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MRCP PART 1 · RHEUMATOLOGY

Rheumatology questions
for MRCP Part 1.

Clinora has 326 rheumatology single best answer questions covering 314 topics. Every question explains all five options, separates the key clue from what it means and what to do next, and links to its source. Try the 5 sample questions below, then practise more for free.

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Question 1Systemic sclerosis/myositisHard

A 50-year-old woman with diffuse cutaneous systemic sclerosis develops a sudden severe headache and markedly elevated blood pressure, with a rapidly rising creatinine. Which complication is most important to recognise immediately?

  1. ARaynaud's phenomenon exacerbation
  2. BSimple essential hypertension unrelated to her underlying disease
  3. CMigraine with no renal significance
  4. DScleroderma renal crisis
  5. ELocalised cutaneous flare with no systemic implication
Show answer and explanation

Answer: D Scleroderma renal crisis

Sudden severe hypertension with rapidly rising creatinine in diffuse cutaneous systemic sclerosis is scleroderma renal crisis until proven otherwise. Damaged renal arteries reduce blood flow to the kidney, which drives renin release and malignant hypertension. There may also be headache, visual disturbance, seizures, and a microangiopathic haemolytic anaemia with low platelets. It is most likely early in diffuse disease, with anti-RNA polymerase III antibodies, and after high-dose corticosteroids, so prednisolone above about 15 mg/day should be avoided where possible. Treatment is an ACE inhibitor (classically captopril, increased quickly). It is continued even if she needs dialysis, because kidney function can recover over months. Before ACE inhibitors, renal crisis was usually fatal. Monitor blood pressure and creatinine closely, and involve renal and rheumatology specialists early.

Key clue
New severe hypertension with acute kidney injury in diffuse systemic sclerosis
What it means
Scleroderma renal crisis
What to do
Start an ACE inhibitor urgently (even with renal impairment, given the specific evidence base in this condition), monitor blood pressure and renal function closely, and involve nephrology and rheumatology emergently

Why the other options are less appropriate

  • A Raynaud's phenomenon is digital vasospasm. It does not cause severe hypertension or acute kidney injury.
  • B New severe hypertension with AKI in diffuse systemic sclerosis must be treated as renal crisis, not put down to essential hypertension.
  • C The headache here is caused by the hypertensive emergency. Ignoring the kidney and blood pressure findings would miss a life-threatening complication.
  • E This affects the kidneys and the whole body, not just the skin.

Source: EULAR recommendations for the treatment of systemic sclerosis

Question 2Autoantibodies/imagingMedium

A patient with suspected inflammatory arthritis has a positive rheumatoid factor but a negative anti-cyclic citrullinated peptide (anti-CCP) antibody. What is the most appropriate interpretation of this result?

  1. AThe positive rheumatoid factor confirms rheumatoid arthritis without needing clinical assessment
  2. BThe negative anti-CCP result makes inflammatory arthritis sufficiently unlikely that rheumatology referral is unnecessary
  3. CAnti-CCP is more specific for rheumatoid arthritis than rheumatoid factor, so this combination should prompt continued clinical correlation rather than being taken as definitive evidence of, or against, rheumatoid arthritis on serology alone
  4. DThe discordant antibodies favour systemic lupus erythematosus and make rheumatoid arthritis unlikely
  5. ERepeat both antibody tests before examining the joints or arranging specialist assessment
Show answer and explanation

Answer: C Anti-CCP is more specific for rheumatoid arthritis than rheumatoid factor, so this combination should prompt continued clinical correlation rather than being taken as definitive evidence of, or against, rheumatoid arthritis on serology alone

Rheumatoid factor (RF) is an antibody against the Fc part of IgG. It is found in many conditions, including Sjögren's syndrome, hepatitis C, endocarditis and chronic infection, and in a proportion of healthy older people. Anti-CCP antibodies (ACPA) target citrullinated proteins. They are much more specific for rheumatoid arthritis, at around 95%, and predict erosive disease, but they are missing in about a third of patients. So a positive RF with negative anti-CCP neither confirms nor excludes rheumatoid arthritis. The diagnosis is clinical, based on the pattern and duration of synovitis, acute-phase markers, imaging and serology together, as in the 2010 ACR/EULAR classification criteria. NICE NG100 advises urgent referral to rheumatology for anyone with suspected persistent synovitis, even if blood tests are normal, particularly if small joints of the hands or feet or more than one joint are affected. Ultrasound can confirm synovitis when examination is unclear. Early DMARD treatment, usually methotrexate, improves outcomes, so serology should not delay referral.

Key clue
Discordant rheumatoid factor and anti-CCP results
What it means
Serology alone is insufficient; clinical correlation is required
What to do
Interpret serology alongside clinical examination and imaging findings, and consider referral to rheumatology for further assessment regardless of a single discordant antibody result

Why the other options are less appropriate

  • A RF is not specific. It can be positive in other diseases and in healthy people, so it cannot confirm RA by itself.
  • B Anti-CCP is negative in many patients with RA. Suspected persistent synovitis still needs urgent referral.
  • D RF positive with anti-CCP negative is not a lupus pattern. ANA and anti-dsDNA would be needed to consider SLE.
  • E Repeating the same tests adds nothing and delays examination and referral of possible synovitis.

Source: British Society for Rheumatology guideline for the management of rheumatoid arthritis with disease-modifying antirheumatic drugs

Question 3Glucocorticoid bridgingMedium

A 48-year-old man with active rheumatoid arthritis starts methotrexate today. He has substantial hand synovitis and morning stiffness, but no infection or diabetes. Methotrexate may take several weeks to work. Which additional strategy is most appropriate?

  1. AAdd indefinite low-dose prednisolone as permanent background treatment
  2. BStop methotrexate and use oral prednisolone alone until radiographic remission
  3. COffer a short course of glucocorticoid as bridging therapy with a clear withdrawal plan
  4. DAdd a biologic immediately solely because methotrexate has not worked on its first day
  5. EAvoid all anti-inflammatory treatment until methotrexate reaches maximal effect
Show answer and explanation

Answer: C Offer a short course of glucocorticoid as bridging therapy with a clear withdrawal plan

A newly started conventional DMARD such as methotrexate takes weeks to work, and NICE NG100 notes this can take 2 to 3 months. In that gap he has painful synovitis and prolonged morning stiffness. NG100 advises considering short-term bridging treatment with glucocorticoids when starting a new conventional DMARD, to improve symptoms until it takes effect. Options include a reducing course of oral prednisolone, an intramuscular depot such as methylprednisolone acetate, or intra-articular injection when only a few joints are active. EULAR advises tapering and stopping glucocorticoids as quickly as clinically feasible, ideally within 3 months. Agree the withdrawal plan at the start, because prolonged use causes osteoporosis, diabetes, hypertension, infection and weight gain. Methotrexate should be escalated to an effective dose within about 4 to 6 weeks, with weekly folic acid on a different day. NG100 recommends treat-to-target care, measuring CRP and DAS28 monthly until remission (DAS28 below 2.6) or low disease activity (below 3.2) is reached, and escalating if the target is missed.

Key clue
Active rheumatoid synovitis on the day a new DMARD is started
What it means
The DMARD has a delayed onset, so temporary anti-inflammatory control may be used without converting steroids into chronic treatment
What to do
Offer a short course of glucocorticoid as bridging therapy with a clear withdrawal plan

Why the other options are less appropriate

  • A Bridging is meant to be short. Indefinite prednisolone builds up harm such as osteoporosis, diabetes and infection.
  • B Glucocorticoids alone do not give sustained disease control. Methotrexate is the disease-modifying anchor and should continue.
  • D Methotrexate cannot be judged on day one. Biologics are considered only after an adequate trial of conventional DMARDs.
  • E Leaving active synovitis untreated for weeks causes avoidable symptoms. NG100 supports short-term bridging during this delay.

Source: NICE NG100 — Rheumatoid arthritis in adults: management, recommendation 1.4.2 and bridging-treatment definition

Question 4DMARD step-downEasy

A 54-year-old woman with rheumatoid arthritis has maintained remission for 14 months while taking methotrexate and hydroxychloroquine. She has taken no glucocorticoids during that period and asks whether treatment can be reduced. What is the most appropriate approach?

  1. AConsider cautious step-down, with prompt return to the previous DMARD regimen if the target is lost
  2. BStop methotrexate and hydroxychloroquine together, then review routinely in one year
  3. CContinue both DMARDs unchanged until remission has persisted for five years
  4. DReduce both DMARD doses now but reinstate them only if new erosions appear
  5. EReplace both DMARDs with prednisolone 5 mg daily during the step-down period
Show answer and explanation

Answer: A Consider cautious step-down, with prompt return to the previous DMARD regimen if the target is lost

In rheumatoid arthritis, once the treatment target (remission or low disease activity) has been held for at least a year without glucocorticoids, NICE NG100 says a cautious step-down can be considered. That means reducing doses or stopping drugs one at a time, agreed with the patient. Reduce gradually, one drug at a time, not everything at once. Keep monitoring disease activity (for example with DAS28) and have a clear plan: if the target is lost, return promptly to the previous regimen that controlled the disease, because uncontrolled inflammation causes joint damage quickly. Many patients can reduce treatment successfully, but stopping all DMARDs carries a high risk of flare, so most stay on at least one. Long-term prednisolone is not a substitute, because of its cumulative harms (osteoporosis, diabetes, infection, cardiovascular disease). She should know how to get rapid review if symptoms return.

Key clue
Rheumatoid arthritis remission maintained for 14 months without glucocorticoids
What it means
The guideline threshold for considering supervised step-down has been met, but relapse requires rapid reversal
What to do
Consider cautious step-down, with prompt return to the previous DMARD regimen if the target is lost

Why the other options are less appropriate

  • B Stopping both drugs at once risks flare, and reviewing only after a year would miss it.
  • C NICE allows step-down to be considered after one year of glucocorticoid-free remission; five years is not required.
  • D Waiting for new erosions means accepting joint damage. Treatment should be restored as soon as the clinical target is lost.
  • E Starting long-term prednisolone defeats the point of step-down and adds steroid harms.

Source: NICE NG100 — Rheumatoid arthritis in adults: management, recommendation 1.9.5

Question 5Acute anterior uveitisEasy

A 31-year-old man with axial spondyloarthritis develops a painful red left eye with marked photophobia and blurred vision. There was no trauma. What is the most appropriate action?

  1. AArrange same-day ophthalmological assessment for suspected acute anterior uveitis
  2. BStart chloramphenicol drops and review routinely in one week
  3. CIncrease his NSAID and wait for the eye symptoms to settle
  4. DBook a routine optometry appointment within three months
  5. EPrescribe topical corticosteroids indefinitely without slit-lamp assessment
Show answer and explanation

Answer: A Arrange same-day ophthalmological assessment for suspected acute anterior uveitis

Pain, redness, photophobia and blurred vision in a man with axial spondyloarthritis point to acute anterior uveitis until proven otherwise. Uveitis is the commonest extra-articular feature of spondyloarthritis and is strongly linked to HLA-B27. It is usually unilateral and recurrent. Typical findings are redness most marked around the cornea (ciliary flush), a small or irregular pupil and, on slit-lamp examination, cells and flare in the anterior chamber, sometimes with a hypopyon. NICE NG65 recommends immediate referral for same-day ophthalmology assessment when someone with spondyloarthritis has symptoms suggesting uveitis. Treatment is directed by the ophthalmologist and usually includes topical corticosteroid drops and a cycloplegic to ease pain and prevent posterior synechiae. Untreated or recurrent inflammation can cause synechiae, raised intraocular pressure, cataract and macular oedema. Frequent recurrences may prompt a change of systemic therapy, as monoclonal anti-TNF antibodies reduce uveitis flares. Teach patients to seek urgent review with any future episode.

Key clue
Spondyloarthritis with a painful red photophobic eye and blurred vision
What it means
The presentation suggests acute anterior uveitis, which needs urgent slit-lamp confirmation and treatment
What to do
Arrange same-day ophthalmological assessment for suspected acute anterior uveitis

Why the other options are less appropriate

  • B Conjunctivitis causes discharge and grittiness, not marked pain, photophobia and blurred vision. Antibiotic drops would delay treatment of uveitis.
  • C Systemic NSAIDs do not treat anterior uveitis, and waiting risks synechiae, raised eye pressure and lasting visual loss.
  • D A three-month wait is far too slow. Painful photophobia with reduced vision needs ophthalmology review the same day.
  • E Steroid drops without slit-lamp diagnosis can worsen infective keratitis and raise eye pressure. They must be started and monitored by an ophthalmologist.

Source: NICE NG65 — Spondyloarthritis in over 16s: diagnosis and management, recommendation 1.1.12

That is 5 of 326. Carry on with rheumatology in the practice bank, with progress tracking, flashcards and timed sessions.

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Topics covered

Show all 314 rheumatology topics
  • A low urate during the flare
  • A positive block before denervation
  • Abatacept mechanism
  • Accelerated rheumatoid nodulosis
  • Achilles tendon rupture
  • Acute anterior uveitis
  • Acute calcific periarthritis
  • Acute gout with CKD and anticoagulation
  • Acutely hot joint in immunosuppressed RA
  • Adhesive capsulitis
  • Adult-onset Still disease recognition
  • Alkaptonuria and ochronosis
  • Amyloid arthropathy
  • An 85-year-old's tool estimate
  • An atypical renal presentation in systemic sclerosis
  • ANCA-associated vasculitis
  • Annual rheumatoid arthritis review
  • Anti-CCP and prognosis
  • Anti-CCP antibodies
  • Anti-fibrillarin systemic sclerosis
  • Anti-HMGCR immune-mediated necrotising myopathy
  • Anti-MDA5 dermatomyositis
  • Anti-NXP2 dermatomyositis
  • Anti-Ro pregnancy counselling
  • Anti-SRP immune-mediated necrotising myopathy
  • Antibiotics after enteric reactive arthritis
  • Antiphospholipid syndrome
  • Antisynthetase syndrome
  • Arthritis mutilans
  • Aspirin changes an NSAID prescribing decision
  • Asymptomatic axial assessment in peripheral spondyloarthritis
  • At target, not finished
  • Atlanto-axial instability
  • Atypical femoral fracture
  • Autoantibodies/imaging
  • Avacopan in ANCA-associated vasculitis
  • Avoiding scintigraphy for suspected axial disease
  • Axial spondyloarthritis
  • Background therapy
  • Baseline assessment after rheumatoid arthritis diagnosis
  • Behçet disease
  • Behçet syndrome
  • Behçet-associated deep-vein thrombosis
  • Biologic choice with recurrent uveitis
  • Biologic DMARD review
  • Bisphosphonate treatment reassessment
  • Blau syndrome
  • Bone assessment before substantial steroid exposure
  • Calcific tendinitis
  • Calcinosis in limited systemic sclerosis
  • Camptodactyly-arthropathy-coxa vara-pericarditis syndrome
  • Camurati–Engelmann disease
  • Caplan syndrome
  • Catastrophic APS
  • Cervical myelopathy in rheumatoid arthritis
  • Changing urate-lowering drug after an adequate first-line trial
  • Chronic primary pain management
  • Clinical diagnosis without routine imaging
  • Cogan syndrome
  • Colchicine–macrolide interaction
  • Complex regional pain syndrome
  • Conception planning in inflammatory myopathy
  • Confirming gout when the diagnosis remains uncertain
  • Core treatment for knee osteoarthritis
  • Coronary disease and ULT choice
  • CPPD
  • Cricoarytenoid arthritis
  • Crowned dens syndrome
  • Crystal proof when uncertainty matters
  • Crystals do not exclude joint infection
  • Culture-negative native-joint septic arthritis after prior antibiotics
  • Cutaneous small-vessel vasculitis biopsy
  • Dactylitis
  • De Quervain tenosynovitis
  • Deficiency of adenosine deaminase 2
  • Degenerative knee symptoms and arthroscopic washout
  • Dermatomyositis
  • Dietary claims in gout counselling
  • Diffuse idiopathic skeletal hyperostosis
  • Digital ulcers
  • Disseminated gonococcal infection
  • Distinguishing two epidural presentations
  • DMARD reduction after sustained control
  • DMARD step-down
  • DMARD/biologic safety
  • Dose titration rather than a fixed allopurinol ceiling
  • Duration of urate-lowering therapy after remission
  • Early-onset CPPD and an associated disorder
  • EGPA
  • Enteropathic peripheral arthritis
  • Eosinophilic fasciitis
  • Erdheim-Chester disease
  • Exercise during inflammatory myopathy care
  • Faecal incontinence in systemic sclerosis
  • Familial Mediterranean fever
  • Fatigue without active systemic Sjogren disease
  • Febuxostat and cardiovascular disease
  • Felty syndrome
  • Femoral-head osteonecrosis
  • Ferric-carboxymaltose-induced hypophosphataemic osteomalacia
  • Fibroblastic rheumatism
  • First-line treatment of a gout flare
  • Flare prophylaxis during urate lowering
  • Flare prophylaxis during urate-lowering titration
  • Flare prophylaxis when colchicine is unsuitable
  • Foot disability despite controlled rheumatoid inflammation
  • Gabapentinoids are not routine sciatica treatment
  • Gastro-oesophageal involvement
  • Giant cell arteritis
  • Giant-cell arteritis
  • Glucocorticoid bridging
  • Glucocorticoid bridging when starting a cDMARD
  • Glucocorticoid minimisation
  • Glucocorticoid safety
  • Glucocorticoid-induced bone loss
  • Glucocorticoid-induced osteoporosis prevention
  • Gout
  • Gout diagnosis
  • Gout during urate lowering
  • Gout in a transplant recipient and specialist input
  • GPA/MPA
  • Haemochromatosis arthropathy
  • Hand osteoarthritis
  • High-dose steroids under 40
  • High-risk cervical symptoms in RA
  • Hip fragility fracture treatment
  • HLA-B27 interpretation
  • Hot joint with possible gout and sepsis
  • Hydralazine-induced ANCA-associated vasculitis
  • Hydroxychloroquine
  • Hydroxychloroquine in pregnancy
  • Hypermobile Ehlers-Danlos syndrome
  • Hypertrophic osteoarthropathy
  • Hypocomplementaemic urticarial vasculitis
  • IgA vasculitis
  • IgG4-related disease
  • IL-17 blockade and inflammatory bowel disease
  • IL-6 blockade and occult infection
  • Imaging is not a routine osteoarthritis response marker
  • Imaging when gout aspiration is not feasible
  • Immune-checkpoint-inhibitor myositis overlap
  • Impending tendon rupture
  • Inclusion-body myositis
  • Inflammatory back pain
  • Infliximab without methotrexate in rheumatoid arthritis
  • Initial disease-modifying strategy
  • Initial disease-modifying treatment
  • Interpreting anti-CCP positivity
  • Intra-articular hyaluronan
  • Jaccoud arthropathy
  • JAK inhibitors and herpes zoster
  • JAK-inhibitor risk minimisation
  • Joint replacement referral despite obesity
  • Joint-replacement referral
  • Knee osteoarthritis
  • Large-vessel giant-cell arteritis
  • Leflunomide
  • Levamisole-adulterated cocaine vasculitis
  • Libman–Sacks endocarditis
  • Live vaccines during immunosuppression
  • Local steroid treatment for a gout flare
  • Lower serum urate target in severe gout
  • Lupus enteritis
  • Lyme arthritis
  • Macrophage activation syndrome in Still disease
  • Macrophage activation syndrome in Still’s disease
  • Malnutrition despite enteral support in systemic sclerosis
  • Manual therapy as an adjunct in hip osteoarthritis
  • Meralgia paraesthetica
  • Methotrexate and trimethoprim
  • Mild palindromic rheumatoid disease and initial DMARD choice
  • Milwaukee shoulder syndrome
  • Mixed connective tissue disease
  • Mixed cryoglobulinaemic vasculitis
  • Monitoring gout once the urate target is stable
  • Monitoring while aiming for remission
  • MRI after normal sacroiliac radiographs
  • MRI as a routine non-specialist gateway
  • MRI-negative axial spondyloarthritis
  • Muckle–Wells syndrome
  • Multicentric reticulohistiocytosis
  • Multiple vertebral fractures and model limitations
  • Mycophenolate and pregnancy
  • Myositis antibodies and disease-activity monitoring
  • Native-joint septic arthritis
  • Neuropsychiatric presentation
  • Non-progressive monoarthritis in peripheral spondyloarthritis
  • NSAID gastroprotection in rheumatoid arthritis
  • NSAID risk reduction in RA
  • Obstetric antiphospholipid syndrome
  • Occupational therapy in rheumatoid arthritis
  • Ocular dryness
  • Ocular inflammation despite conventional lubrication
  • One flare but high-risk chronic disease
  • Oral NSAID risk mitigation in knee osteoarthritis
  • Osteitis condensans ilii
  • Osteoarthritis
  • Osteopoikilosis
  • Pachydermodactyly
  • Palindromic rheumatism
  • Palmar fasciitis and polyarthritis
  • Paradoxical psoriasis
  • Parvovirus B19 arthritis
  • Peripheral psoriatic arthritis
  • Persistent enthesitis referral
  • Persistent extrarenal disease
  • Persistent single-joint peripheral spondyloarthritis
  • Persistent small-joint synovitis
  • PFAPA syndrome
  • PMR
  • PMR versus myopathy
  • Polyarteritis nodosa
  • Polyarteritis nodosa angiography
  • Polymyalgia rheumatica
  • Poncet disease
  • Preserving extra-articular benefit when arthritis remains active
  • Preventing a treatment-triggered flare
  • Preventing dental damage in Sjogren disease
  • Progressive axial deformity and surgical referral
  • Pulmonary arterial hypertension screening
  • Punctal occlusion with active ocular-surface inflammation
  • RA-related tendon rupture
  • Raynaud phenomenon
  • Reactive arthritis
  • Recognition and referral
  • Recurrent digital ulcers with vasodilator intolerance
  • Referral for persistent enthesitis with psoriasis
  • Refractory gout flare and the IL-1 treatment threshold
  • Refractory reflux in systemic sclerosis
  • Relapsing polychondritis
  • Remission does not end comprehensive review
  • Repeating serum urate after an acute flare
  • Rheumatoid arthritis
  • Rheumatoid interstitial lung disease
  • Rheumatoid pleural effusion
  • Rheumatoid vasculitis
  • Rhupus syndrome
  • Rituximab baseline immunoglobulins
  • Rituximab-associated late-onset neutropenia
  • Romosozumab cardiovascular contraindication
  • Rotator-cuff tear
  • RS3PE syndrome
  • Sacroiliac imaging
  • SAPHO syndrome
  • Schnitzler syndrome
  • Scleredema adultorum of Buschke
  • Scleroderma renal crisis
  • Second NSAID trial in axial spondyloarthritis
  • Selecting a brace for biomechanical instability
  • Selecting treatment for an acute gout flare
  • Septic olecranon bursitis
  • Serological activity
  • Serological lupus activity
  • Serology after enteric reactive arthritis
  • Seronegative rheumatoid arthritis referral
  • Seronegative Sjögren disease investigation
  • Seronegative small-joint synovitis
  • Serum eye drops after maximal usual therapy
  • Setting expectations for a knee corticosteroid injection
  • Severe myositis with dysphagia
  • Short-term treatment of an rheumatoid arthritis flare
  • Shrinking lung syndrome
  • Sicca treatment when gland function remains
  • Sjögren disease
  • Small intestinal bacterial overgrowth in systemic sclerosis
  • Smoking status is not a referral veto
  • Spinal DXA can mask osteoporosis in axial disease
  • Spinal fracture
  • Starting urate-lowering therapy
  • Step-up conventional therapy after optimised monotherapy
  • Strong opioids are not the default escalation for osteoarthritis
  • Structured exercise prescription
  • Subclavian steal in Takayasu arteritis
  • Sulfasalazine and male fertility
  • Suspected spinal fracture in axial spondyloarthritis
  • Swallowing safety despite improved limb strength
  • Systemic lupus erythematosus
  • Systemic sclerosis sine scleroderma
  • Systemic sclerosis–myositis overlap
  • Systemic sclerosis/myositis
  • Systemic steroids for uncomplicated Sjogren dryness
  • Systemic-sclerosis gastric antral vascular ectasia
  • Systemic-sclerosis interstitial lung disease
  • T-cell large granular lymphocytic leukaemia
  • Takayasu arteritis
  • Targeted hand rehabilitation in controlled rheumatoid arthritis
  • Temporal-artery ultrasound in giant cell arteritis
  • Tenosynovial giant cell tumour
  • Timing of urate-lowering therapy after a gout flare
  • Timing ULT after an attack
  • TNF inhibitor and demyelination
  • TNF inhibitors in severe heart failure
  • TNF receptor-associated periodic syndrome
  • Tocilizumab and CYP3A4 normalisation
  • Tocilizumab in relapsing giant cell arteritis
  • Tophi change the target
  • Treat-to-target
  • Treat-to-target urate lowering
  • Treat-to-target urate reduction
  • Troponin selection in inflammatory myopathy
  • Tumoral calcinosis
  • Ultrasound after inconclusive peripheral radiographs
  • Ultrasound in stable remission
  • Ultrasound is not a routine RA activity target
  • Unexplained dactylitis
  • Unmodelled medicine exposure
  • Unreliable oral absorption during myositis induction
  • Urate-lowering therapy
  • Urgent referral for synovitis
  • Uveitis case-finding when psoriasis is present
  • Very-high fracture risk
  • VEXAS syndrome
  • When to recalculate fracture risk
  • Younger age and rheumatoid joint replacement

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