Polyarteritis nodosa — SCE Rheumatology MCQ
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Correct answer: D — Rituximab is not routine first-line therapy
Rituximab is not routine first-line therapy is the single best answer because medium-vessel microaneurysms with neuropathy and no glomerulonephritis suggest polyarteritis nodosa. The stem is testing biologic selection, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Migraine is less suitable because it fits a different clinical pattern or a different treatment threshold; Sarcoidosis, Aspirin 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: BSR/EULAR vasculitis recommendations; NICE technology appraisals; BNF