A 52-year-old with rheumatoid arthritis presenting with decreased tearing and a gritty feeling in the eyes most likely has which condition?

The condition most likely affecting the 52-year-old patient with rheumatoid arthritis, characterized by decreased tearing and a gritty feeling in the eyes, is Sjogren's syndrome. This syndrome is an autoimmune disorder that primarily affects moisture-producing glands, leading to dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia). It often coexists with other autoimmune diseases, such as rheumatoid arthritis, and is marked by the presence of symptoms related to dryness due to glandular inflammation.

The nonspecific symptom of a gritty feeling in the eyes, coupled with the patient's history of rheumatoid arthritis, strongly points towards Sjogren's syndrome because it indicates a significant reduction in tear production. This decrease results in ocular discomfort and can lead to more serious complications if left untreated.

While other autoimmune conditions like systemic lupus erythematosus and scleroderma can present with a variety of symptoms, they do not primarily manifest the hallmark features of dry eyes and dry mouth as prominently as Sjogren's syndrome does. Vasculitis, although related to systemic inflammation and autoimmune processes, typically presents with vascular inflammation and specific systemic symptoms rather than primary ocular dryness. Therefore, Sjogren's syndrome is the most fitting diagnosis in this context.