June, 59 years old and not a real patient. Has sicca with severe eye and mouth dryness. Symptoms include lymphadenopathy and abnormal lab findings (elevated IgG and low complement). ESSDAI score of 9 (moderate).

Prior history:

Eczema
Hypertension
Osteopenia

Prior/current treatments and medications:

Topical cyclosporin A
Serum eye drops
Lozenges
Pilocarpine

Clinical presentation and reported impact:

Has trouble swallowing and speaking, particularly in the morning
Constantly feels like she has gritty eyes, which makes driving difficult
Only has energy to complete 1 or 2 chores at a time before needing to take a break
Requires frequent naps to get through the day

Current lab assessments and physical exam:

Patient history:

Questions to help uncover additional manifestations:

“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; 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; UWSFR, unstimulated whole salivary flow rate.