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Cervical myelopathy in rheumatoid arthritis — SCE Rheumatology MCQ

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ModerateInflammatory ArthritisCervical myelopathy in rheumatoid arthritisSCE Rheumatology

A 72-year-old woman has longstanding erosive rheumatoid arthritis, occipital pain, hand paraesthesia, brisk reflexes and suspected atlanto-axial subluxation on radiography. What is the most appropriate investigation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — MRI cervical spine

MRI cervical spine is the single best answer because neurological signs with cervical instability suggest rheumatoid cervical myelopathy. The stem is testing investigation selection, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Palindromic rheumatism is less suitable because it fits a different clinical pattern or a different treatment threshold; Erosive osteoarthritis, Hydroxychloroquine monotherapy and Etanercept do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: NICE NG100; BSR rheumatoid arthritis guideline; BNF