Closing the Diagnostic Gap in Sjögren's, With Kara Wada, MD

Sjögren's disease affects an estimated 1 in 50 women, yet diagnostic delays averaging several years remain the norm.¹ Kara Wada, MD, a board-certified allergist-immunologist and lifestyle medicine physician at The Ohio State University Wexner Medical Center, Columbus, Ohio, and herself a Sjögren's patient, spoke with RheumatologyLive about the recognition failures driving that gap and the diagnostic and therapeutic advances beginning to address it.

Recognition Breaks Down Before the Rheumatology Referral

Recognition breaks down across specialties before a rheumatology referral ever happens, Wada explained. Dry eye, reduced salivary flow, fatigue, gastrointestinal symptoms labeled as IBS, migraine, and neuropathic pain each reach different specialists who address them in isolation. Her allergy-immunology background has shaped an unusually cross-disciplinary lens on a disease that routinely escapes categorical classification. Adding to the diagnostic challenge, an estimated 30–40% of Sjögren's patients are seronegative — meaning normal labs in a rushed clinical encounter often effectively end the workup. "When labs are normal and someone is tired or in pain, and we may not think to ask about the dryness or the neurologic symptoms, it gets brushed off and pushed aside," she said.

Sjögren’s Diagnostic Tools: A Field in Evolution

On the diagnostic front, Wada identified growing interest in more granular anti-SSA characterization — specifically, distinguishing anti-Ro52 from anti-Ro60 positivity, which carry different clinical implications for disease phenotype and complication risk.² Multiplex autoantibody platforms including Exagen's AVISE CTD and comparable connective tissue disease testing panels from major reference laboratories now offer separate Ro52/Ro60 quantification, and Wada expressed hope that broader adoption of these tools alongside salivary gland ultrasound — a technique she noted she was actively pursuing training in — will reduce reliance on minor salivary gland biopsy for seronegative patients.

The treatment pipeline, she said, is generating a level of momentum the Sjögren's community has not previously experienced, with agents targeting CD40 ligand, BAFF/APRIL, BTK, interferon, and FcRn pathways all in active development. She drew an analogy to how precision phenotyping transformed asthma management and expressed hope for a similar evolution in Sjögren's. Alongside pharmacologic advances, she emphasized that cardiovascular and lymphoma risk — both elevated in Sjögren's — make lifestyle medicine an essential complement to disease management, not an alternative to it.

Wada’s disclosures include Exagen.

References

1. Ramos-Casals M, Brito-Zerón P, Bombardieri S, et al; EULAR-Sjögren Syndrome Task Force Group. EULAR recommendations for the management of Sjögren's syndrome with topical and systemic therapies. Ann Rheum Dis. 2020;79(1):3–18. doi:10.1136/annrheumdis-2019-216114

2. Armagan B, Robinson SA, Bazoberry A, et al. Antibodies to both Ro52 and Ro60 for identifying Sjögren's syndrome patients best suited for clinical trials of disease-modifying therapies. Arthritis Care Res (Hoboken). 2022;74(9):1559–1565. doi:10.1002/acr.24592