Carla, 48 years old and not a real patient. Has sicca with severe eye and moderate mouth dryness. Symptoms include abnormal lab findings (elevated IgG and low complement), vasculitis (purpura), synovitis (dull, aching pain and stiffness in right knee and right wrist) and night sweats (mild). ESSDAI score of 14 (high).

Prior history:

IBS
Hypothyroidism

Prior/current treatments and medications:

Prednisone
Triamcinolone
Methotrexate

Clinical presentation and reported impact:

Was an active runner, but stopped running due to worsening knee pain
Scaled back involvement at home
Skipped several work trips as her symptoms progressed

Current lab assessments and physical exam:

Patient history:

Questions to help uncover additional manifestations:

How have you been sleeping?
Does the rash bother you at night? Does it worsen with sun exposure?
Does your joint stiffness get better with more movement?
Have you had any unexplained weight loss?
Have you noticed any rashes or red or purple spots on your skin in areas other than your lower extremities?
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 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 muscle pain?
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 including SPEP, cryoglobulins, free light chains, immunoglobulins, and total complement activity.”

Eric Anderson, MD, RhMSUS

Evaluate more sicca plus patients

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

ANA, antinuclear antibody; C3, complement component 3; C4, complement component 4; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; ESSDAI, EULAR Sjögren’s syndrome disease activity index; EULAR, European Alliance of Associations for Rheumatology; IBS, irritable bowel syndrome; IgG, immunoglobulin G; PCP, primary care provider; SPEP, serum protein electrophoresis; SSA, Sjögren's syndrome type A; UWSFR, unstimulated whole salivary flow rate.