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Anti-CCP positive rheumatoid arthritis — SCE Rheumatology MCQ

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ModerateMusculoskeletal investigationsAnti-CCP positive rheumatoid arthritisSCE Rheumatology

A 47-year-old woman has inflammatory musculoskeletal symptoms evolving over several weeks with features suggestive of anti-ccp positive rheumatoid arthritis. Examination shows there is objective synovitis or organ involvement on examination. Investigations show targeted investigations support an immune-mediated rheumatological disorder. 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: A — Anti-CCP antibody

Anti-CCP antibody is the best answer because anti-ccp antibody is the investigation most likely to resolve the immediate diagnostic or monitoring question in anti-ccp positive rheumatoid arthritis. MRI sacroiliac joints is a plausible distractor, but it does not account for the key discriminator in the stem. Plain radiograph and CRP and ESR 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