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Psoriatic arthritis — SCE Rheumatology MCQ

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EasyRheumatoid arthritisPsoriatic arthritisSCE Rheumatology

A 63-year-old woman has inflammatory joint pain with heel pain and a scaly rash behind the ears. Examination shows dactylitis of one toe and nail pitting. Investigations show rheumatoid factor is negative and radiographs show juxta-articular new bone formation. The admitting team asks which diagnosis best explains the whole presentation. What is the most likely diagnosis?

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Correct answer: E — Psoriatic arthritis

Psoriatic arthritis is the best answer because the pattern described is most consistent with Psoriatic arthritis, including the distribution of symptoms and the targeted investigation results. Granulomatosis with polyangiitis is a plausible distractor, but it does not account for the key discriminator in the stem. Osteomalacia and Septic arthritis would be more appropriate in a different clinical pattern or at another point in the pathway, while SLE 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