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Septic arthritis — SCE Rheumatology MCQ

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HardCrystal arthropathiesSeptic arthritisSCE Rheumatology

A 76-year-old has new temporal headache, jaw claudication and transient monocular visual loss. Prednisolone is started immediately. Where skilled vascular ultrasound is available the same day, what diagnostic test should be prioritised?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Ultrasound of temporal and axillary arteries without delaying glucocorticoid treatment

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

B is correct. EULAR recommends temporal and axillary artery ultrasound as first-line imaging for suspected GCA where expertise is available. It should be obtained promptly because glucocorticoids reduce imaging sensitivity, but sight-saving treatment must never wait for the scan. A deliberately reverses the timing principle. C relies on a treatment-responsive biomarker. D investigates an unrelated site. E can help selected large-vessel presentations but is not the sole immediate cranial assessment in a patient with visual ischaemia. Discordant imaging and clinical probability may still require biopsy or alternative imaging.

Reference: EULAR imaging recommendations in large-vessel vasculitis — 2023 update: https://ard.bmj.com/content/83/6/741