Patient Case #1 v5

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Quiz Configuration

Which of the following best reflects this patient's Sjögren's disease activity?

Primarily sicca

Primarily functional, with sicca and intermittent quality-of-life impact

Systemic involvement beyond sicca, associated with high symptom burden

“Multisystemic disease with sicca and significant quality of life impact would be the more accurate classification here. Nancy’s symptoms go beyond dryness, with fatigue, neutropenia, synovitis, and myalgia all contributing to how she’s feeling. In my experience, that kind of burden often warrants a change in treatment.”

Ghaith Noaiseh, MD

“It goes beyond what I’d consider primarily sicca. The combination of dryness with fatigue, synovitis, and myalgia is significantly impacting her quality of life and points to multisystemic involvement.”

Primarily sicca

Ghaith Noaiseh, MD

“Functional doesn’t quite capture it for me. The dryness is just one piece; when you add in fatigue, synovitis, and myalgia and consider how much they’re disrupting her day-to-day life, it feels more consistent with a multisystemic impact.”

Primarily functional, with sicca and intermittent quality-of-life impact

Question 1 of 4

Question 2 of 4

What adjustments to the current treatment plan would you suggest?

Her symptoms are not serious and don’t require a change

Her symptoms suggest suboptimal disease control and warrant reevaluation

“I agree. Her symptoms suggest suboptimal disease control and warrant reevaluation. Nancy’s dryness, fatigue, neutropenia, synovitis, and myalgia are still present despite prior treatment, which tells me her disease may not be well controlled. It’s time to reassess her treatment plan.”

Ghaith Noaiseh, MD

“I do think her symptoms are significant enough to warrant change. Nancy is still dealing with dryness, fatigue, neutropenia, synovitis, and myalgia despite prior treatment, which makes me question whether her current plan is really controlling the disease. It may be time to take another look at our approach.”

Her symptoms are not serious and don’t require a change

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Which of the following should be prioritized to address the most critical unmet need in Nancy's care?

Her ocular symptoms have not improved with over-the-counter management

Her cardiovascular risk factors are not currently being managed by her PCP

Her persistent symptoms, despite hydroxychloroquine treatment, suggest a gap between clinical targets and the patient's quality of life

“Nancy is still experiencing ongoing symptoms and pain despite treatment. From my experience with patients with Sjögren's disease, this suggests we should consider a more comprehensive approach.”

Ghaith Noaiseh, MD

Question 3 of 4

Ghaith Noaiseh, MD

“Her persistent systemic symptoms should come first. While lack of relief from over-the-counter eye care is frustrating, it is the continued fatigue, synovitis, and myalgia that most affect her quality of life.”

Her ocular symptoms have not improved with over-the-counter management

Ghaith Noaiseh, MD

“Her persistent symptoms are the more pressing concern. Cardiovascular risk is important, of course, but it doesn’t explain the ongoing dryness, fatigue, synovitis, and myalgia that continue to limit her day-to-day life.”

Her cardiovascular risk factors are not currently being managed by her PCP

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If an approved biologic were available, would you recommend one to a patient like Nancy?

Yes

“Yes. Given Nancy’s ongoing synovitis, biologic therapy would be appropriate due to measured systemic involvement being present."

Ghaith Noaiseh, MD

Question 4 of 4

Ghaith Noaiseh, MD

“I’d still consider her a potential candidate for a biologic therapy. Even if it might seem early, Nancy has active synovitis, persistent sicca symptoms, moderate neutropenia, and minimal response to previous treatment. A biologic could address what prior therapy hasn’t.”

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