Can You Have Sjögren's Syndrome with Normal Blood Test Results? - Internal Medicine

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Sjögren's syndrome (SS) is an autoimmune disorder characterized primarily by dry eyes and dry mouth due to the destruction of the glands that produce saliva and tears. While the diagnosis of SS often involves specific blood tests, including the presence of autoantibodies such as anti-SSA (Ro) and anti-SSB (La), it is indeed possible to have Sjögren's syndrome even if blood test results are normal.

Firstly, it is essential to understand that the diagnosis of Sjögren's syndrome is not solely dependent on laboratory tests. The American College of Rheumatology has established criteria for diagnosing SS, which include clinical symptoms, laboratory findings, and histopathological evidence. Therefore, a patient can exhibit symptoms consistent with SS while having normal serological test results.
In your case, you mentioned having dry eyes and a history of salivary gland swelling, which are common symptoms of Sjögren's syndrome. The fact that you have experienced these symptoms, even if they are not persistent, raises the possibility of an underlying condition. Additionally, the presence of splenomegaly (enlarged spleen) could indicate systemic involvement, which is often seen in autoimmune diseases.

It's also worth noting that some patients with Sjögren's syndrome may have seronegative forms of the disease, meaning they do not test positive for the typical autoantibodies associated with the condition. This can occur in early stages of the disease or in cases where the immune response is not robust enough to produce detectable levels of these antibodies. Furthermore, the absence of these antibodies does not rule out the possibility of SS, especially if clinical symptoms are present.

Regarding your concerns about potential neurological involvement, it is known that Sjögren's syndrome can be associated with peripheral neuropathy. This can manifest as pain, numbness, or tingling in the extremities. The mechanism behind this is thought to be related to the autoimmune process affecting nerve tissues. If your neurologist suspects that your back pain and other neurological symptoms may be related to Sjögren's syndrome, it would be prudent to further investigate this connection.

In conclusion, while normal blood test results can make the diagnosis of Sjögren's syndrome less likely, they do not completely exclude the possibility. It is crucial to consider the full clinical picture, including symptoms and any other relevant findings. If you continue to experience symptoms suggestive of Sjögren's syndrome, it may be beneficial to seek a second opinion or further evaluation from a rheumatologist who specializes in autoimmune diseases. They may recommend additional tests, such as a lip biopsy to assess for lymphocytic infiltration in the salivary glands, which can provide more definitive evidence of Sjögren's syndrome.

In summary, while normal blood tests can complicate the diagnosis of Sjögren's syndrome, they do not rule it out entirely. Clinical symptoms, patient history, and possibly further diagnostic testing should guide the evaluation and management of your condition.