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SLE — SCE Rheumatology MCQ

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HardConnective tissue diseasesSLESCE Rheumatology

A 74-year-old woman has photosensitive rash, oral ulcers and migratory arthralgia. Examination shows there is synovitis without erosions. Investigations show ANA and anti-dsDNA are positive with low C3. 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: B — Urine protein:creatinine ratio

The best answer is “Urine protein:creatinine ratio”. Urine protein:creatinine ratio is the best answer because urine protein:creatinine ratio is the investigation most likely to resolve the immediate diagnostic or monitoring question in sle. Autoantibody profile is a plausible distractor, but it does not account for the key discriminator in the stem. Plain radiograph and Ultrasound-guided aspiration would be more appropriate in a different clinical pattern or at another point in the pathway, while High-resolution CT chest is suboptimal for this presentation. Clinical pearl: autoantibodies are supportive tests and should be interpreted alongside phenotype, inflammatory markers, urinalysis and imaging. The competing options represent related diagnoses, tests or treatments, but they do not match the decisive phenotype, safety constraint or management point in this stem.

Reference: EULAR systemic lupus erythematosus recommendations: https://ard.bmj.com/content/83/1/15