Secondary Sjogren in RA — SCE Rheumatology MCQ

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ModerateConnective Tissue DiseaseSecondary Sjogren in RASCE Rheumatology

A 65-year-old man with established seropositive rheumatoid arthritis reports persistent gritty, dry eyes and daily dry mouth. Schirmer testing is reduced and ocular surface staining is positive. Anti-Ro and anti-La antibodies are positive. Which is the most likely diagnosis?

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Correct answer: A — Rheumatoid arthritis-associated Sjögren disease

This is rheumatoid arthritis-associated Sjögren disease, historically called secondary Sjögren syndrome. The combination of objective aqueous tear deficiency, positive ocular staining, sicca symptoms affecting both eyes and mouth, and anti-Ro/anti-La antibodies strongly supports Sjögren disease. Because the patient already has established rheumatoid arthritis, the appropriate diagnostic label is RA-associated rather than primary Sjögren disease. Age-related dry eye would not explain xerostomia and Sjögren serology. Methotrexate is not the likely explanation for this characteristic multisystem sicca phenotype. Allergic keratoconjunctivitis usually causes prominent itching and allergic ocular inflammation, rather than autoimmune lacrimal and salivary gland dysfunction.

Reference: British Society for Rheumatology, Guideline for the management of adult and juvenile onset Sjögren disease, 2024. https://www.rheumatology.org.uk/guidelines