A 50 -year-old shopkeeper has plaques on the extensor surfaces of her upper limbs. She complains of pain in her hands. On examination there is a telescoping deformity of both index fingers. The nails show pining and horizontal ridging. From what is she most probably suffering?

A 45-year-old woman with a history of flitting joint pains comes to the Rheumatology Clinic for review. She has suffered from dry eyes and has felt like she has not had enough spit in her mouth to enable her to chew her food. On examination her eyes look red and sore, you notice cracking and drying of her lips. You suspect Sjogren's. Which of the following would be supportive of a Sjogren's diagnosis? 

A patient with type 1 diabetes mellitus has been complaining of a 3-month history of right shoulder pain. She describes this as a frozen shoulder, and says it hurts to move her shoulder at all. What is the most likely diagnosis?

A 67-year-old woman presents with a 10-week history of pain affecting the cervical spine, both shoulders, lumbar spine and both hips. Early morning stiffness lasts until luncht ime and she feels markedly tired. She has a low-grade pyrexia of 37.4 •c, bilateral knee effusions and a right carpal tunnel syndrome. Investigations reveal: normochromic normocytic anaemia wit h haemoglobin 10.1 g/dl, erythrocyte sedimentation rate (ESR) 81 mm in 1st hour, C-reactive protein (CRP) 27 mg/I, negative rheumatoid factor, serum immunoglobulins and protein electrophoresis show a polyclonal increase in gammaglobulins and elevated a1- and a2-globulins. What is the most likely diagnosis?