Myositis requiring biopsy — SCE Rheumatology MCQ

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EasyMusculoskeletal InvestigationsMyositis requiring biopsySCE Rheumatology

A 24-year-old man has proximal weakness, CK 3800 IU/L, thigh MRI muscle oedema and negative myositis antibodies, with inclusion body myositis in the differential. What is the most appropriate investigation?

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Correct answer: E — Muscle biopsy

Muscle biopsy is the single best answer because biopsy helps define inflammatory myopathy subtype when serology is negative. The stem is testing investigation selection, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Synovial fluid microscopy, Gram stain and culture is less suitable because it fits a different clinical pattern or a different treatment threshold; MRI of the sacroiliac joints, High-resolution CT chest and Renal biopsy 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: BSR hot swollen joint guidance; EULAR imaging/autoantibody recommendations