Systemic sclerosis — SCE Rheumatology MCQ

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ModerateConnective tissue diseasesSystemic sclerosisSCE Rheumatology

A 74-year-old woman has Raynaud phenomenon, reflux and progressive skin thickening. Examination shows there is sclerodactyly with digital pitting. Investigations show anti-centromere antibody is positive. The admitting team asks which diagnosis best explains the whole presentation. What is the most likely diagnosis?

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Correct answer: E — Systemic sclerosis

Systemic sclerosis is the best answer because the pattern described is most consistent with Systemic sclerosis, including the distribution of symptoms and the targeted investigation results. Gout is a plausible distractor, but it does not account for the key discriminator in the stem. Dermatomyositis and Septic arthritis would be more appropriate in a different clinical pattern or at another point in the pathway, while Mixed connective tissue disease 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: BSR SLE guideline; EULAR SLE and systemic sclerosis recommendations; BNF