Primary Sjögren syndrome — SCE Rheumatology MCQ

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HardConnective tissue diseasesPrimary Sjögren syndromeSCE Rheumatology

A 63-year-old woman with primary Sjögren syndrome develops persistent unilateral parotid swelling. Examination shows purpura is present on the lower legs. Investigations show C4 is low and serum electrophoresis shows a monoclonal band. What is the most important complication to screen for?

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Correct answer: B — B-cell lymphoma

The best answer is “B-cell lymphoma”. B-cell lymphoma is supported by the cited UK or directly applicable specialist authority and best matches the tested threshold, complication or monitoring principle. The remaining choices—“Achilles rupture, after specialist assessment”, “Pulmonary embolism, with clinical reassessment”, “Atlantoaxial instability, after safety review”, “Macrophage activation syndrome, after specialist assessment”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: BSR guideline on Sjögren disease: https://academic.oup.com/rheumatology/article/64/2/409/7645909