Sjögren disease — SCE Rheumatology MCQ

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ModerateConnective Tissue DiseasesSjögren diseaseSCE Rheumatology

A 60-year-old woman with primary Sjögren disease reports unilateral persistent parotid swelling, night sweats and 5 kg weight loss. Examination shows firm left parotid enlargement and palpable cervical nodes. C4 is low and serum cryoglobulins are positive. What is the most important complication to screen for?

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Correct answer: A — Mucosa-associated lymphoid tissue lymphoma

Explanation lettering: B = shown as A · A = shown as B

Mucosa-associated lymphoid tissue lymphoma is best because persistent salivary gland enlargement with B symptoms, low complement and cryoglobulins raises concern for lymphoma, especially MALT lymphoma. A is less suitable because renal artery stenosis does not explain gland enlargement and B symptoms; C is less suitable because scleroderma renal crisis presents with hypertension and renal injury; D is less suitable because rheumatoid nodules are not a Sjögren parotid complication; E is less suitable because temporal arteritis causes cranial ischaemic symptoms rather than parotid mass. Clinical pearl: lymphoma risk is a central long-term complication to screen for in Sjögren disease.

Reference: BSR Sjögren disease guideline 2023