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Sjögren syndrome — SCE Rheumatology MCQ

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ModerateMusculoskeletal investigationsSjögren syndromeSCE Rheumatology

A 24-year-old woman has dry eyes, dry mouth and episodic parotid swelling. Examination shows there are dental caries and reduced salivary pooling. Investigations show ANA is positive. The consultant wants the next test most likely to confirm the suspected process or guide treatment. The result will change diagnosis, staging or immediate treatment. What is the most appropriate investigation?

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Correct answer: C — ENA profile

ENA profile is the best answer because ena profile is the investigation most likely to resolve the immediate diagnostic or monitoring question in sjögren syndrome. Urinalysis is a plausible distractor, but it does not account for the key discriminator in the stem. MRI sacroiliac joints and Complement and anti-dsDNA would be more appropriate in a different clinical pattern or at another point in the pathway, while MRI scan is suboptimal for this presentation. Clinical pearl: autoantibodies are supportive tests and should be interpreted alongside phenotype, inflammatory markers, urinalysis and imaging.

Reference: BSR hot swollen joint guideline; NICE NG100; EULAR imaging recommendations