Palindromic rheumatism — SCE Rheumatology MCQ

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HardRheumatoid arthritisPalindromic rheumatismSCE Rheumatology

A 39-year-old man reports abrupt episodes of painful swelling affecting one wrist or knee, each resolving completely within 48 hours. Examination shows no persistent synovitis between attacks. Investigations show anti-CCP positive, RF negative and normal radiographs. What is the most likely diagnosis?

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Correct answer: E — Palindromic rheumatism

The best answer is “Palindromic rheumatism”. The full clinical pattern is most consistent with Palindromic rheumatism; competing diagnoses share isolated features but not the decisive combination described. The remaining choices—“Early rheumatoid arthritis, with clinical reassessment”, “Intermittent hydrarthrosis, after safety review”, “Reactive arthritis, after specialist assessment”, “Gout, with clinical reassessment”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG100 rheumatoid arthritis in adults: https://www.nice.org.uk/guidance/ng100/chapter/Recommendations