Palindromic rheumatism — SCE Rheumatology MCQ

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EasyRheumatoid arthritisPalindromic rheumatismSCE Rheumatology

A 33-year-old woman has recurrent 24-hour attacks of swelling affecting different hand joints. Examination shows the joints are normal between attacks. Investigations show anti-CCP is positive but radiographs show no erosions. The admitting team asks which diagnosis best explains the whole presentation. What is the most likely diagnosis?

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Correct answer: D — Palindromic rheumatism

Palindromic rheumatism is the best answer because the pattern described is most consistent with Palindromic rheumatism, including the distribution of symptoms and the targeted investigation results. Septic arthritis is a plausible distractor, but it does not account for the key discriminator in the stem. Gout and CPP crystal arthritis would be more appropriate in a different clinical pattern or at another point in the pathway, while Leflunomide hepatotoxicity 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: NICE NG100; BSR biologic/targeted DMARD safety guideline; BNF