The Rheumatology SCE in full: two papers of 100 questions, how the pass mark is set, the 16 June 2027 date and fee, and the topics that carry marks.
The Specialty Certificate Examination in Rheumatology is the knowledge assessment for UK higher specialty training in rheumatology, and passing it entitles you to the post-nominal SCE (Rheumatology). It is a broad exam for a specialty that has changed faster than most over the last decade, and the questions reflect that: a substantial proportion turn on therapeutic decisions that did not exist when the current consultant body was in training.
Format and marking
| Papers | Two, both computer-based |
| Questions | 100 per paper, 200 in total |
| Question type | Best of five |
| Time | Three hours per paper |
| Break | Usually one hour between papers |
| Marking | One mark per correct answer, no deduction for a wrong one |
There are no prerequisites for entry. Six attempts are permitted automatically; beyond that you must complete further educational experience for each resit with evidence endorsed by your educational supervisor and training programme director. Non-attendance counts as an attempt.
How the pass mark works
The exam is criterion referenced. There is no fixed percentage and no fixed proportion of candidates who pass. A panel judges the standard expected of a competent specialist for each question, and the pass mark for that paper follows from those judgements.
This matters for how you revise. A borderline result is almost never caused by weak performance across the whole curriculum; it is caused by two or three areas where the candidate's knowledge is clearly below specialist level. Finding and fixing those areas is worth more than deepening the areas you already enjoy.
Dates and fees
| Sitting | Exam date | Applications open and close |
|---|---|---|
| 2026/01 | 17 June 2026 | Closed |
| 2027/01 | 16 June 2027 | 24 February to 24 March 2027 |
The fee is 700 pounds at a UK centre and 875 pounds internationally. Applications open and close at 8:00am UK time and the window is four weeks.
Rheumatology has previously had an additional diet arranged at short notice outside the usual schedule, so it is worth checking the Federation's news page as well as the dates page if you are hoping to sit sooner.
Where the marks actually are
Lupus and antiphospholipid syndrome
The highest-yielding area, and the one with the most new therapy to know. Be able to apply the current classification criteria rather than recite them, and understand that classification and diagnosis are not the same thing. Know the histological classes of lupus nephritis and which classes change management. Know where the newer biologic and targeted agents sit in the treatment sequence, and what hydroxychloroquine monitoring now requires.
For antiphospholipid syndrome, the single most examinable point is anticoagulant choice. Know why a direct oral anticoagulant is not the default here, which antibody profile carries the greatest risk, and how management differs in obstetric disease.
Vasculitis
Reliably heavy. For ANCA-associated vasculitis, know the induction options and how organ involvement and severity determine the choice, the role of plasma exchange and how that has narrowed, and the agent that allows steroid reduction. For giant cell arteritis, know the fast-track pathway, what ultrasound of the temporal artery adds and when it is diagnostic, the ocular indications for intravenous therapy, and the biologic used for steroid sparing. Large-vessel vasculitis and Behcet disease appear less often but are rarely answered well.
Inflammatory arthritis and the sequencing of therapy
Treat-to-target is the organising principle, and questions test whether you can apply it to a patient whose disease activity has not reached target on a given agent. For rheumatoid arthritis, know the sequence through conventional, biologic and targeted synthetic agents and what must be checked before each. The safety signal around JAK inhibition, and the resulting restrictions in older patients and those with cardiovascular risk factors or a smoking history, is examinable and frequently missed.
For axial spondyloarthritis, know the distinction between radiographic and non-radiographic disease and the therapeutic consequences. For psoriatic arthritis, questions almost always hinge on which domain of disease dominates, because that determines the agent.
Systemic sclerosis
The most efficient area to revise, because the autoantibody profile maps so directly onto the phenotype and the complication to screen for. Know which antibody goes with limited disease and pulmonary arterial hypertension, which with diffuse disease and interstitial lung disease, and which carries the risk of renal crisis and an association with malignancy. Scleroderma renal crisis is a standard question, and the answer rests on starting an ACE inhibitor rather than withholding it.
Myositis
Worth more marks than its share of the curriculum because the myositis-specific antibodies are so discriminating. Know the antibody associated with rapidly progressive interstitial lung disease and a characteristic rash, the one associated with the antisynthetase phenotype, and the one associated with statin exposure. Inclusion body myositis, and why it does not respond to immunosuppression, is a recurring question.
Crystal arthropathy
Gout is examined on long-term management far more than on the acute attack. Know the urate target, how allopurinol should be escalated and why it is so often left at a starting dose, the comparative cardiovascular safety data on febuxostat, and the place of the enzyme therapy in refractory disease.
Metabolic bone disease
Know fracture risk assessment and the threshold at which treatment is indicated, the rationale and timing of a bisphosphonate holiday, and the rebound risk on stopping denosumab, which is a favourite because the correct answer is counterintuitive. Know the sequence issue with the anabolic agents, and recognise atypical femoral fracture. Paget disease, osteomalacia and the hereditary hypophosphataemias appear in single questions.
Infection and the acutely swollen joint
Septic arthritis, including in a prosthetic joint and in a patient already on immunosuppression. Know what to do about biologic therapy during infection and when to restart.
Immunology and laboratory interpretation
A cluster of questions each sitting tests whether you can interpret an antibody or complement result in context rather than treat it as a diagnosis. An isolated positive result in a patient without clinical disease is a frequent trap.
Autoinflammatory disease
Increasing in weight. Familial Mediterranean fever, adult-onset Still disease, macrophage activation syndrome and the newer somatic autoinflammatory syndromes described in older men with cytopenias all now appear.
Pregnancy
Drug compatibility before conception, during pregnancy and in breastfeeding, for each of the agents above. Easy marks for anyone who has made a table; hard marks for anyone who has not.
A twelve-week approach
Weeks one to four, lupus, antiphospholipid syndrome and vasculitis. Weeks five to eight, inflammatory arthritis and therapeutic sequencing, systemic sclerosis, myositis. Weeks nine to ten, metabolic bone disease, crystal arthropathy, infection, paediatric transition and pregnancy. Weeks eleven and twelve, timed questions only, and a careful review of everything answered wrongly.
Spend the time on questions rather than on reading. Rheumatology rewards pattern recognition built from cases, and best-of-five questions with full explanations build that faster than any textbook chapter.
Clinical Tip: when a systemic sclerosis question gives you an autoantibody, decide the phenotype and the organ at risk before you read the options. The antibody is usually the whole question, and the five options are five different complications.
Our Rheumatology SCE question bank is written in the exam format, with explanations covering the mechanism, why each wrong option is wrong, and the decision the question is testing. Free sample questions are available without payment. Rheumatology SCE question bank
Related: Specialty Certificate Exams explained
Exam format, dates and fees are taken from the Federation of Royal Colleges of Physicians of the UK. Confirm them on their site before applying, as additional sittings are sometimes arranged.