MKSAP: 56-year-old woman with Sjögren syndrome

A 56-year-old woman is evaluated during a follow-up visit for a 6-year history of Sjögren syndrome treated with low-dose hydroxychloroquine and cyclosporine eyedrops. She has had two episodes of cutaneous vasculitis, which resolved with corticosteroids. On physical examination, temperature is 36.4 °C (97.6 °F), blood pressure is 116/64 mm Hg, pulse rate is 72/min, and respiration rate is 18/min. Oral mucous membranes are dry. There is a new firm, left parotid gland enlargement without tenderness or warmth, reported by the patient to be progressive over several months, with asymmetry of the parotid glands. Laboratory studies at the time of diagnosis revealed elevated serum immunoglobulin levels; positive mixed monoclonal cryoglobulin levels; and positive rheumatoid factor, antinuclear antibodies, and anti-Ro/SSA antibodies. Current laboratory studies: Complete blood count Normal Alkaline phosphatase Normal Calcium Normal Rheumatoid factor Negative C3 Normal C4 Decreased Antinuclear antibodies Positive Anti-Ro/SSA antibodies Positive Which of the following is the most appropriate management? A: Add pilocarpine B: Add prednisone C: Bone marrow biopsy D: Increase hydroxychloroquine E: Parotid gland biopsy Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Family Physicians Tags: Conditions Cancer Rheumatology Source Type: blogs