Rheumatoid Arthritis — SCE Rheumatology MCQ

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EasyRheumatoid ArthritisRheumatoid ArthritisSCE Rheumatology

A 40-year-old woman has an 8-week history of prolonged morning stiffness and persistent symmetrical clinical synovitis affecting 12 joints, including both wrists and several MCP and PIP joints. Her ESR and CRP are raised. Rheumatoid factor, anti-CCP antibodies and ANA are negative. She has had no recent febrile illness, rash or other systemic features. What is the most likely diagnosis?

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Correct answer: C — Seronegative rheumatoid arthritis

The most likely diagnosis is seronegative rheumatoid arthritis. Persistent symmetrical synovitis of the wrists, MCP and PIP joints, prolonged morning stiffness and raised acute-phase reactants are characteristic of RA; negative RF and anti-CCP antibodies do not exclude it. This presentation scores 7/10 under the 2010 ACR/EULAR classification framework. Viral arthritis is usually more acute and is often associated with a recent infection, fever or rash. SLE is unsupported by the negative ANA and absence of systemic manifestations. Osteoarthritis usually has a non-inflammatory pattern involving the DIP joints or first CMC joints, with normal inflammatory markers. Crystal arthritis is typically episodic and often initially monoarticular or oligoarticular rather than a persistent symmetrical small-joint polyarthritis.

Reference: ACR/EULAR, 2010 ACR/EULAR Classification Criteria for Rheumatoid Arthritis, target population and final scoring criteria, 2010. https://www.eular.org/document/download/203/5f9b305e-fe7a-4d8a-a23c-b02be823db3a/315