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Rheumatoid vasculitis — SCE Rheumatology MCQ

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HardRheumatoid arthritisRheumatoid vasculitisSCE Rheumatology

A 61-year-old woman with long-standing rheumatoid arthritis develops painful purpuric leg ulcers and a new right foot drop. Examination shows active wrist synovitis, livedo change and reduced pinprick in the peroneal distribution. ESR is 92 mm/hour, complement is low and urine dip is negative for blood and protein. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Rheumatoid vasculitis

Painful ulcers plus mononeuritis multiplex in severe seropositive RA are classical for rheumatoid vasculitis. ANCA-associated vasculitis usually has renal, pulmonary or ENT features, and diabetic neuropathy does not explain purpura and systemic inflammation. Biopsy of skin or nerve may support the diagnosis before immunosuppression.

Reference: BSR rheumatology curriculum; EULAR vasculitis recommendations