Steroid-Associated Tendinopathy — SCE Rheumatology MCQ

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ModerateSoft Tissue RheumatologySteroid-Associated TendinopathySCE Rheumatology

A 65-year-old man with RA on Methotrexate and Prednisolone 5 mg daily develops bilateral Achilles tendon pain. X-ray shows enthesophyte formation at the Achilles insertion. What risk factor for tendon pathology is most relevant in this patient?

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Correct answer: A — Long-term glucocorticoid use increasing risk of tendon weakening and rupture

Long-term glucocorticoid use (even low-dose) is associated with tendon weakening and increased risk of tendon rupture. The Achilles tendon is particularly vulnerable. In RA patients the combination of chronic inflammation affecting tendon sheaths and peritendinous tissues plus glucocorticoid-induced tendon matrix changes creates a dual risk. BSR guidance recommends awareness of tendon pathology in patients on long-term steroids. Additionally fluoroquinolone antibiotics (sometimes co-prescribed) synergistically increase tendon rupture risk with steroids.

Reference: BSR 2025 csDMARD guidelines; BNF corticosteroid adverse effects