UCTD — SCE Rheumatology MCQ

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EasyConnective Tissue DiseasesUCTDSCE Rheumatology

A 32-year-old woman has Raynaud's phenomenon, arthralgia and intermittent mouth ulcers for 18 months. ANA is 1:640 speckled, ENA is negative, anti-dsDNA is negative and complements are normal. There is no synovitis, nephritis, rash or skin thickening. Nailfold capillaroscopy is normal. What is the most likely diagnosis?

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Correct answer: D — Undifferentiated connective tissue disease

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

Undifferentiated connective tissue disease is best because persistent autoimmune symptoms with ANA positivity but insufficient disease-defining clinical or serological features fit undifferentiated connective tissue disease. B is less suitable because systemic sclerosis would need scleroderma features or abnormal capillaroscopy/antibodies; C is less suitable because RA requires persistent inflammatory synovitis; D is less suitable because APS requires thrombosis or pregnancy morbidity plus persistent aPL; E is less suitable because definite SLE is not supported by organ features, dsDNA or low complement. Clinical pearl: many ANA-positive patients require longitudinal review rather than premature labelling.

Reference: Oxford Textbook of Rheumatology; EULAR connective tissue disease recommendations