18th January 2024

A 65-year-old man attends his routine outpatient’s clinic appointment.

A 65-year-old man attends his routine outpatient’s clinic appointment. He has had RA for over 25 years, which has been very difficult to control despite multiple trials of conventional and biologic DMARDs. On examination, he has worsening bilateral lower limb swelling with pitting oedema. He is also noted to have macroglossia and an abdominal mass on the right. A urine dipstick shows protein +++. Which is the most appropriate investigation to confirm the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.