A 42-year-old female presents for a follow-up visit regarding persistent sicca symptoms and arthralgias. She was recently diagnosed with an autoimmune condition based on serological markers and a positive minor salivary gland biopsy. She reports significant difficulty with dry eyes, requiring frequent artificial tears, and dry mouth affecting her ability to eat dry foods. She also mentions ongoing generalized muscle aches and fatigue that impact her daily activities. Her past medical history includes Hashimoto's thyroiditis and peripheral neuropathy. Her current medications include levothyroxine and gabapentin. On physical examination, she exhibits bilateral parotid gland enlargement and evidence of dental erosion. Ocular examination reveals reduced tear production, and a vaginal examination shows mucosal dryness with mild erythema. Given her established diagnosis and current symptoms, what is the most appropriate initial management strategy for her sicca symptoms and what serious long-term complication should be regularly monitored?

A 32-year-old woman presents to her general internist with a 2-year history of persistent dry eyes and dry mouth. She reports waking with a gritty sensation in her eyes, often feeling as if foreign particles are present. Consuming dry foods is difficult without copious amounts of water, and she has noted an increasing difficulty speaking for extended periods due to oral dryness. She also mentions experiencing persistent fatigue and intermittent arthralgia affecting her small joints. Her ophthalmologist previously confirmed significant ocular surface dryness consistent with keratoconjunctivitis sicca and prescribed artificial tears, which provide only partial relief. On physical examination, her vital signs are stable. Inspection reveals noticeable bilateral enlargement of the parotid and lacrimal glands. Oral examination shows minimal pooled saliva under the tongue and a dry oral mucosa. The remainder of her physical examination, including joint assessment, is otherwise unremarkable. Given her ongoing symptoms and clinical presentation, what is the most appropriate next diagnostic step and initial symptomatic management strategy?

A 48-year-old woman, diagnosed with primary Sjögren's syndrome five years ago, presents for a routine follow-up. She reports persistent ocular and oral dryness, managed with artificial tears and oral lubricants. However, over the past six months, she has experienced increasing fatigue, diffuse arthralgias, and a recent unexplained weight loss of 3 kg. On examination, significant dental caries are noted, and her parotid glands remain diffusely enlarged. She exhibits mild non-erosive synovitis in her metacarpophalangeal joints. Her neurological exam reveals no focal deficits. Considering her clinical progression, what is the most appropriate long-term management strategy and what significant complication should be closely monitored?