Additional symptoms include joint pain, swelling, and stiffness; skin rashes or dry skin; vaginal dryness leading to painful intercourse; persistent dry cough; prolonged fatigue; fever; change in the color of hands or feet; esophageal dysphagia, epigastric pain, and dyspepsia; and tingling and numbness in the limbs.
Useful tests that should be ordered as part of SS work-up include laboratory tests, ocular and oral functional tests, and chest X-rays Table 1 Table 2 Table 3. Sera exhibiting a high degree of hemolysis, icterus, lipemia, or microbial growth should not be used because these conditions may cause aberrant results.
False-negative tests can occur when the titers of autoantibodies are low or because of the limitation of the assay. The differences in the detection of 52 kDa, 60kDa Ro, and La could explain the inconsistencies noted between individual assays.
There is no single laboratory test that will confirm the diagnosis of SS. To help physicians diagnose SS, six classification criteria have been established revised European-American Consensus Group criteria. Ocular symptoms include dry eyes for more than 3 months, foreign body sensation in the eyes, and use of artificial tears more than three times per day.
Oral symptoms include dry mouth for more than 3 months, recurrent or persistently swollen salivary glands, and need for liquids to swallow dry foods.
Exclusion criteria include past head and neck radiation treatment, hepatitis C infection, acquired immunodeficiency syndrome AIDS , pre-existing lymphoma, sarcoidosis, graft versus host disease, and current use of anticholinergic drugs. Patients are classified as primary SS if four of the six criteria are present, as long as histopathology or serology is positive, or if three or any four objective criteria are present.
In patients with another well-defined major connective tissue disease, the presence of one symptom plus two of the three objective criteria is indicative of secondary SS. In the rare instances in which the cause of patient symptoms remains obscure, repeat testing and sometimes even additional salivary gland biopsies may be required. All rights reserved. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC.
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Table 1. Immunoglobulins Immunoglobulins are usually elevated in SS patients. Anti-nuclear Antibodies ANA These are a group of antibodies that react against normal components of a cell nucleus. They seem to be associated with primary SS forms with vasculitis and leucopenia. The anti-SSA autoantibodies can bind to several antigenic epitopes expressed by two proteins of molecular masses of 52 and 60 kDa associated with RNA.
Only the anti-SSA autoantibodies that recognize the kDa protein are tested routinely. Kidney function testing Urine testing urinalysis ad microscopy is helpful in assessing kidney involvement. The presence of red cells and protein indicates active kidney inflammation in the absence of bladder and kidney infection.
In the case of kidney involvement and reduction of kidney function, blood urea nitrogen BUN and creatinine will be elevated. More than 10 mm of moisture on the filter paper after 5 minutes is a sign of normal tear production. Both eyes normally release the same amount of tears. A scoring system has been developed to rate the severity of these changes and is useful for monitoring dry eye treatment over time. The two dyes can be used interchangeably, but lissamine is better tolerated.
Slit-lamp test This is an examination of the surface of the eye with the help of a fluorescin dye and a biomicroscope slit lamp to provide a magnified image of the tear film, the ocular surface and the eyelids, and to allow careful examination of the anterior portions of the eye, including the anterior chamber and iris.
Fluorscein allows evaluation of the quality of the tear film and detection of small areas of the cornea where the lining cells have been lost because of dryness or other forms of damage. Table 3. A positive result for SSA antibodies in a woman with LE prior to delivery indicates an increased risk of congenital heart block in the neonate.
Homburger H, Larsen S: Detection of specific antibodies. Clinical Immunology: Principles and Practice. Mosby-Year Book; Kotzin B, West S: Systemic lupus erythematosus.
Clinical Immunology Principles and Practice. Elsevier; Email Us Phone: Useful For Evaluating patients with signs and symptoms of a connective tissue disease in whom the test for antinuclear antibodies is positive, especially those with signs and symptoms consistent with Sjogren syndrome or lupus erythematosus This test is not useful in patients without demonstrable antinuclear antibodies. Day s Performed Monday through Saturday. Clinical Reference 1.
Mosby-Year Book; 2.
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