A 47-year-old woman with a 12-month history of dry mouth and eyes presented with painful bilateral swelling, which was markedly more prominent and painful on the left. She complained of fatigue and polyarthralgias. She was taking levothyroxine for hypothyroidism, and had taken two courses of antibiotics for infection and later prednisone(Drug information on prednisone) (5-20 mg/day) for the parotid swelling. She denied fevers, weight loss, malaise, and night sweats.
Lab results showed anemia (Hgb 9.8 g/dl), mild thrombocytopenia, positive ANA (1:32), ESR=6-, abnormal salitary scintigraphy, and anti-SSB. A biopsy of the lymph glads showed focal lymphocytic sialadenitis.
Which test would you order first?
• PET/CT of head and neck
• MRI scan of head/neck
• Parotid tail biopsy
• Complement C4/cryoglobulins
• Noncontrast CT of neck
Check your answer against other rheumatologists.* (Favored response is in bold face.)
* (Adapted from presentation and responses at a Curbside Consult session during the 2012 annual meeting of the American College of Rheumatology.)