A 55-year-old man with long-standing seropositive rheumatoid arthritis presents with dry eyes and dry mouth for 8 months. Schirmer test is 3 mm in both eyes. Lip biopsy shows focal lymphocytic sialadenitis with a focus score of 3 foci per 4 mm2. Anti-SSA (Ro) and anti-SSB (La) antibodies are positive. Which of the following best describes this condition?
- A Primary Sjogren syndrome
- B Secondary Sjogren syndrome ✓
- C IgG4-related disease
- D Sarcoidosis
Correct answer: B. Secondary Sjogren syndrome
Explanation
Secondary Sjogren syndrome occurs in the context of another autoimmune disease, most commonly rheumatoid arthritis. The 2016 ACR/EULAR classification criteria for primary Sjogren require anti-SSA/SSB positivity or focal lymphocytic sialadenitis with focus score >/=1, plus objective dry eye and dry mouth measures. When these features coexist with established RA, it is classified as secondary Sjogren. IgG4-related disease shows storiform fibrosis and IgG4-positive plasma cells, not seen here.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.