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Cryoglobulinaemia in Sjogren — SCE Rheumatology MCQ

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HardConnective Tissue DiseaseCryoglobulinaemia in SjogrenSCE Rheumatology

A 48-year-old woman with primary Sjogren syndrome and anti-Ro positivity presents with palpable purpura on her legs. Skin biopsy shows leucocytoclastic vasculitis. Cryoglobulins are positive. What type of cryoglobulinaemia is most commonly associated with Sjogren syndrome?

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Correct answer: A — Type II (monoclonal IgM with rheumatoid factor activity against polyclonal IgG)

The best answer is “Type II (monoclonal IgM with rheumatoid factor activity against polyclonal IgG)”. Type II (monoclonal IgM with rheumatoid factor activity against polyclonal IgG) is supported by the cited UK or directly applicable specialist authority and best matches the tested threshold, complication or monitoring principle. The remaining choices—“No cryoglobulinaemia occurs in Sjogren, after safety review, after specialist assessment”, “Type IV, after specialist assessment, after specialist assessment, with clinical reassessment”, “Type I (monoclonal immunoglobulin), with clinical reassessment, within a rheumatology pathway”, “Type III (polyclonal IgM against polyclonal IgG), within a rheumatology pathway”—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