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Basic calcium phosphate disease — SCE Rheumatology MCQ

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HardCrystal ArthropathiesBasic calcium phosphate diseaseSCE Rheumatology

A 70-year-old woman has acute severe shoulder pain. Radiograph shows amorphous calcification in the supraspinatus tendon and ultrasound shows calcific tendinopathy with subacromial bursitis. Synovial fluid has no urate or CPP crystals under polarised light. What is the most likely diagnosis?

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Correct answer: A — Basic calcium phosphate crystal disease

The best answer is “Basic calcium phosphate crystal disease”. The full clinical pattern is most consistent with Basic calcium phosphate crystal disease; competing diagnoses share isolated features but not the decisive combination described. The remaining choices—“Polymyalgia rheumatica, with clinical reassessment”, “Septic arthritis, within a rheumatology pathway”, “Gout, after safety review”, “Rheumatoid arthritis, with clinical reassessment”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: NICE NG219 gout: https://www.nice.org.uk/guidance/ng219/chapter/Recommendations