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SLE flare — SCE Rheumatology MCQ

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ModerateMusculoskeletal investigationsSLE flareSCE Rheumatology

A 33-year-old man has SLE with fatigue, rash and new inflammatory arthralgia. Examination shows there is mild synovitis and oral ulceration. Investigations show complement is low and anti-dsDNA has risen. 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: A — Complement and anti-dsDNA

Complement and anti-dsDNA is the best answer because complement and anti-dsdna is the investigation most likely to resolve the immediate diagnostic or monitoring question in sle flare. Anti-CCP antibody is a plausible distractor, but it does not account for the key discriminator in the stem. ENA profile and Ultrasound-guided aspiration would be more appropriate in a different clinical pattern or at another point in the pathway, while Plain radiographs of hands is suboptimal for this presentation. Clinical pearl: autoantibodies are supportive tests and should be interpreted alongside phenotype, inflammatory markers, urinalysis and imaging.

Reference: BSR hot swollen joint guideline; NICE NG100; EULAR imaging recommendations