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Granulomatosis with polyangiitis — SCE Rheumatology MCQ

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HardVasculitisGranulomatosis with polyangiitisSCE Rheumatology

A 38-year-old woman has chronic sinusitis, haemoptysis and weight loss. Examination shows nasal crusting and purpura are present. Investigations show PR3-ANCA is positive with haematuria. 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: E — ANCA testing

ANCA testing is the best answer because anca testing is the investigation most likely to resolve the immediate diagnostic or monitoring question in granulomatosis with polyangiitis. Urinalysis is a plausible distractor, but it does not account for the key discriminator in the stem. CT angiography and Tissue biopsy would be more appropriate in a different clinical pattern or at another point in the pathway, while Ultrasound-guided aspiration is suboptimal for this presentation. Clinical pearl: autoantibodies are supportive tests and should be interpreted alongside phenotype, inflammatory markers, urinalysis and imaging.

Reference: BSR GCA guideline; EULAR ANCA-associated vasculitis recommendations; BNF