Rheumatoid cervical spine disease — SCE Rheumatology MCQ

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HardInflammatory ArthritisRheumatoid cervical spine diseaseSCE Rheumatology

A 70-year-old woman with erosive rheumatoid arthritis reports occipital pain, hand clumsiness and unsteady gait. Examination shows brisk reflexes and reduced vibration sense in both feet. She is being assessed before elective knee arthroplasty. Plain cervical radiographs have not been performed recently. What is the most appropriate investigation?

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Correct answer: B — MRI cervical spine

The best answer is “MRI cervical spine”. MRI cervical spine is best because neurological signs in long-standing RA raise concern for cervical myelopathy from atlantoaxial or subaxial disease, best assessed with MRI. nerve conduction studies can assess neuropathy but should not delay spinal imaging; DEXA assesses fracture risk rather than cord compression; shoulder ultrasound does not explain myelopathic signs; CT abdomen and pelvis is unrelated to the neurological syndrome. Clinical pearl: cervical spine instability in RA is particularly important before anaesthesia and intubation. The competing options represent related diagnoses, tests or treatments, but they do not match the decisive phenotype, safety constraint or management point in this stem.

Reference: NICE NG100 rheumatoid arthritis recommendations: https://www.nice.org.uk/guidance/ng100/chapter/Recommendations