Pathology · patient case question
The strongly positive anti-SSA (Ro) result points most directly to which diagnosis?
Patient case: The mouth that will not stay wet
demo: 54-year-old female
chief: Burning, sticky mouth for the past eight months; food gets caught and she wakes at night to sip water.
history: Hashimoto thyroiditis. Her rheumatologist ordered an autoantibody panel after she reported gritty, burning eyes.
meds: Levothyroxine 75 mcg daily. Amitriptyline 25 mcg at night for chronic tension headache.
findings: Anti-SSA (Ro) strongly positive. Salivary pooling is absent; the mucosa is dry and the tongue is fissured with papillary atrophy. Cracking and erythema at both commissures. Two new cervical lesions since her last visit a year ago.
Show answer and explanation
Correct answer: D. Sjogren syndrome
- A. Systemic sclerosis is associated with anti-Scl-70 (topoisomerase I) in diffuse disease and anticentromere antibodies in limited disease.
- B. Rheumatoid arthritis is characterised serologically by rheumatoid factor and anti-CCP antibodies. Anti-SSA may appear in RA patients with secondary Sjogren, but it is not the marker of RA itself.
- C. Anti-SSA can appear in lupus, particularly in subacute cutaneous and neonatal lupus, but the dry eyes and dry mouth in a patient with another autoimmune endocrine disease make Sjogren the far better fit.
- D. Correct. Anti-SSA (Ro) and anti-SSB (La) are the hallmark serologies of Sjogren syndrome, an autoimmune exocrinopathy that destroys salivary and lacrimal tissue. The combination with an existing autoimmune thyroid disease is a very typical clustering.