You are: a Certified Medical Assistant working with Susan Lee, MD, a primary care physician at Fulwood Medical Center.

Your patient is: Mrs. Helen Schreiber, a 45-year-old high school principal. Your task is to document her care.

Documentation.

Mrs. Helen Schreiber, a 45-year-old high school principal, presents with a 6-month history of dry mouth, bleeding gums, and difficulty in chewing and swallowing food.

Questioning by Dr. Susan Lee, her primary care physician, reveals that she also has dry eyes, is having pain in some joints of both hands, and has felt fatigued. Her previous medical history is uneventful. Physical examination shows a dry mouth, mild gingivitis, and an ulcer on the back of the lower lip. Her salivary glands are not swollen. Her eyes show no ulceration or conjunctivitis. The metacarpophalangeal joints of both index fingers are swollen, stiff, and tender. All other systems show no abnormality.

Initial laboratory reports show anemia, decreased WBC count, and an elevated ESR. Dr. Lee made a provisional diagnosis of Sjogren syndrome. The results of blood studies for SSA and SSB antibodies (Sjögren syndrome antibodies A and B) and for rheumatoid factor titers are pending, as are x-rays of her hands. Mrs. Schreiber was given advice about symptomatic treatment for her dry mouth and will be seen again in 1 week. Luisa Guitterez, CMA 06/12/12, 1530 hrs.

Based on the above case report, answer the following question.
What other complaints does Dr. Lee discover on further questioning of the patient?