Primary Sjögren syndrome — SCE Rheumatology MCQ

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ModerateConnective tissue diseasesPrimary Sjögren syndromeSCE Rheumatology

A 47-year-old man has dry eyes, dry mouth and fatigue. Examination shows parotid enlargement and dental caries are present. Investigations show anti-Ro antibody is positive and Schirmer test is abnormal. The admitting team asks which diagnosis best explains the whole presentation. What is the most likely diagnosis?

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Correct answer: D — Primary Sjögren syndrome

Primary Sjögren syndrome is the best answer because the pattern described is most consistent with Primary Sjögren syndrome, including the distribution of symptoms and the targeted investigation results. Osteomalacia is a plausible distractor, but it does not account for the key discriminator in the stem. Leflunomide hepatotoxicity and Paget disease of bone would be more appropriate in a different clinical pattern or at another point in the pathway, while CPP crystal arthritis is suboptimal for this presentation. Clinical pearl: in SCE-style questions, the decisive clue is usually the pattern across joints, extra-articular features and targeted immunology rather than a single antibody result.

Reference: BSR SLE guideline; EULAR SLE and systemic sclerosis recommendations; BNF