Rheumatology: antisynthetase syndrome: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Rheumatology: antisynthetase syndrome

Sample item

A 45-year-old woman has fever, dry cough and breathlessness, with proximal muscle weakness, a raised CK, Raynaud phenomenon and symmetrical arthritis. Her fingers show rough, cracked skin along the lateral borders (mechanic's hands), and HRCT shows a basal non-specific interstitial pneumonia pattern. Which autoantibody is most likely positive?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Anti-Jo-1 (anti-histidyl tRNA synthetase)

Antisynthetase syndrome combines myositis, interstitial lung disease, arthritis, Raynaud phenomenon, fever and mechanic's hands, caused by antibodies to aminoacyl-tRNA synthetases, of which anti-Jo-1 is the most common. Lung involvement determines prognosis. Treatment is glucocorticoids with a steroid-sparing agent such as azathioprine or mycophenolate.

Option by option

  • A. Anti-Mi-2

    Anti-Mi-2 is linked to classic dermatomyositis with a shawl sign and a good response to treatment.

  • B. Anti-centromere

    Anti-centromere antibodies mark limited systemic sclerosis with CREST features.

  • C. Anti-signal recognition particle (anti-SRP)

    Anti-SRP is associated with severe necrotising myopathy and cardiac involvement, with little lung disease.

  • D. Anti-Jo-1 (anti-histidyl tRNA synthetase) (correct)

    Correct. Anti-Jo-1 is the most frequent antibody in this syndrome of myositis with interstitial lung disease.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Anti-Jo-1 (anti-histidyl tRNA synthetase). Antisynthetase syndrome combines myositis, interstitial lung disease, arthritis, Raynaud phenomenon, fever and mechanic's hands, caused by antibodies to aminoacyl-tRNA synthetases, of which anti-Jo-1 is the most common.

Why is "Anti-Mi-2" not the answer?

Anti-Mi-2 is linked to classic dermatomyositis with a shawl sign and a good response to treatment.

Why is "Anti-centromere" not the answer?

Anti-centromere antibodies mark limited systemic sclerosis with CREST features.

Why is "Anti-signal recognition particle (anti-SRP)" not the answer?

Anti-SRP is associated with severe necrotising myopathy and cardiac involvement, with little lung disease.

What concept does this question test?

It tests Rheumatology: antisynthetase syndrome in General Medicine. Lung involvement determines prognosis. Treatment is glucocorticoids with a steroid-sparing agent such as azathioprine or mycophenolate.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Rheumatology: antisynthetase syndrome?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.