Increasingly Sjögren syndrome is being recognized in patients who are not Caucasian, the tennis player Venus Williams being a prominent example. We saw a 33-year-old African American woman who experienced severe fatigue eight months after a "viral infection." The problem was so disabling that she was on the point of either losing her job or resigning. After extensive workup by multiple consultants she had been diagnosed with euthyroid Hashimoto's thyroiditis. She had no signs of connective tissue disease other than occasional dry eyes, which could be related to the fact that she wears contact lenses. Her highest recorded TSH measurement was 9mU/L. Treatment with thyroxine failed. The ANA titer was 1:320-640.
Which of the following tests is least helpful for evaluation of fatigue in Sjögren syndrome?
• Sleep study
• Screening for depression
• Examination of tender points
• Serum vitamin B12
• Empiric treatment with immunosuppressives
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.)