Dermatomyositis — SCE Rheumatology MCQ

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ModerateConnective Tissue DiseasesDermatomyositisSCE Rheumatology

A 41-year-old woman has heliotrope rash, Gottron papules and proximal weakness. CK is 2,900 IU/L and ANA is positive. She also has dysphagia. The clinician wants to confirm inflammatory myopathy and assess distribution of active muscle inflammation before biopsy. What is the most appropriate investigation?

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Correct answer: B — MRI of proximal muscles

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

MRI of proximal muscles is best because MRI can demonstrate muscle oedema and guide biopsy in suspected inflammatory myopathy. A is less suitable because hand radiographs do not assess muscle inflammation; B is less suitable because serum urate is not relevant to dermatomyositis confirmation; D is less suitable because DEXA assesses bone density; E is less suitable because temporal artery biopsy is for suspected GCA. Clinical pearl: MRI is useful when weakness, CK elevation and rash suggest myositis but biopsy targeting matters.

Reference: BSR idiopathic inflammatory myopathy guideline 2022