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Sjogren syndrome

Last reviewed: 1 Nov 2023
Last updated: 27 Jul 2023



History and exam

Key diagnostic factors

  • fatigue
  • dry eyes
  • dry mouth
More key diagnostic factors

Other diagnostic factors

  • vasculitis
  • dental caries
  • 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
Other diagnostic factors

Risk factors

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

Diagnostic investigations

1st investigations to order

  • Schirmer test
  • anti-60 kD (SS-A) Ro and anti-La (SS-B)
More 1st investigations to order

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
More investigations to consider

Emerging tests

  • MRI salivary glands
  • ultrasound salivary glands

Treatment algorithm


dry eyes

dry mouth

with fatigue

with musculoskeletal manifestations

with vasculitis

with renal tubular acidosis

with neuropathy



Biji T. Kurien, PhD

Staff Scientist

Arthritis and Clinical Immunology Research Program

Oklahoma Medical Research Foundation

Research Associate

Department of Veterans Affairs

Oklahoma City



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

R. Hal Scofield, MD


Section of Endocrinology and Diabetes

Department of Medicine

University of Oklahoma Health Sciences Center


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



RHS received honorarium and travel expenses from Eisai Korea for speaking at the Korean Rheumatology Association meeting. RHS has been a paid consultant for UCB in regards to Sjogren's and he has received honorarium for speaking on Sjogren's at Lily. Both instances included travel expenses. RHS is an author of several articles cited in this topic.

Peer reviewers

Nora Sandorfi, MD

Associate Professor of Medicine

University of Pennsylvania




NS declares she has no competing interests.

  • Differentials

    • Systemic lupus erythematosus (SLE)
    • Rheumatoid arthritis
    • Hepatitis C
    More Differentials
  • Guidelines

    • Guideline for vaccinations in patients with rheumatic and musculoskeletal disease
    • Consensus guidelines for the evaluation and management of pulmonary disease in Sjorgren's
    More Guidelines
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