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Sjogren Syndrome — SCE Rheumatology MCQ

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ModerateConnective Tissue DiseaseSjogren SyndromeSCE Rheumatology

A 48-year-old woman with primary Sjogren syndrome has severe parotid gland enlargement and fatigue but minimal sicca symptoms. Her serum IgG is 28 g/L (elevated). Anti-Ro is positive. Which treatment is recommended for systemic manifestations of Sjogren according to BSR 2024?

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Correct answer: C — Hydroxychloroquine as first-line systemic treatment

BSR 2024 Sjogren guidelines recommend Hydroxychloroquine as first-line systemic treatment for musculoskeletal and constitutional manifestations (fatigue, arthralgia, parotid enlargement). For more severe systemic manifestations (vasculitis, neuropathy, ILD), Rituximab may be considered. Pilocarpine and Cevimeline are used for sicca symptoms (muscarinic agonists) but do not address systemic disease. TNF inhibitors have not shown efficacy in Sjogren syndrome. Immunosuppressive agents (Azathioprine, MMF) may be used for organ-threatening disease.

Reference: BSR 2024 - Guideline on management of Sjogren disease