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Osteoarthritis — SCE Rheumatology MCQ

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HardOsteoarthritis and soft tissue rheumatologyOsteoarthritisSCE Rheumatology

A 52-year-old woman has activity-related knee pain and brief stiffness after rest. Examination shows there is crepitus and bony enlargement without synovitis. Investigations show radiographs show joint-space narrowing and osteophytes. 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: E — Make a clinical diagnosis and begin management without routine imaging

The best answer is “Make a clinical diagnosis and begin management without routine imaging”. Clinical diagnosis without routine imaging is the best answer because clinical diagnosis without routine imaging is the investigation most likely to resolve the immediate diagnostic or monitoring question in osteoarthritis. CT angiography is a plausible distractor, but it does not account for the key discriminator in the stem. Ultrasound-guided aspiration and Vitamin D level would be more appropriate in a different clinical pattern or at another point in the pathway, while Plain radiograph 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: NICE NG226 osteoarthritis recommendations: https://www.nice.org.uk/guidance/ng226/chapter/Recommendations