Sjögren Syndrome — ORE Part 1 MCQ

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ModerateOral MedicineSjögren SyndromeORE Part 1

A patient presents with bilateral parotid swelling, dry eyes, and multiple cervical dental caries at the gingival margins. Which additional investigation would be most helpful in confirming the suspected diagnosis?

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Correct answer: B — Anti-Ro (SSA) and anti-La (SSB) antibody screen

The presentation is classic for primary Sjögren syndrome: bilateral salivary gland swelling, xerophthalmia (dry eyes), and xerostomia (dry mouth evident from cervical caries pattern). Under the 2016 ACR/EULAR classification criteria (internationally standard, applied in UK rheumatology), anti-Ro/SSA positivity is mandatory to confirm the autoimmune inflammatory nature of the disease. The serum antibody screen (option A) has superior diagnostic accuracy compared to salivary flow rate measurement (option C) or Schirmer's test alone, both of which show poor discriminative value. ANA alone (option D) lacks specificity for Sjögren syndrome and was explicitly excluded from modern criteria. CT imaging (option B) and FBC (option E) are non-specific. The anti-Ro/SSA and anti-La/SSB antibody screen is the single most helpful investigation to confirm diagnosis and establish autoimmune aetiology.

Reference: 2016 ACR/EULAR Classification Criteria for Primary Sjögren's Syndrome. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5374666/ (2017). Validation study: https://pubmed.ncbi.nlm.nih.gov/29444331/ (May 2018).