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Raynaud phenomenon — SCE Rheumatology MCQ

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HardConnective tissue diseasesRaynaud phenomenonSCE Rheumatology

A 29-year-old man has triphasic colour change of the fingers and new puffy hands. Examination shows nailfold capillaries appear abnormal clinically. Investigations show ANA is positive with negative inflammatory markers. 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: D — Nailfold capillaroscopy

Nailfold capillaroscopy is the best answer because nailfold capillaroscopy is the investigation most likely to resolve the immediate diagnostic or monitoring question in raynaud phenomenon. Plain radiograph is a plausible distractor, but it does not account for the key discriminator in the stem. Urinalysis and Anti-dsDNA and complement levels would be more appropriate in a different clinical pattern or at another point in the pathway, while Urine protein:creatinine ratio is suboptimal for this presentation. Clinical pearl: autoantibodies are supportive tests and should be interpreted alongside phenotype, inflammatory markers, urinalysis and imaging.

Reference: BSR SLE guideline; EULAR SLE and systemic sclerosis recommendations; BNF