Adult IgA Vasculitis Renal Prognosis — SCE Rheumatology MCQ
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Correct answer: A — Arrange urgent targeted assessment for B-cell lymphoma, including imaging and tissue diagnosis of the abnormal gland or node
Explanation lettering: C = shown as A · D = shown as B · A = shown as C · B = shown as D
C is correct. Persistent gland enlargement, lymphadenopathy or systemic symptoms together with palpable purpura, cryoglobulinaemia, low C4 and monoclonal gammopathy are recognised lymphoma predictors in Sjögren disease. This cluster requires prompt haematology/rheumatology assessment and tissue diagnosis from the most informative abnormal site. A normalises multiple red flags. B treats dryness while delaying a potentially curable malignancy. D risks obscuring histology and does not establish a diagnosis; glucocorticoids are reserved for a defined indication or genuine emergency. E dismisses a clonal signal unrelated to simple hydration. The answer does not imply that every enlarged salivary gland is lymphoma—persistence and the accompanying biological features create the high-risk pattern.
Reference: 2024 BSR guideline on management of adult and juvenile-onset Sjögren disease: https://pmc.ncbi.nlm.nih.gov/articles/PMC12013823/