Rheumatoid vasculitis — SCE Rheumatology MCQ

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ModerateInflammatory ArthritisRheumatoid vasculitisSCE Rheumatology

A 53-year-old woman has severe nodular rheumatoid arthritis with digital infarcts, livedo reticularis, foot drop, low complement and high inflammatory markers. What is the most appropriate management?

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Correct answer: A — Admit for high-dose glucocorticoids and immunosuppression after excluding infection

Admit for high-dose glucocorticoids and immunosuppression after excluding infection is the single best answer because mononeuritis multiplex and digital infarcts in severe seropositive rheumatoid arthritis suggest rheumatoid vasculitis. The stem is testing management choice, 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