The flaring of your lips with swelling and redness is not typical for Sjogren's, but CAN happen...just not all that common. It's more about mouth dryness...and things like this (with your lips) would happen much later when Sjogren's symptoms are more severe.

If you suspect Sjogren's then the lip biopsy is the appropriate test...especially if the the labs are negative (as up to 40% of those with Sjogren's have negative labs). Therefore, the biopsy is the ONLY way to accurately Dx Sjogren's if you have negative labs. You should see a different doctor, if he is not willing to order this test.

I do understand him questioning the need for the test since you don't have dry eyes/mouth, but you are correct in that SFN can show up first with sicca coming later (this is how mine appeared---although I had some dryness of my mouth all my life, but never considered it abnormal, because I never experienced anything different). I don't see how you can have 'flaking' of your lips and NOT have some dryness. It seems that would go together.

Also: if you have dental issues (like excessive cavities or other dental problems that your dentist thinks might be from Sjogren's (and lack of proper moisture), then use this as a means to get the biopsy ordered. Dental problems are VERY common with Sjogren's and can start showing up with first signs of dry mouth...even before you notice a big difference. All it takes is improper balance of bacteria in the saliva (higher concentration of bacteria) to affect your mouth, which causes gingivitis and cavities.

Being that you have a diagnosed autoimmune disease already, it should help to get the biopsy...as there is what they call 'overlap' of autoimmune diseases where one triggers another, or they come together.

Hope this helps.