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Psoriatic arthritis dactylitis — SCE Rheumatology MCQ

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HardSpondyloarthropathiesPsoriatic arthritis dactylitisSCE Rheumatology

A 39-year-old man with psoriasis has a swollen tender whole toe and forefoot pain. Examination shows nail onycholysis and Achilles tenderness are present. Investigations show plain radiograph shows no erosion. What is the most appropriate investigation?

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Correct answer: C — Musculoskeletal ultrasound of digits and entheses

The best answer is “Musculoskeletal ultrasound of digits and entheses”. Musculoskeletal ultrasound of digits and entheses most directly resolves the diagnostic or staging uncertainty at this point in the pathway; the other investigations answer different questions or have lower yield. The remaining choices—“Serum urate alone, after safety review”, “Temporal artery ultrasound, after specialist assessment”, “Nerve conduction studies, with clinical reassessment”, “Anti-dsDNA antibody, within a rheumatology pathway”—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 NG65 spondyloarthritis: https://www.nice.org.uk/guidance/ng65/chapter/Recommendations