A 55-year-old woman with a 10-year history of RA on methotrexate and etanercept develops dry eyes, dry mouth, parotid enlargement, and positive anti-Ro and anti-La antibodies. Which additional autoantibody, if strongly positive, would raise concern for lymphoma development?
- A Anti-CCP (cyclic citrullinated peptide)
- B Anti-centromere antibody
- C Anti-dsDNA antibody
- D Cryoglobulinemia (type II, rheumatoid factor + monoclonal IgM) ✓
Explanation
In primary Sjögren's syndrome (this presentation indicates overlapping secondary Sjögren's), the development of type II cryoglobulinemia (mixed cryoglobulinemia with monoclonal IgM rheumatoid factor plus polyclonal IgG) is a strong risk marker for progression to MALT lymphoma (marginal zone B-cell lymphoma), the most common lymphoma in Sjögren's. Other risk factors for lymphoma in Sjögren's include persistent parotid enlargement, palpable purpura, low C4, and high Foci score on biopsy. Anti-CCP is specific for RA, anti-centromere for limited scleroderma, and anti-dsDNA for SLE.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.