Patient Case #2 v5

Next Question >

Number of questions to ask? This layer SDK payload 0 (ask all) or number to display eg. 5

Randomize question order? This layer SDK payload 1 (yes) or 0 (no)

Question Timer in seconds? This layer SDK payload number of seconds

Timer on answering question? This layer SDK payload 1 (yes) or 0 (no)

Delay on auto advance in seconds? This layer SDK payload number of seconds

Auto advance to next question post submit? This layer SDK payload 1 (yes) or 0 (no)

Submit on first click? (user can't change their mind) This layer SDK payload 1 (yes) or 0 (no)

Show correct answer? This layer SDK payload 1 (yes) or 0 (no)

Quiz Configuration

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

Primarily sicca

Systemic disease activity, functional with sicca and intermittent quality-of-life impact

Multisystemic disease with sicca and significant quality-of-life impact

"Multisystemic disease with sicca and significant quality-of-life impact is the most accurate description. In addition to sicca, Martha is experiencing recurrent parotid gland swelling and moderate neutropenia. This means that multiple organs and systems are involved."

Ghaith Noaiseh, MD

“I wouldn’t describe her presentation as primarily sicca. Martha’s persistent gland swelling and fatigue, in addition to vaginal dryness, point more toward a primarily functional symptom burden with intermittent quality-of-life impact.”

Primarily sicca

Ghaith Noaiseh, MD

"This is more consistent with multisystemic disease with sicca and significant quality-of-life impact. Martha is experiencing recurrent parotid gland swelling and moderate neutropenia, and her dryness is affecting her diet, intimacy, and emotional well being. This indicates the presence of multisystemic disease."

Systemic disease activity, 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 that 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. Ongoing parotid gland swelling and fatigue, despite prior treatment, tell me the current plan may not be adequately controlling her disease, and a reassessment of treatment options could help identify a better approach.”

Ghaith Noaiseh, MD

“Her symptoms suggest the current treatment may not be meeting her needs. Martha’s persistent fatigue, parotid gland swelling, and vaginal dryness tell me it’s worth reevaluating her plan to ensure we’re addressing her full symptom burden.”

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

Next Question >

What does Martha's persistent salivary gland swelling—despite dryness symptoms, normal IgG, and complement levels—suggest?

Potential ongoing inflammation of the salivary tissues

A sign of dehydration

An unrelated ENT condition

“Ongoing inflammation is a more likely cause than an ENT disease. In a patient with established Sjögren’s disease like Martha, persistent swelling—especially with supportive imaging—usually reflects disease activity.”

Ghaith Noaiseh, MD

Question 3 of 4

Ghaith Noaiseh, MD

“Potential ongoing inflammation of the salivary tissues is the most likely explanation, since ENT ruled out ductal obstruction. Visible and persistent swelling of the parotid glands, especially with ultrasound confirmation, can reflect disease activity even when IgG and complement levels are normal.”

Potential ongoing inflammation of the salivary tissues

Ghaith Noaiseh, MD

“Although dehydration can increase the risk of salivary gland infection and swelling, ongoing inflammation of the parotid glands is more likely a reflection of active Sjögren's disease, even in the absence of inflammatory changes on her laboratory tests.”

A sign of dehydration

Next Question >

If an approved biologic were available, would you recommend it to a patient like Martha?

Yes

"Yes, a biologic would be appropriate here. Martha is dealing with persistent parotid gland swelling, which reflects measurable glandular involvement. Persistent glandular involvement and moderate neutropenia suggests the presence of systemic disease beyond sicca and warrants treatment escalation."

Ghaith Noaiseh, MD

Question 4 of 4

Ghaith Noaiseh, MD

“I would still recommend a biologic treatment. While some of Martha’s symptoms may appear limited to sicca, her persistent parotid gland swelling and moderate neutropenia, along with vaginal dryness and fatigue, suggest that her disease may not be adequately controlled.”

Next >

final score

View more patient cases >

Thanks for diving deeper into Sjögren's disease!

Would you like to review more patient cases?

Retake quiz