Primary Sjögren syndrome — SCE Rheumatology MCQ

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EasyConnective tissue diseasesPrimary Sjögren syndromeSCE Rheumatology

A 49-year-old woman has gritty eyes, dry mouth and recurrent dental caries. Examination shows bilateral parotid enlargement without synovitis, rash or other features of systemic lupus erythematosus. Schirmer testing without topical anaesthetic measures 4 mm in 5 minutes, and anti-Ro/SSA antibodies are positive. What is the most likely diagnosis?

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Correct answer: B — Primary Sjögren syndrome

Primary Sjögren syndrome is correct. The combination of persistent ocular and oral sicca, recurrent caries and salivary-gland enlargement is typical. Anti-Ro/SSA positivity provides strong support for an autoimmune Sjögren phenotype, and the Schirmer result is objectively abnormal. In the 2016 ACR/EULAR classification system, anti-Ro/SSA contributes 3 points and a Schirmer result of ≤5 mm in 5 minutes contributes 1 point, reaching the threshold of 4; classification criteria support but do not replace clinical diagnosis. Anticholinergic drugs can cause sicca but do not explain anti-Ro positivity or parotid enlargement. SLE may be anti-Ro positive, but there are no independent lupus features. Sarcoidosis and IgG4-related disease can enlarge salivary glands, but the overall sicca-serological phenotype favours primary Sjögren syndrome.

Reference: Price EJ et al. British Society for Rheumatology guideline on management of adult and juvenile onset Sjögren disease, 2025. https://pubmed.ncbi.nlm.nih.gov/38621708/