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Early RA imaging — SCE Rheumatology MCQ

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HardMusculoskeletal investigationsEarly RA imagingSCE Rheumatology

A 46-year-old woman has swollen MCP joints for 10 weeks. Examination shows symmetrical synovitis but hand radiographs are normal. Anti-CCP is positive and CRP is raised. What is the most appropriate investigation?

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Correct answer: BMusculoskeletal ultrasound of hands and wrists

The best answer is “Musculoskeletal ultrasound of hands and wrists”. Musculoskeletal ultrasound of hands and wrists 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—“CT abdomen, with clinical reassessment”, “DEXA scan, within a rheumatology pathway”, “Temporal artery ultrasound, after safety review”, “Schirmer test, after specialist assessment”—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: British Society for Rheumatology clinical guidelines: https://academic.oup.com/rheumatology/pages/clinical-guidelines