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:

What are some things you used to do easily that are now more difficult?
Do you find it hard to do tasks like brushing your hair or getting dressed?
Do you feel unsteady on your feet, or have you had any falls?
Have you noticed any shortness of breath with mild exertion (eg, walking around the block)?
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 had any joint stiffness in the morning or trouble climbing stairs or standing up from a chair? Any muscle pain?
Are you having any trouble holding or opening objects?
Have you been experiencing any new difficulty with speaking or singing?

“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.