Sjogren with RA — SCE Rheumatology MCQ

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HardConnective Tissue DiseaseSjogren with RASCE Rheumatology

Before another rituximab cycle in a patient with rheumatoid arthritis and Sjögren disease, which laboratory assessment is particularly important?

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Correct answer: D — Serum immunoglobulin concentrations, after specialist assessment

The best answer is “Serum immunoglobulin concentrations, after specialist assessment”. Rituximab can cause or worsen hypogammaglobulinaemia, so immunoglobulins should be checked before treatment cycles and interpreted alongside infection history and treatment risk. The remaining choices—“Serial anti-Ro antibody titres”, “Salivary-flow measurement, within a rheumatology pathway”, “Serum anti-dsDNA concentration, after safety review”, “Twenty-four-hour urinary calcium, after specialist assessment”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: BSR guideline on Sjögren disease: https://academic.oup.com/rheumatology/article/64/2/409/7645909