Adult-onset Still's disease — SCE Rheumatology MCQ

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EasyConnective Tissue DiseasesAdult-onset Still's diseaseSCE Rheumatology

A 31-year-old woman has quotidian fever, evanescent salmon rash, inflammatory arthritis, neutrophilia, ferritin 18000 micrograms/L and negative ANA/RF after infection exclusion. What is the most likely diagnosis?

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Correct answer: C — Adult-onset Still's disease

Adult-onset Still's disease is the single best answer because spiking fever, evanescent rash, arthritis and very high ferritin suggest adult-onset Still's disease. The stem is testing diagnostic synthesis, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Mixed connective tissue disease is less suitable because it fits a different clinical pattern or a different treatment threshold; Primary Sjögren's disease, Repeat ANA titre alone and Adalimumab 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/EULAR connective tissue disease recommendations; BNF