Bone scan Paget disease — SCE Rheumatology MCQ

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ModerateMusculoskeletal InvestigationsBone scan Paget diseaseSCE Rheumatology

A 71-year-old man has isolated raised ALP with normal liver enzymes. Radiograph of the pelvis suggests Paget disease. He has mild skull pain and hearing loss. The clinician wants to define the full skeletal extent of metabolically active disease. What is the most appropriate investigation?

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Correct answer: A — Radionuclide bone scan

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

Radionuclide bone scan is best because bone scan maps the extent of active Paget disease across the skeleton. A is less suitable because synovial culture assesses septic arthritis; B is less suitable because Schirmer test assesses ocular dryness; C is less suitable because anti-CCP assesses RA; D is less suitable because ANCA titre assesses vasculitis context. Clinical pearl: Paget disease may be polyostotic and asymptomatic at some sites.

Reference: Endocrine Society Paget guideline; Oxford Textbook of Rheumatology