Anti-RNA polymerase III systemic sclerosis — SCE Rheumatology MCQ

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ModerateMusculoskeletal InvestigationsAnti-RNA polymerase III systemic sclerosisSCE Rheumatology

A 53-year-old woman has rapidly progressive proximal skin thickening, tendon friction rubs, new hypertension and anti-RNA polymerase III antibodies. What is the most likely diagnosis?

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Correct answer: D — Diffuse cutaneous systemic sclerosis

Diffuse cutaneous systemic sclerosis is the single best answer because anti-RNA polymerase III predicts diffuse systemic sclerosis and renal crisis risk. The stem is testing diagnostic synthesis, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Rheumatoid arthritis is less suitable because it fits a different clinical pattern or a different treatment threshold; Systemic lupus erythematosus, Psoriatic arthritis and Gout 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 hot swollen joint guidance; EULAR imaging/autoantibody recommendations