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Peripheral spondyloarthritis — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesPeripheral spondyloarthritisSCE Rheumatology

A 32-year-old woman has recurrent heel pain, knee swelling and a history of psoriasis. Examination shows plantar fascia tenderness and a small knee effusion. She has no spinal pain. The clinician wants to document active enthesitis and synovitis to guide escalation. What is the most appropriate investigation?

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Correct answer: B — Musculoskeletal ultrasound with power Doppler

Explanation lettering: D = shown as A · E = shown as B · B = shown as D · A = shown as E

Musculoskeletal ultrasound with power Doppler is best because ultrasound with power Doppler can demonstrate enthesitis and synovitis in peripheral spondyloarthritis. A is less suitable because chest radiograph is not relevant to peripheral SpA assessment; B is less suitable because temporal artery biopsy is for suspected GCA; C is less suitable because UPCR screens nephritis rather than enthesitis; D is less suitable because RF alone does not assess active enthesitis. Clinical pearl: ultrasound is often used as an extension of examination in peripheral inflammatory arthritis.

Reference: NICE NG65; EULAR imaging recommendations