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Systemic vasculitis — SCE Rheumatology MCQ

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ModerateMusculoskeletal investigationsSystemic vasculitisSCE Rheumatology

A 63-year-old man has constitutional symptoms and a purpuric rash. Examination shows there is ankle oedema and mild hypertension. Investigations show creatinine is rising with active urinary sediment. 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: B — Urinalysis

Urinalysis is the best answer because urinalysis is the investigation most likely to resolve the immediate diagnostic or monitoring question in systemic vasculitis. MRI scan is a plausible distractor, but it does not account for the key discriminator in the stem. Plain radiograph and DXA scan would be more appropriate in a different clinical pattern or at another point in the pathway, while CT angiography 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