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IL-17 Inhibitor Candidiasis — SCE Rheumatology MCQ

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HardSpondyloarthropathyIL-17 Inhibitor CandidiasisSCE Rheumatology

A patient has strongly suspected Sjögren disease with abnormal Schirmer and unstimulated salivary-flow tests, but anti-Ro and anti-La antibodies are negative. Salivary ultrasound is equivocal. Which test best resolves adult classification?

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Correct answer: E — Minor labial salivary-gland biopsy with focus-score assessment

Explanation lettering: D = shown as A · E = shown as C · C = shown as D · A = shown as E

A is correct. In anti-Ro-negative patients with objective sicca, minor labial salivary-gland biopsy is the key remaining weighted classification investigation; focal lymphocytic sialadenitis with focus score at least one per 4 mm² supports the diagnosis. CT and PET may answer selected differential or lymphoma questions but are not routine classification criteria. Treatment response and serial ANA testing do not establish Sjögren disease. Technique and expert histopathological interpretation matter because biopsy has real, though generally limited, sensory morbidity.

Reference: BSR guideline on adult and juvenile-onset Sjögren disease: https://pmc.ncbi.nlm.nih.gov/articles/PMC12013823/