26th February 2025

You see a 36-year-old female in rheumatology clinic.

You see a 36-year-old female in rheumatology clinic. She has been feeling generally run down and exhausted for months, to the point where she has had to take time off from her job as a corporate lawyer.

She also has widespread joint and muscle aches, which are present throughout the day, with no significant morning stiffness. She has no skin rashes or nail changes. She has noted some hair loss; however, this has been a problem for many years. She is a contact lens-wearer; however has recently stopped wearing them as she started finding they were too uncomfortable due to dryness. On direct questioning, she tells you she has been experiencing some dryness ‘down below’ and has experienced some dyspareunia. She also feels a sensation of dryness in the mouth; however, she has put all this down to being dehydrated from not drinking enough water in her busy job.

On examination, there is no skin rash, no evidence of synovitis, and muscle power is normal throughout.

She has some blood tests, which are demonstrated below:

 What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.