Polyarteritis nodosa — SCE Rheumatology MCQ

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HardVasculitisPolyarteritis nodosaSCE Rheumatology

A 63-year-old woman has fever, weight loss, abdominal pain and mononeuritis multiplex. Examination shows livedo reticularis and tender nodules are present. Investigations show ANCA is negative and hepatitis B serology is positive. The admitting team asks which diagnosis best explains the whole presentation. What is the most likely diagnosis?

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Correct answer: D — Polyarteritis nodosa

Polyarteritis nodosa is the best answer because the pattern described is most consistent with Polyarteritis nodosa, including the distribution of symptoms and the targeted investigation results. Behçet disease is a plausible distractor, but it does not account for the key discriminator in the stem. Osteoarthritis and Neonatal lupus risk would be more appropriate in a different clinical pattern or at another point in the pathway, while Reactive arthritis 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 GCA guideline; EULAR ANCA-associated vasculitis recommendations; BNF