• Swollen parotid glands (1.5 cm x 2 cm diameter)

• SSA+

• ANA 1:160–

• Schirmer’s test 2-3 mm/5 min

  • normal: >15 mm/5 min

  • possible dry eyes: 10-15 mm/5 min

  • moderately dry eyes: 5-10 mm/5 min

  • extremely dry eyes: <5 mm/5 min

• UWSFR 0.3 mL/min (normal: 0.3-0.4 mL/min)

• Normal IgG

• Normal complement

• ANC 920 cells/mm³ (normal: ≥1500 cells/mm³)

• HBV/HCV–  

• Ultrasound evidence of parotid involvement 

3 years ago
Began using artificial tears and chewing gum to address mild dry eye and dry mouth

1 year ago
Consulted a gynecologist for discomfort during intercourse

Concurrently, parotid gland swelling prompted a visit to an ENT, who treated with a 2-week course of prednisone and ruled out ductal obstruction. Swelling returned after prednisone taper, requiring another course of prednisone; swelling returned for a third time, prompting referral to a rheumatologist

Following Sjögren’s disease diagnosis
Rheumatologist initiated HCQ, which was discontinued due to gastrointestinal side effects

• Have you had any vaginal infections or UTIs lately?

• What are some things you used to do easily that are now more difficult?

• How often have you had swelling in your salivary glands? How many episodes? Any persistent swelling or nodular changes?

• Have you been experiencing any new difficulty with speaking or singing?

• 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 noticed any swelling of lymph nodes in your neck, armpits, groin, or behind your ears?

• Have you been feeling any tingling, numbness, or pain in your hands or feet? Any trouble holding or opening objects?

• Have you had any joint stiffness in the morning or trouble climbing stairs or standing up from a chair? Any muscle pain?

• Have you been experiencing any brain fog or difficulty with concentration?