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Sjögren's Self-Help Questionnaire

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Fill in and print this questionnaire. It may be helpful in discussions with your doctor.

 

 

Symptom

Yes

No

 

Oral

Dry Mouth

 

 

 

 

Sore Mouth

 

Difficulty in Chewing

Difficulty in Swallowing

 

Change in Taste

Ocular

Dry eyes

Ocular discharge

Itchy eyes

Sandy feeling

Foreign body sensation

Tired eyes

Intolerance to light

Vaginal

Dry vagina

Vaginal burning

Recurrent candidiasis

Gastric

Hyper acidity/reflux

Indigestion

Diarrhea

Constipation

Pulmonary

Chronic cough

Recurrent bronchitis

Skin

Dry skin

Skin rash

Burning skin

Others

Arthritis

Muscle pain

Psychological disorders

Thyroid gland disorders

 

Statistical analysis showed that combined symptoms of dry mouth, sore mouth, and dry eyes symptoms, correctly classified 93% of SS and 97.7% of the controls. Excluding mouth and eyes, combined gastric, muscle, psychological, vaginal, skin, nasal, and thyroid symptoms correctly classified 64.3% of SS and 86.1% of the controls.

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