Would you start hydroxychloroquine (or another DMARD) in a mid-20s female patient with positive ANA, SSA, SSB, and dsDNA, whose only clinical manifestation is intermittent parotid gland swelling?  

Hmm... I think the better question to ask is, do you code as Sjogren's lupus overlap to get way more medication options? Certainly, HCQ is a reasonable DMARD and a place to start for both diseases. I would code as lupus and Sjogren's to have more options for the future. Hope someone can weigh in on ...

If there are absolutely no other clinical symptoms such as oral/ocular sicca (usually seen in Sjogren's) or other symptoms of SLE (photosensitive rashes, complement abnormalities, CBC abnormalities), I would keep an open differential diagnosis and consider alternative causes of intermittent parotid ...

I absolutely would offer HCQ (using shared decision-making, of course, as recommended by Dr. @Abhishek Nandan). Though there is no strong data to show that HCQ prevents recurrent parotitis, after taking care of many patients with SLE/SjD overlap over the past 3 decades, I can say that those patients...

Given the serologies, would follow for likely Sjogren's vs UCTD and would monitor for other organ involvement (of course) and also any other manifestations that may arise that are more likely to have potential response to HCQ (inflammatory arthralgia, rashes, +/- fatigue). Hydroxychloroquine is reas...

YES! This is parotitis and needs treatment it prevent long-term gland damage.