Sjögren objective dryness — SCE Rheumatology MCQ

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ModerateMusculoskeletal investigationsSjögren objective drynessSCE Rheumatology

A 50-year-old woman reports persistent gritty eyes and dry mouth. Examination shows bilateral parotid enlargement, and Sjögren disease is suspected. Which investigation directly quantifies tear production over 5 minutes and provides objective evidence of ocular gland dysfunction?

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Correct answer: A — Schirmer I test

The Schirmer I test directly measures tear production by recording the length of filter paper wetted over 5 minutes. A result of 5 mm or less in 5 minutes is an objective ocular item in the 2016 ACR/EULAR Sjögren classification criteria. Ocular surface staining assesses corneal and conjunctival epithelial damage rather than tear output. Unstimulated whole salivary flow objectively assesses oral gland dysfunction. Minor labial salivary gland biopsy identifies focal lymphocytic sialadenitis, while salivary gland ultrasonography assesses structural gland abnormalities. These may all contribute to evaluating suspected Sjögren disease, but only the Schirmer test directly answers the question about quantifying tear production.

Reference: Shiboski CH et al. 2016 ACR/EULAR classification criteria for primary Sjögren's syndrome. Annals of the Rheumatic Diseases. 2017;76:9-16. https://pubmed.ncbi.nlm.nih.gov/27789466/