Sjögren disease — SCE Rheumatology MCQ

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EasyConnective Tissue DiseasesSjögren diseaseSCE Rheumatology

A 52-year-old woman reports dry eyes, dry mouth and fatigue. She needs water to swallow dry food and has recurrent dental caries. Schirmer test is abnormal, ANA is positive and anti-Ro antibody is positive. Parotid glands are mildly enlarged without fever. What is the most likely diagnosis?

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Correct answer: E — Primary Sjögren disease

Explanation lettering: D = shown as A · E = shown as C · A = shown as D · C = shown as E

Primary Sjögren disease is best because sicca symptoms with objective ocular dryness and anti-Ro positivity are typical of primary Sjögren disease. A is less suitable because sarcoidosis can cause sicca but would have granulomatous lung, lymph node or calcium features; B is less suitable because IgG4-related disease may enlarge salivary glands but usually has IgG4-rich systemic fibroinflammation; D is less suitable because systemic sclerosis would feature Raynaud's, skin thickening or capillaroscopy changes; E is less suitable because fibromyalgia does not cause objective glandular dysfunction. Clinical pearl: objective tests matter because dryness symptoms alone are non-specific.

Reference: BSR Sjögren disease guideline 2023