Sicca syndrome (dry mouth or eyes): suspected Sjögren's disease

Internal medicine and immunology · Symptom or situation · updated 2026-10-30

BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.

Frequency: Sjögren disease: between 1/1000 and 1/10 000 ^[1]

Disabling dry mouth or dry eyes: suspected Sjögren's disease

Laboratory tests (state "suspected Sjögren syndrome" on the request form)

Antinuclear antibodies (on HEp-2 cells transfected with Ro60/SSA) with anti-SSA/Ro60 and anti-SSB/La antibodies
Rheumatoid factor
Serum protein electrophoresis
FBCif neededPart of the initial laboratory tests of the PNDS (cytopenias, lymphopenia) ^[2].
TSH (if signs of thyroid dysfunction)if neededThyroid dysfunction is among the causes of dryness other than Sjögren's disease ^[2].
Hepatitis C serology (if risk factor)if neededHepatitis C is a cause of dryness to be ruled out ^[2].
HIV serology (if swelling of the parotid or submandibular glands)if neededHIV is among the general causes of parotid enlargement to look for, like sarcoidosis, IgG4-related disease or MALT lymphoma ^[2].
HbA1c (if known diabetes, to assess control)if neededPoorly controlled diabetes is a cause of dryness ^[2].

Detailed explanation and international comparison (in French): read it in English (machine translation)

Also consider

Anti-Ro60 positive? Anti-Ro60 antibodies also point towards lupus: see the page "Lupus systémique".

Do not order

Follow-up anti-SSA or anti-SSB antibodies: they remain positive for life and their titre does not track activity; do not repeat ^[2].

Confirmed Sjögren's disease: laboratory monitoring

At every follow-up visit (every 3 to 6 months if active disease, every 1 to 2 years if quiescent)

FBC
Serum electrolytes
Serum creatinine with eGFR
CRP
Serum albumin
AST
ALT
GGT
Bilirubin
Alkaline phosphatase
Creatine kinase (CK)
Serum protein electrophoresis
IgG
Urine protein:creatinine ratio (spot sample)
Rheumatoid factor, complement C3 and C4, cryoglobulins (if cryoglobulin positive at baseline, vasculitis, renal involvement or progressive disease)if neededThe PNDS reserves them for patients with initial cryoglobulinaemia or signs of active disease, vasculitis or glomerular renal involvement ^[2].
LDH (if lymphoma suspected)if neededNot a routine test, if lymphoma is suspected ^[2].
Hepatitis B serologyif neededBefore starting an immunosuppressive treatment ^[2].
Hepatitis C serologyif neededBefore starting an immunosuppressive treatment ^[2].
HIV serologyif neededBefore starting an immunosuppressive treatment ^[2].
IgA anti-tissue transglutaminase antibodies (tTG-IgA) (once, in the baseline tests of confirmed Sjögren disease)if needednon-French guidelineThe BSR (2024) recommends, at baseline in confirmed Sjögren's disease and then according to the clinical picture, looking for associated conditions, including coeliac disease by anti-transglutaminase antibodies: a Hungarian series found 4.5% in Sjögren's, versus 4.5 to 5.5 per 1 000 in the European population ^[4]. The initial work-up of the PNDS does not include this test ^[2]. The NABM lists this test as first-line in adults suspected of coeliac disease ^[6].
25-hydroxyvitamin D (once, in the baseline tests of confirmed Sjögren disease)if needednon-French guidelineThe BSR (2024) recommends a vitamin D level at baseline (strong recommendation, level of evidence B): deficiency is common beyond 40° of latitude and, in Sjögren's, associated with peripheral neuropathy and lymphoma ^[4]. The PNDS does not provide for it ^[2] and the NABM does not cover this test for this indication ^[6].

Detailed explanation and international comparison (in French): read it in English (machine translation)

Do not order

Follow-up anti-SSA/SSB antibodies: useless, their titre does not vary with activity ^[2].

Sources (6)