Nancy, 32 years old and not a real patient. Has sicca with severe eye and mouth dryness. Other symptoms include synovitis (swelling in the hands, wrists, and ankles), myalgia, and cytopenia. ESSDAI score of 10 (moderate).

Prior history:

Hypertension
Hyperlipidemia

Prior/current treatments and medications:

Artificial tears
Naproxen
Hydroxychloroquine (HCQ)

Clinical presentation and reported impact:

Mouth dryness is disrupting her sleep, making it harder to get through the day
Difficulty writing due to wrist and hand pain
Struggles to present/talk at work due to mouth dryness
Can no longer wear contact lenses
Doesn't have enough energy to get through the day anymore without frequent naps
Too tired and in too much pain to engage with her children

Current lab assessments and physical exam:

Patient history:

Questions to help uncover additional manifestations:

Since presentation of Sjögren’s disease symptoms, how has your sleep quality and duration been affected?
What are some things you used to do easily that are more difficult now?
Do you find it hard to walk, climb stairs, or sit down and get up from a chair?
Have you been having night sweats or any unexplained weight loss?
Have you noticed any rashes or red or purple spots on your skin?
Have you noticed any shortness of breath with mild exertion (eg, walking around the block) or a persistent cough?
Have you been experiencing any new difficulty with speaking or singing?
Have you noticed any swelling of lymph nodes in your neck, armpits, groin, or behind the ears?
Have you been feeling any tingling, numbness, or pain in your hands or feet? Any trouble holding or opening objects?
Have you been experiencing any brain fog or difficulty with concentration?

“To ensure her disease is being adequately evaluated, I would order additional lab tests for CBC/CMP, urinalysis, CRP/ESR, SPEP, IgG, free light chains, Kappa and Lambda with ratio, complement C3 and C4, beta-2 microglobulin, CPK, cryoglobulins, and anti-SSB.”

Ghaith Noaiseh, MD

Evaluate more sicca plus patients

Dr Noaiseh was compensated for his time by Novartis Pharmaceuticals Corporation.

ANA, antinuclear antibody; CBC, complete blood count; CCP, cyclic citrullinated peptide; CMP, complete metabolic panel; CMR, cardiac magnetic resonance; CPK, creatine phosphokinase; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; ESSDAI, EULAR Sjögren’s syndrome disease activity index; EULAR, European Alliance of Associations for Rheumatology; IgG, immunoglobulin G; PCP, primary care provider; RF, rheumatoid factor; SPEP, serum protein electrophoresis; SSA, Sjögren's syndrome type A; SSB, Sjögren's syndrome type B; UWSFR, unstimulated whole salivary flow rate; WBC, white blood cell count.