Sjogren Syndrome — MFDS Part 1 MCQ

Correct answer: B — Sjögren syndrome

The diagnosis is Sjögren syndrome. The discriminating combination is persistent ocular and oral sicca, objective reduction in tear and unstimulated salivary production, recurrent bilateral parotid swelling and anti-Ro/SSA antibodies. Sjögren syndrome is an autoimmune exocrinopathy affecting the lacrimal and salivary glands. Sarcoidosis can cause lacrimal or parotid enlargement and occasionally sicca symptoms, but the anti-Ro-associated pattern strongly favours Sjögren syndrome. HIV-associated disease can produce bilateral parotid enlargement but does not typically produce this autoimmune serological and objective sicca profile. Lymphoma may complicate Sjögren syndrome and should be considered with persistent asymmetric swelling, lymphadenopathy or systemic features, but it is not the best unifying diagnosis here. Bulimia may cause bilateral sialadenosis and dental erosion but not objective ocular dryness or anti-Ro antibodies.

Reference: NHS England. Rituximab for the treatment of primary Sjögren's syndrome in adults, sections 1–2, 2016. https://www.england.nhs.uk/wp-content/uploads/2018/07/Rituximab-for-the-treatment-of-primary-Sjogrens-syndrome-in-adults.pdf