Diagnostics of Sjogren's syndrome by means of anti-α-fodrin antibody

Background: Sjogren's syndrome (SS) is a common connective tissue disease concerning 0.5% of the white population. Typical symptoms are dry eyes and a dry mouth. The diagnostics of SS often are difficult, especially during early stages of the disease as long as the leading symptoms have not yet fully developed. Previously employed serum antibodies have neither been sensitive nor specific enough to be able to differentiate SS from different rheumatic diseases. We report on a patient with relapsing corneal erosions. In his case we have been able to support the diagnosis of SS by detecting the anti-alpha-fodrin-antibody as well as antinuclear antibodies. Case Report: The patient appeared with incomplete closure of the eyelids and corneal ulcers on both eyes. Smears of the conjunctivae from both eyes were sterile. Schirmer's test indicated a decrease in tear production with 5 mm in the right eye and a normal tear production with 19 mm in the left eye. Three months before, the results of this test had been even more pronounced with 1 mm and 3 - 4 mm, respectively. Additionally the patient described relapsing erosions and a dry mouth. We then examined his blood to help diagnose SS. Results were negative for rheumatoid factor, anti-Ro/SSA antibody and anti-La/SSB antibody, but positive for anti-nuclear-antibodies. In order to spare the patient an invasive biopsy we examined the anti-a-fodrin-antibody which was positive. Conclusion: Even with negative anti-Ro/SSA and anti-La/SSB antibodies the positive anti-alpha-fodrin-antibody supported the diagnosis of SS. Therefore, we consider it a useful addition to the diagnostics previously employed in the diagnosis of SS (Schirmer's-test, anti-Ro/SSA-AK, anti-La/SSB-AK, rheumatoid factor, eventually biopsy).