Mixed connective tissue disease — SCE Rheumatology MCQ

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ModerateConnective tissue diseasesMixed connective tissue diseaseSCE Rheumatology

A 24-year-old man has Raynaud phenomenon, swollen hands, arthralgia and dysphagia. Examination shows there is puffy hand swelling and mild synovitis. Investigations show anti-U1-RNP antibody is strongly positive. The admitting team asks which diagnosis best explains the whole presentation. What is the most likely diagnosis?

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Correct answer: B — Mixed connective tissue disease

Mixed connective tissue disease is the best answer because the pattern described is most consistent with Mixed connective tissue disease, including the distribution of symptoms and the targeted investigation results. Enthesitis-related arthritis is a plausible distractor, but it does not account for the key discriminator in the stem. Palindromic rheumatism and Acute CPP crystal arthritis would be more appropriate in a different clinical pattern or at another point in the pathway, while Rotator cuff tendinopathy is suboptimal for this presentation. Clinical pearl: in SCE-style questions, the decisive clue is usually the pattern across joints, extra-articular features and targeted immunology rather than a single antibody result.

Reference: BSR SLE guideline; EULAR SLE and systemic sclerosis recommendations; BNF