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Seronegative rheumatoid arthritis — SCE Rheumatology MCQ

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ModerateInflammatory ArthritisSeronegative rheumatoid arthritisSCE Rheumatology

A 36-year-old man has symmetrical wrist and MCP synovitis for 5 months with prolonged morning stiffness, raised ESR, negative rheumatoid factor and negative anti-CCP; ultrasound shows power Doppler synovitis. What is the most likely diagnosis?

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Correct answer: D — Seronegative rheumatoid arthritis

Seronegative rheumatoid arthritis is the single best answer because seronegative rheumatoid arthritis remains likely when persistent symmetrical inflammatory synovitis is documented. The stem is testing diagnostic synthesis, 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