ANCA-associated vasculitis — SCE Rheumatology MCQ

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EasyMusculoskeletal investigationsANCA-associated vasculitisSCE Rheumatology

A 29-year-old man has purpura, sinus symptoms and acute kidney injury. Examination shows blood pressure is elevated with ankle oedema. Investigations show urinalysis shows blood, protein and red-cell casts. The admitting team asks which diagnosis best explains the whole presentation. What is the most likely diagnosis?

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Correct answer: A — ANCA-associated vasculitis

ANCA-associated vasculitis is the best answer because the pattern described is most consistent with ANCA-associated vasculitis, including the distribution of symptoms and the targeted investigation results. Reactive arthritis is a plausible distractor, but it does not account for the key discriminator in the stem. Hydroxychloroquine retinopathy and Osteoporosis 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 hot swollen joint guideline; NICE NG100; EULAR imaging recommendations