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Palindromic rheumatism — SCE Rheumatology MCQ

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HardRheumatoid arthritisPalindromic rheumatismSCE Rheumatology

An older adult develops acute severe upper-cervical pain, fever and restricted rotation. CRP is high; blood cultures are negative. Plain radiography is unrevealing and crowned dens syndrome is suspected. Which imaging test is preferred?

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

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Correct answer: A — Conventional CT focused on C1–C2

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

B is correct. EULAR recommends conventional CT when axial CPPD is suspected and identifies crowned dens syndrome as a setting in which CT remains the preferred modality. Ultrasound lacks an adequate deep axial window; foot DECT investigates urate, and bone scintigraphy is nonspecific. MRI may assess alternative infection or cord pathology but is less sensitive for the defining peri-odontoid calcification.

Reference: 2023 EULAR recommendations on imaging in crystal-induced arthropathies. https://ard.bmj.com/content/83/6/752