The researchers of a recent study stress the importance of diagnosing Sjögren’s syndrome (SS) early, as the chronic autoimmune condition comes with serious systemic complications, including an increased risk of B-cell non-Hodgkin lymphoma. However, patients whose primary compliant is dry eye aren’t diagnosed, on average, for another 10 years after the onset of ocular symptoms. To address this, the team developed a four-question screening questionnaire that can help to identify patients with dry eye with a high likelihood of having underlying SS.

The cross-sectional study included 848 participants with dry eye complaints who were self-referred or referred by an ophthalmologist to the Sjögren's International Collaborative Clinical Alliance study. A team assessed the discriminatory value of 88 screening questions to pinpoint the association between dry eye signs and symptoms with SS. They assigned questions numerical values within different regression models and assessed the subsequent likelihood scores.

Of the initial set of questions, the investigators found four that were statistically significant:

  1. Is your mouth dry when eating a meal? (Yes = OR 1.63)
  2. Can you eat a cracker without drinking a fluid or liquid? (No = OR 1.46)
  3. How often do you have excessive tearing? (None of the time = OR 4.06)
  4. Are you able to produce tears? (No = OR 2.24).

They noted that the SS likelihood score had a moderate discriminative ability for detecting SS, which improved with the addition of tear break-up time and conjunctival staining.

Even if clinicians are asking patients about dry mouth, the way the question is worded is important, the researchers realized. The commonly asked question, “Does your mouth feel dry?” was not useful in discriminating between the SS patients and controls. However, more specific questions about dryness while eating a meal or even a cracker helped to differentiate one group from the other.  

“With future refinement and validation, this screening tool could be used alone or in combination with examination findings to identify patients with SS earlier, thereby facilitating better clinical outcomes,” the study authors concluded in their final paper.

Bunya VY, Maguire MG, Akpek EK, et al. A new screening questionnaire to identify patients with dry eye with a high likelihood of having Sjögren syndrome. Cornea. October 13, 2020. [Epub ahead of print].