A 60-year-old female complains of dry mouth and a gritty sensation in her eyes. She states it is sometimes difficult to speak for more than a few minutes. There is no history of diabetes mellitus or neurologic disease. The patient is on no medications. On exam, the buccal mucosa appears dry and the salivary glands are enlarged bilaterally. The next step in evaluation is

(Braunwald, 15/e, pp 1947-1949.) The complaints described are characteristic of Sjogren syndrome, an autoimmune disease with presenting symptoms of dry eyes and dry mouth. The disease is caused by lymphocytic infiltration and destruction of lacrimal and salivary glands. Dry eyes can be measured objectively by the Schirmer test, which measures the amount of wetness of a piece of filter paper when exposed to the lower eyelid for 5 minutes. Most pati ents with Sjogren syndrome produce auto- antibodies, paicularly anti-Ro (SSA). Lip biopsy is needed only to evaluate unceain cases, such as when dry mouth occurs without dry eye symptoms.Mumps can cause bilateral parotitis, but would not explain the patient's dry eye syndrome. Coicosteroids are reserved for life-threatening vasculitis, paicularly when renal or pulmonary disease is severe.