Rheumatoid arthritis extra-articular disease — SCE Rheumatology MCQ

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ModerateInflammatory ArthritisRheumatoid arthritis extra-articular diseaseSCE Rheumatology

A 63-year-old man with rheumatoid arthritis has progressive exertional breathlessness and basal crackles. He has taken methotrexate for 9 years with stable blood tests. Chest radiograph shows basal reticulation. Oxygen saturation drops from 96% to 90% after walking 100 metres. What is the most appropriate investigation?

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Correct answer: D — High-resolution CT chest and pulmonary function tests

Explanation lettering: D = shown as C · C = shown as D

High-resolution CT chest and pulmonary function tests is best because HRCT and lung function testing are appropriate to assess suspected RA-associated interstitial lung disease. A is less suitable because RF titre does not evaluate pulmonary involvement; B is less suitable because DEXA assesses osteoporosis rather than breathlessness; D is less suitable because shoulder ultrasound is unrelated; E is less suitable because hand radiographs do not assess lung disease. Clinical pearl: RA-associated ILD may be more clinically important than articular progression in older seropositive men.

Reference: BSR RA guidance; ERS/EULAR CTD-ILD guidance