1=Schoppmeier |first1=Christoph Matthias |last2=Helpap |first2=Juliane |last3=Hagemeier |first3=Anna |last4=Wicht |first4=Michael Jochen |last5=Barbe |first5=Anna Greta |title=Using the modified Schirmer test for dry mouth assessment: A cross-sectional study |journal=European Journal of Oral Sciences |date=August 2022 |volume=130 |issue=4 |pages=e12880 |doi=10.1111/eos.12880 |pmid=35692181 |s2cid=249622808 |doi-access=free }}</ref><ref>{{cite journal | pmc=8137574 | year=2021 | last1=Wróbel-Dudzińska | first1=D. | last2=Kubik-Komar | first2=A. | last3=Rykwa | first3=D. | last4=Kosior-Jarecka | first4=E. | last5=Żarnowski | first5=T. | last6=Chałas | first6=R. | title=The use of Schirmer strips to measure salivary and lacrimal flow in non-Sjögren patients | journal=Clinical Oral Investigations | volume=25 | issue=6 | pages=4107–4114 | doi=10.1007/s00784-020-03741-3 | pmid=33389133 }}</ref>

====Saliva flow tests====
Symptoms of dry mouth and dryness in the oral cavity are caused by the reduced production of saliva from the salivary glands ([[parotid gland]], [[submandibular gland]], and [[sublingual gland]]).
In unstimulated whole saliva flow collection, the person spits into a [[test tube]] every minute for approximately 15 minutes. A resultant collection of less than {{Convert|1.5|ml|abbr=on}} is considered a positive result.<ref name="Dr. J. Parks, Ancaster ON Canada">Dr. J. Parks, Ancaster ON Canada</ref>
<ref name="Fox, R. I 2005"/> In a stimulated saliva flow test the person sucks on a sugar-free sweet, whilst collecting saliva. An unstimulated salivary flow rate of 0.1 to 0.2 ml/min and a stimulated flow rate of 0.7 ml/min or less is considered to be abnormally low flow rates indicative of salivary gland hypofunction.<ref>{{cite web | url=https://ostrowon.usc.edu/salivary-gland-and-flow-exam/ | title=How to Perform a Salivary Gland and Salivary Flow Exam | date=15 June 2020 }}</ref>

Unstimulated saliva production reduces by 40 to 70% between the ages of 20 and 80 years, but stimulated saliva production is not affected.<ref>{{cite journal |last1=Lacombe |first1=Valentin |last2=Lacout |first2=Carole |last3=Lozac'h |first3=Pierre |last4=Ghali |first4=Alaa |last5=Gury |first5=Aline |last6=Lavigne |first6=Christian |last7=Urbanski |first7=Geoffrey |title=Unstimulated whole saliva flow for diagnosis of primary Sjögren's disease: time to revisit the threshold? |journal=Arthritis Research & Therapy |date=December 2020 |volume=22 |issue=1 |pages=38 |doi=10.1186/s13075-020-2132-3 |pmid=32093745 |pmc=7041275 |s2cid=211265587 |doi-access=free }}</ref>

====Lip biopsy====
A lip/salivary gland [[biopsy]] takes a tissue sample that can reveal [[lymphocyte]]s [[Gene cluster|clustered]] around salivary glands, and damage to these glands from inflammation. This test involves removing a sample of tissue from a person's inner lip/salivary gland and examining it under a [[microscope]]. On such biopsies, the single most important test result in the diagnosis of the oral component of Sjögren syndrome is likely the ''focus score'', which is the number of mononuclear cell infiltrates containing at least 50 inflammatory cells in a 4&nbsp;mm<sup>2</sup> glandular section.<ref name="pmid3473649">{{cite journal| author=Segerberg-Konttinen M, Konttinen YT, Bergroth V| title=Focus score in the diagnosis of Sjögren's disease. | journal=Scand J Rheumatol Suppl | year= 1986 | volume= 61 | issue=  | pages= 47–51 | pmid=3473649 }}</ref> The Chisholm-Mason grades are also widely used for salivary gland biopsies (see table).<ref name="pmid25433039">{{cite journal| author=Costa S, Quintin-Roué I, Lesourd A, Jousse-Joulin S, Berthelot JM, Hachulla E | display-authors=etal| title=Reliability of histopathological salivary gland biopsy assessment in Sjögren's syndrome: a multicentre cohort study. | journal=Rheumatology (Oxford) | year= 2015 | volume= 54 | issue= 6 | pages= 1056–64 | pmid=25433039 | doi=10.1093/rheumatology/keu453 | doi-access=free }}</ref>

====Ultrasound====
Salivary gland ultrasonography is not invasive and may help reduce unnecessary biopsies in anti-SSA-negative patients.
<ref>{{cite journal | url=https://www.sciencedirect.com/science/article/abs/pii/S0720048X23000797 | doi=10.1016/j.ejrad.2023.110765 | title=Diagnostic value of ultrasound evaluation of major salivary glands for Sjögren's disease based on the novel OMERACT scoring system | date=2023 | last1=Tang | first1=Guoxue | last2=Luo | first2=Yi | last3=Mo | first3=Yingqian | last4=Yao | first4=Jiyi | last5=Yang | first5=Haiyun | last6=Hao | first6=Shaoyun | journal=European Journal of Radiology | volume=162 | pmid=36893528 | s2cid=257370253 }}</ref><ref>{{cite web | url=https://sjogrenssyndromenews.com/news/salivary-gland-ultrasound-may-help-diagnose-study-effective/?preview_id=72789 | title=Salivary gland ultrasound may help diagnose Sjögren's disease: Study &#124; Ultrasound may be as effective as salivary gland biopsy for diagnosis: Study &#124; Sjogren's Syndrome News | date=10 March 2023 }}</ref><ref>{{cite journal | pmc=9444027 | date=2022 | last1=Lorenzon | first1=M. | last2=Spina | first2=E. | last3=Tulipano Di Franco | first3=F. | last4=Giovannini | first4=I. | last5=De Vita | first5=S. | last6=Zabotti | first6=A. | title=Salivary Gland Ultrasound in Primary Sjögren's Syndrome: Current and Future Perspectives | journal=Open Access Rheumatology: Research and Reviews | volume=14 | pages=147–160 | doi=10.2147/OARRR.S284763 | pmid=36072437 | doi-access=free }}</ref><ref>{{cite web | url=https://www.niams.nih.gov/health-topics/sjogrens-syndrome/diagnosis-treatment-and-steps-to-take#:~:text=Ultrasound%20imaging%20and%20biopsy%20can,syndrome%20and%20other%20autoimmune%20disorders | title=Sjögren's Syndrome | work=National Institute of Arthritis and Musculoskeletal and Skin Diseases | date=7 April 2017 | access-date=29 October 2023 | archive-date=19 July 2024 | archive-url=https://web.archive.org/web/20240719114500/https://www.niams.nih.gov/health-topics/sjogrens-disease/diagnosis-treatment-and-steps-to-take#:~:text=Ultrasound%20imaging%20and%20biopsy%20can,syndrome%20and%20other%20autoimmune%20disorders | url-status=live }}</ref>

====Other tests====
A radiological procedure is available as a reliable and accurate test for Sjögren's disease, in the form of a [[sialogram]]. A [[contrast agent]] is injected into the parotid duct, which opens from the cheek into the [[Human mouth|vestibule of the mouth]] opposite the neck of the upper second [[Molar (tooth)|molar tooth]]. The test is intended to detect any blockage in the salivary gland ducts (i.e. [[parotid duct]]) and the amount of saliva that flows into the mouth.<ref name="Fox, R. I 2005"/>

For Sjögren's disease, [[sudomotor]] function through [[electrochemical skin conductance]] may help in the diagnosis process.<ref>{{cite journal |last1=Zouari |first1=Hela G. |last2=Wahab |first2=Abir |last3=Ng Wing Tin |first3=Sophie |last4=Sène |first4=Damien |last5=Lefaucheur |first5=Jean-Pascal |title=The Clinical Features of Painful Small-Fiber Neuropathy Suggesting an Origin Linked to Primary Sjögren's Syndrome |journal=Pain Practice |date=April 2019 |volume=19 |issue=4 |pages=426–434 |doi=10.1111/papr.12763 |pmid=30636091 |s2cid=58646701 }}</ref><ref>{{cite journal |last1=Ng Wing Tin |first1=Sophie |last2=Zouari |first2=Hela G |last3=Wahab |first3=Abir |last4=Sène |first4=Damien |last5=Lefaucheur |first5=Jean-Pascal |title=Characterization of Neuropathic Pain in Primary Sjögren's Syndrome with Respect to Neurophysiological Evidence of Small-Fiber Neuropathy |journal=Pain Medicine |date=1 May 2019 |volume=20 |issue=5 |pages=979–987 |doi=10.1093/pm/pny183 |pmid=30247738 }}</ref>