How would you approach evaluation and management of a patient with chronic arthralgias and bilateral hand weakness who has a positive ANA (1:160) and low-titer anti-SSB positivity, in the setting of otherwise negative ENA panel, normal inflammatory markers, normal complement levels and immunoglobulins, and unrevealing EMG/NCS testing?

The low titer SSB/La antibody would only factor into the consideration of SjD if there were other suggestive features, like documented hypo salivation and/or high ocular staining score, neuropathy, etc.

Would learn when they were totally well and what potential triggering events may have occurred.

I...

In order to answer this question, I'm going to make a few assumptions: this is an adult patient, there are no other neurologic signs or symptoms, there is no synovitis on exam, there is no apparent hand weakness on exam, and basic lab testing like complete blood count (CBC), comprehensive metabolic ...

Agreed, I have done the same. If clearly having inflammatory symptoms or photosensitivity, I would add hydroxychloroquine. Education is key here. It would explain the risks of hydroxychloroquine and possible benefits. Since all patients may not present with classic symptoms, no harm in doing a trial...

There is probably a reasonable role for diagnostic ultrasound of the salivary glands in this setting. It is possible to have a normal scan provide reassurance or watchful waiting over starting therapy. The review by Dai et al., PMID 37658892, supports the use of salivary gland ultrasound to make dec...

I agree with my colleagues' answers, especially considering treating with HCQ, but only if inflammatory arthralgia is most likely (and I would use MSK ultrasonography to help determine this, as Dr. @Dr. First Last recommends). However, I would strongly consider alternative diagnoses (e.g., OA pain, ...