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Rheumatoid arthritis — SCE Rheumatology MCQ

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ModerateRheumatoid arthritisRheumatoid arthritisSCE Rheumatology

A 58-year-old man has 4 months of symmetrical pain and early morning stiffness in the small joints of both hands. Examination shows bilateral MCP and PIP synovitis with reduced grip. Investigations show anti-CCP is positive and CRP is raised. The consultant wants the next test most likely to confirm the suspected process or guide treatment. The result will change diagnosis, staging or immediate treatment. What is the most appropriate investigation?

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Correct answer: C — Musculoskeletal ultrasound

Musculoskeletal ultrasound is the best answer because musculoskeletal ultrasound is the investigation most likely to resolve the immediate diagnostic or monitoring question in rheumatoid arthritis. Chest radiograph is a plausible distractor, but it does not account for the key discriminator in the stem. Synovial fluid microscopy and MRI cervical spine would be more appropriate in a different clinical pattern or at another point in the pathway, while CT angiography is suboptimal for this presentation. Clinical pearl: autoantibodies are supportive tests and should be interpreted alongside phenotype, inflammatory markers, urinalysis and imaging.

Reference: NICE NG100; BSR biologic/targeted DMARD safety guideline; BNF