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Anti-U1 RNP overlap disease — SCE Rheumatology MCQ

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HardMusculoskeletal InvestigationsAnti-U1 RNP overlap diseaseSCE Rheumatology

A 28-year-old woman has Raynaud's, swollen fingers, synovitis, mild myositis and strongly positive anti-U1 RNP antibodies. What is the most appropriate investigation?

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Correct answer: B — ENA profile and cardiopulmonary screening

The best answer is “ENA profile and cardiopulmonary screening”. ENA profile and cardiopulmonary screening 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—“Synovial fluid microscopy, Gram stain and culture”, “MRI of the sacroiliac joints”, “High-resolution CT chest, after specialist assessment”, “Renal biopsy, 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: BSR 2024 systemic sclerosis guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC11534099/