A 32 yrs old lady diagnosed as a case of Sjogren's syndrome with ANA immunoblot positive with SS A+ abs, RA positive, anti CCP negative, CRP - normal and clinical symptoms like B/L knee joint pain, skin rash on knee joint and muscular pain over calf muscle and neck pain and dryness of throat eye etc. She is prescribed with HCQS and symptomatic treatment and she has been given a short course of oral prednisolone 3 times until today, and she has been given injectable 2 ml of prednisolone IM as a single shot 15 days ago as she suffered from B/L knee joint reactive arthritis while she is on treatment for terminal ileitis.
She consulted another senior rheumatologist two days ago for the last event of reactive arthritis and he advised lip biopsy, B-Cd 19, serum level of IgG, IgM, IgA and IgG4 and routine tests and he wants to start rituximab injection (1000mg) IV twice at fortnight…
