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Diffuse idiopathic skeletal hyperostosis — SCE Rheumatology MCQ

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EasySpondyloarthropathiesDiffuse idiopathic skeletal hyperostosisSCE Rheumatology

A 74-year-old woman has spinal stiffness without inflammatory back pain. Examination shows there is reduced thoracic movement but sacroiliac joints are spared. Investigations show radiographs show flowing anterolateral ossification. The admitting team asks which diagnosis best explains the whole presentation. What is the most likely diagnosis?

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Correct answer: C — Diffuse idiopathic skeletal hyperostosis

Diffuse idiopathic skeletal hyperostosis is the best answer because the pattern described is most consistent with Diffuse idiopathic skeletal hyperostosis, including the distribution of symptoms and the targeted investigation results. Adhesive capsulitis is a plausible distractor, but it does not account for the key discriminator in the stem. Hydroxychloroquine retinopathy and Palindromic rheumatism would be more appropriate in a different clinical pattern or at another point in the pathway, while Granulomatosis with polyangiitis 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 NG65; EULAR/ASAS axial spondyloarthritis recommendations; BNF