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Suspected hip osteoarthritis — SCE Rheumatology MCQ

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HardOsteoarthritis and soft tissue rheumatologySuspected hip osteoarthritisSCE Rheumatology

A 72-year-old woman has groin pain worse on walking and difficulty putting on socks. Examination shows hip internal rotation is reduced and painful. Investigations show there is no fever or raised inflammatory marker. What is the most appropriate investigation?

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Correct answer: B — Plain radiograph of the pelvis and affected hip

The best answer is “Plain radiograph of the pelvis and affected hip”. Plain radiograph of the pelvis and affected hip 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—“MRI sacroiliac joints, within a rheumatology pathway”, “Synovial biopsy, after safety review, after safety review”, “Temporal artery ultrasound, with clinical reassessment, after specialist assessment”, “Anti-CCP antibody, within a rheumatology pathway, 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 NG226 osteoarthritis: https://www.nice.org.uk/guidance/ng226/chapter/Recommendations