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Lupus serositis — SCE Rheumatology MCQ

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ModerateConnective Tissue DiseasesLupus serositisSCE Rheumatology

A 72-year-old woman has known SLE, pleuritic chest pain, pleural and pericardial effusions, rising anti-dsDNA and falling complement with normal troponin. What is the most appropriate management?

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Correct answer: A — Treat active lupus with glucocorticoids and optimise steroid-sparing therapy

Treat active lupus with glucocorticoids and optimise steroid-sparing therapy is the single best answer because dual serosal inflammation with lupus serological activity supports lupus serositis. The stem is testing management choice, 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